EXHIBIT A
438-005-0055
Notice of Claim Denial and Hearing Rights
(1) Except for a denial issued under ORS 656.262[(14)](15), in addition
to the requirements
of 656.262, the notice of denial shall specify the factual and legal reasons for denial; and shall
contain a notice, in prominent or bold-face type, as follows:
"IF YOU THINK THIS DENIAL IS NOT RIGHT, WITHIN 60 DAYS AFTER THE MAILING OF THIS DENIAL
YOU MUST FILE A LETTER WITH THE WORKERS' COMPENSATION BOARD, 2601 25TH STREET SE, SUITE 150, SALEM
OREGON 97302-1280. YOUR LETTER MUST STATE THAT YOU WANT A HEARING, YOUR ADDRESS AND THE DATE OF
YOUR ACCIDENT IF YOU KNOW THE DATE. IF YOUR CLAIM QUALIFIES, YOU MAY RECEIVE AN EXPEDITED HEARING
WITHIN 30 DAYS. YOUR REQUEST CANNOT, BY LAW, AFFECT YOUR EMPLOYMENT. IF YOU DO NOT FILE A REQUEST
WITHIN 60 DAYS, YOU WILL LOSE ANY RIGHT YOU MAY HAVE TO COMPENSATION UNLESS YOU CAN SHOW GOOD CAUSE
FOR DELAY BEYOND 60 DAYS. AFTER 180 DAYS ALL YOUR RIGHTS WILL BE LOST. YOU MAY BE REPRESENTED BY
AN ATTORNEY OF YOUR CHOICE AT NO COST TO YOU FOR ATTORNEY FEES.IF YOU MAKE A TIMELY REQUEST FOR
HEARING ON A DENIAL OF COMPENSABILITY OF YOUR CLAIM AS REQUIRED BY ORS 656.319(1)(a) THAT IS BASED
ON ONE OR MORE REPORTS OF EXAMINATIONS CONDUCTED AT THE REQUEST OF THE INSURER OR SELF-INSURED
EMPLOYER UNDER ORS 656.325(1)(a) AND YOUR ATTENDING PHYSICIAN DOES NOT CONCUR WITH THE REPORT OR
REPORTS, YOU MAY REQUEST AN EXAMINATION TO BE CONDUCTED BY A PHYSICIAN SELECTED BY THE DIRECTOR.
THE COST OF THE EXAMINATION AND THE EXAMINATION REPORT SHALL BE PAID BY THE INSURER OR SELF-INSURED
EMPLOYER. IF YOU HAVE QUESTIONS YOU MAY CALL THE WORKERS' COMPENSATION DIVISION TOLL FREE AT 1-800-452-0288."
(2) If an insurer or self-insured employer intends to deny a claim under ORS 656.262[(14)](15)
because of a worker's failure to cooperate in the investigation of the claim, in addition to the
requirements of 656.262, the notice of denial shall specify the factual and legal reasons for denial,
and shall contain a notice, in prominent or bold-face type, as follows:
"IF YOU THINK THIS DENIAL IS NOT RIGHT, WITHIN 60 DAYS AFTER THE MAILING OF THIS DENIAL
YOU MUST FILE A LETTER WITH THE WORKERS' COMPENSATION BOARD, 2601 25TH STREET SE, SUITE 150, SALEM
OREGON 97302-1280. YOUR LETTER MUST STATE THAT YOU WANT AN EXPEDITED HEARING, YOUR ADDRESS AND
THE DATE OF YOUR ACCIDENT IF YOU KNOW THE DATE. YOU WILL RECEIVE AN EXPEDITED HEARING WITHIN 30
DAYS. YOUR REQUEST CANNOT, BY LAW, AFFECT YOUR EMPLOYMENT. IF YOU DO NOT FILE A REQUEST WITHIN
60 DAYS, YOU WILL LOSE ANY RIGHT YOU MAY HAVE TO COMPENSATION UNLESS YOU CAN SHOW GOOD CAUSE FOR
DELAY BEYOND 60 DAYS. AFTER 180 DAYS ALL YOUR RIGHTS WILL BE LOST. YOU MAY BE REPRESENTED BY AN
ATTORNEY OF YOUR CHOICE AT NO COST TO YOU FOR ATTORNEY FEES. IF YOU HAVE QUESTIONS YOU MAY CALL
THE WORKERS' COMPENSATION DIVISION TOLL FREE AT 1-800-452-0288."
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.262(6), ORS 656.262(15)
Hist.: WCB 1-1984, f. 4-5-84, ef. 5-1-84; WCB 5-1987, f. 12-18-87, ef. 1-1-88;
WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95;
WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 1-1999, f. 8-24-99, cert. ef. 11-1-99;
WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 1-2004, f. 6-23-04 cert. ef. 9-1-04;
WCB 3-2005, f. 11-15-05, cert. ef. 1-1-06; WCB 2-2007, f. 12-11-07, cert. ef. 1-1-08
EXHIBIT B
438-006-0055
Depositions
Depositions of medical or vocational experts are permitted by agreement of the parties, or
by approval of an Administrative Law Judge, subject to the provisions of ORS 656.285. Depositions
of claimants are permitted in the manner prescribed by ORS 656.262[(13)](14).
Depositions of other lay witnesses are not permitted over objection unless the Presiding Administrative
Law Judge or his or her delegate finds that extraordinary circumstances justify the deposition.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.262(14), ORS 656.388, ORS 656.593 & ORS 656.726(5)
Hist.: WCB 1-1984, f. 4-5-84, ef. 5-1-84; WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 2-1989,
f. 3-3-89, ef. 4-1-89; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96
EXHIBIT C
438-015-0038
Attorney Fees When a Claimant Requests a Hearing on a Responsibility Denial
If the claimant's attorney appears in any proceeding regarding a responsibility
denial issued under ORS 656.308(2), and actively and meaningfully participates[ through an attorney],
and finally prevails against that responsibility denial, the Administrative Law Judge shall award
a reasonable assessed fee to be paid by the insurer or self-insured employer who issued the responsibility
denial. Absent a showing of extraordinary circumstances, the assessed attorney fee shall not exceed
$[1,000]2,500. The maximum attorney fee awarded under this rule is subject to an
annual adjustment on July 1 as calculated by the Workers' Compensation Division (on behalf of the
Director) by the same percentage increase as made to the average weekly wage defined in ORS 656.211,
if any.
Stat. Auth.: ORS 656.307, ORS 656.388, ORS 656.593 & ORS 656.726(5)
Stats. Implemented: ORS 656.308(2), ORS 656.386(1) & ORS 656.388(3)
Hist.: WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96
EXHIBIT D
438-015-0055
Attorney Fees When a Claimant Requests Review by the Board
(1) If a claimant requests review of an Administrative Law Judge's order on the issue of compensation
for temporary disability and the Board awards additional compensation, the Board shall approve
a fee of 25 percent of the increased compensation, provided that the total of fees approved by
the Administrative Law Judge and the Board shall not exceed $5,000.
(2) If a claimant requests review of an Administrative Law Judge's order on the issue of compensation
for permanent disability and the Board awards additional compensation, the Board shall approve
a fee of 25 percent of the increased compensation, provided that the total of fees approved by
the Administrative Law Judge and the Board shall not exceed $6,000.
(3) If a claimant requests review of an Administrative Law Judge's order on the issue of compensation
for permanent total disability and the Board awards additional compensation, the Board shall approve
a fee of 25 percent of the increased compensation, provided that the total of fees approved by
the Administrative Law Judge and the Board shall not exceed $16,300.
(4) If a claimant requests review of an Administrative Law Judge's order that upheld a denial of
compensability for a claim and the Board orders the claim accepted, the Board shall
assess a reasonable attorney fee to be paid by the insurer or self-insured employer to the claimant's
attorney.
(5) If a claimant requests review of an Administrative Law Judge's order that upheld a responsibility
denial issued under ORS 656.308 and the claimant's attorney actively and meaningfully participates
in finally prevailing against the responsibility denial, the Board shall award a reasonable assessed
fee to be paid by the insurer or self-insured employer who issued the responsibility denial. Absent
a showing of extraordinary circumstances, the assessed attorney fee for prevailing over the responsibility
denial shall not exceed $2,500. The maximum attorney fee awarded under this section is subject
to an annual adjustment on July 1 as calculated by the Workers' Compensation Division (on behalf
of the Director) by the same percentage increase as made to the average weekly wage defined in
ORS 656.211, if any.
Stat. Auth.: ORS 656.386(1), ORS 656.386(2), ORS 656.388(3) & ORS 656.726(5)
Stats. Implemented: ORS 656.308(2), ORS 656.386(1), ORS 656.386(2) & ORS 656.388(3)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 1-1998, f. 11-20-98, cert. ef. 2-1-99
EXHIBIT E
438-015-0065
Attorney Fees When Insurer or Self-Insured Employer Requests a Hearing
(1) If an insurer or self-insured employer requests a hearing or otherwise seeks a reduction
in compensation and the Administrative Law Judge [does not reduce the compensation,] finds
that the compensation awarded to the claimant should not be disallowed or reduced, the
Administrative Law Judge shall award a reasonable assessed fee to the claimant's attorney.
(2) If an insurer or self-insured employer requests a hearing regarding a reconsideration
order rescinding a notice of closure, and the Administrative Law Judge finds that the reconsideration
order should not be reversed, the Administrative Law Judge shall award a reasonable assessed fee
to the claimant's attorney.
(3) If an insurer or self-insured employer requests a hearing regarding a reconsideration
order, and the ALJ finds that the compensation awarded by the reconsideration order issued under
ORS 656.268 should not be reduced or disallowed, the Administrative Law Judge shall award a reasonable
assessed fee to the claimant's attorney.
(4) If an insurer or self-insured employer requests a hearing regarding a claim reclassification
order from the Workers' Compensation Division, and the Administrative Law Judge finally determines
that the claim should be classified as disabling, the Administrative Law Judge may award a reasonable
assessed fee.
Stat. Auth.: ORS 656.307, ORS 656.388, ORS 656.593 & ORS 656.726(5)
Stats. Implemented: ORS 656.382(2), ORS 656.386(3) & ORS 656.388(3)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88
EXHIBIT F
438-015-0070
Attorney Fees When Insurer or Self-Insured Employer Requests or Cross-Requests Review by
the Board
(1) If an insurer or self-insured employer requests or cross-requests review
of the Administrative Law Judge's order and the Board [does not disallow or reduce the claimant's
compensation,] finds that the compensation awarded to the claimant should not be disallowed
or reduced, the Board shall award a reasonable assessed fee to the claimant's attorney.
(2) If an insurer or self-insured employer requests or cross-requests review of the Administrative
Law Judge's order regarding a reconsideration order rescinding a notice of closure, and the Board
finds that the reconsideration order should not be reversed, the Board shall award a reasonable
assessed fee to the claimant's attorney.
(3) If an insurer or self-insured employer requests or cross-requests review of the
Administrative Judge's order regarding a reconsideration order, and the Board finds that the compensation
awarded by the reconsideration order issued under ORS 656.268 should not be reduced or disallowed,
the Board shall award a reasonable assessed fee to the claimant's attorney.
(4) If an insurer or self-insured employer requests or cross-requests review of the
Administrative Law Judge's order regarding a claim reclassification order from the Workers' Compensation
Division, and the Board finally determines that the claim should be classified as disabling, the
Board may award a reasonable assessed fee.
Stat. Auth.: ORS 656.307, ORS 656.388, ORS 656.593 & ORS 656.726(5)
Stats. Implemented: ORS 656.382(2), ORS 656.386(3) & ORS 656.388(3)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88
EXHIBIT G
438-015-0110
Attorney Fees in Cases Involving ORS 656.262(11)(a)
If the Director, an Administrative Law Judge, the Board, or the Court find that the insurer
or self-insured employer unreasonably delayed or unreasonably refused to pay compensation, or unreasonably
delayed acceptance or denial of a claim, an assessed attorney fee shall be awarded in a reasonable
amount that:
(1) Is proportionate to the benefit to the claimant;
(2) Takes into consideration the factors set forth in OAR 438-015-0010(4), giving primary consideration
to the results achieved and to the time devoted to the case; and
(3) Does not exceed $[2,000]3,000, absent a showing of extraordinary circumstances.
The maximum attorney fee awarded under this section is subject to an annual adjustment on
July 1 as calculated by the Workers' Compensation Division (on behalf of the Director) by the same
percentage increase as made to the average weekly wage defined in ORS 656.211, if any.
Stat. Auth.: ORS 656.283, ORS 656.388 & ORS 656.726(5)
Stats. Implemented: ORS 656.262(11)(a)
Hist.: WCB 3-2003, f. 12-12-03 cert. ef. 1-1-04