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All Contested Case Subject
Penalties and Sanctions
In General
The appropriate penalty for a violation of ORS 656.331, where an insurer improperly contacts a represented worker without contacting their attorney, is not disenrollment from the MCO, but financial penalties under OAR 436-060-0015(2). Meier, William,
16 CCHR 290 (2011).
Where the only remaining issue concerned whether the insurer should be subject to penalties for unreasonably delaying or refusing to pay compensation, jurisdiction over the matter lay with the director and not the board. Boggs, Janice M.,
15 CCHR 279 (2010).
When the insurer acted unreasonably and substantially delayed payment of benefits, a penalty is appropriate because the insurer failed to respond to the application for lump sum payment within 14 days, issued a check payable to an attorney who did not represent claimant at hearing or at any time thereafter, and issued checks jointly payable despite a final order and request from counsel to the contrary. Sanchez, Juan A*,
12 CCHR 329 (2007).
A penalty is not warranted when employer supplied insurer with requested payroll information in a timely manner that was reasonable under the circumstances. Flower, Michael L,
12 CCHR 264 (2007).
The penalty issue based on an alleged unreasonable basis for initiating the contested case with WCD is a new issue and cannot be considered because no penalty issue was raised in the medical services dispute proceeding with WCD. Hagen, Kerry,
14 CCHR 70 (2009).
"Continuous non-payment or underpayment" refers to successive violations of payments, not just one violation until it is paid. Scheminske, Leona D.,
9 CCHR 443 (2004).
The discretionary term, "may," in OAR 436-060-0155 authorizes the director to promulgate rules establishing penalty processing timelines. Watterson, Calvan,
9 CCHR 154 (2004).
Because insurer raised issue of entitlement, WCD and Hearing Officer Panel lack jurisdiction to decide ORS 656.262 penalty dispute. Buell, Kenneth E.,
8 CCHR 15 (2003).
Awarded
The worker was entitled to a penalty-based attorney fee because the insurer had unreasonably delayed and refused to pay compensation where the insurer refused to pay a requested expense but delayed offering an explanation for its refusal and never ultimately did explain why it refused to pay. Parker II, Clay D.,
16 CCHR 389 (2011).
A claimant was entitled to a penalty under ORS 656.262(11) for the insurer's unreasonably delaying or refusing to pay compensation because the insurer failed to provide an explanation of why it refused to pay, and at times failed to respond at all to the claimant's inquiries. Parker II, Clay D.*,
16 CCHR 325 (2011).
Insurer liable for a penalty under ORS 656.262(11), payable to the provider, because it unreasonably withheld discounts from medical fee payments. Chehalem Physical Therapy*,
15 CCHR 59 (2010).
The 14 day time frame for the insurer to make timely payment of an agreed stipulation amount begins to run from the date the agreement is approved and dismissed, not on the date when it becomes final. Galeana, Mario,
11 CCHR 46 (2006).
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