The following questions were submitted to WCD by insurers and self-insured employers. The answers to these questions apply to EAIPs or EAIP reimbursements covered by the OAR 105 rules in effect on or after Dec. 1.2007. The answers may not be correct for earlier versions of the rules.

A worker had an auto accident on May 11, 2005 and suffered a C-5 vertebral fracture and a small laceration on the forehead. He was treated at the emergency room and discharged with instructions to wear an Aspen collar for six to eight weeks. Between the accident date and Aug. 17, 2005, the worker saw his physician three times. The June 16, 2005 chart note stated the worker was doing his regular work, but avoiding certain aspects of the job. In late December, the employer discovered there were no documented specific work restrictions for the worker while the claim was open. The employer wrote to the worker's physician and asked him to provide what he felt would have been appropriate restrictions between the accident date and Aug. 17, 2005. The physician confirmed he had not given the worker specific work restrictions during that time. He then gave the employer what he would have considered reasonable restrictions if he had done so at the time. Is this considered clarifying a medical release and allowable under OAR 436-105-0500(6)?

No. The rule allows an employer or insurer to get clarifi cation about a medical release from the medical service provider who issued the release any time prior to submitting the reimbursement request. In this case there was no medical release to clarify, so this rule does not apply. Modified work that may have been provided between the accident and Aug. 17, 2005 is not eligible for EAIP reimbursement.

If the restriction at the time of purchase of a worksite modification is "light duty", will reimbursement for worksite modification be allowed if clarification after the purchase date provides specific restrictions? In this particular case the doctor's release said the worker was to work on light duty until the next appointment in 30 days. The employer asked the worker if he knew what the doctor meant, and the worker said he was told not to lift over 10 pounds and not to repetitively bend or twist. The employer immediately purchased modifications to overcome these restrictions.

If the employer made worksite modification purchases based upon what they understood the worker's restrictions were at the time, and later clarification proved their understanding to be accurate, then reimbursement should be allowed. In a case like this the employer believed the restrictions were known on the date the purchases were initiated. We want the employer to be reimbursed for what is done correctly even if it takes some information gathering to allow reimbursement. 436-105-0500(6) allows an employer or insurer to get clarification about a medical release from the medical service provider who issued the release any time prior to submitting the reimbursement request.

Under the EAIP rules effective 7/1/05 the payroll record only has to include the dates and hours worked if the worker has hourly restrictions. If the first or last payroll period for wage subsidy includes days of paid leave it is not evident from the payroll record whether any days are not eligible. Is it sufficient to document a phone call to an employer to clarify which dates were taken as vacation, holiday or other paid leave?

In the case you described the Workers' Compensation Division would accept your documented phone call to the employer. As an insurer you are required to administer the EAIP and have documentation showing how you determined the reimbursement for wage subsidy. If, however, there is conflicting documentation, in the claim file for instance, OAR 430-105-0550(2) states "…the division will utilize a preponderance of evidence standard to decide eligibility for reimbursement and if there is no clear preponderance, reimbursement will be allowed."

If the one year and 30th day lands on a Saturday, Sunday or legal holiday, can the Employer-at-Injury Program Reimbursement Request, Form 2360 be sent to the division the next business day?

Yes. OAR 436-105 does not say so, but the division will accept a request sent on the next business day under these circumstances.