EXHIBIT A

438-005-0040
General Definitions
(1) "Administrative Law Judge" means an individual appointed by the Board to perform the duties, functions and powers provided in ORS 654, 655 and 656, and such other duties, functions and powers as may be prescribed by the Board.
(2) "Aggravation" means an actual worsening of the compensable condition(s) after the last award or arrangement of compensation, which is established by medical evidence supported by objective findings, and otherwise satisfies the statutory requirements of ORS 656.273.
(3) "Aggravation rights" means the time periods specified in ORS 656.273 during which an injured worker is entitled to additional compensation for worsened conditions as a matter of right.
[(4) "Benefits Section" means the Benefits Section of the Workers' Compensation Division of the Department of Consumer & Business Services.]
[(5)] (4) "Board" means the Workers' Compensation Board.
[(6)] (5) "Claimant" means an injured worker or any other person entitled to initiate or continue a claim for compensation.
[(7)] (6) "Director" means the Director of the Department of Consumer & Business Services or his/her designee.
[(8)] (7) "Due diligence" means the diligence reasonably expected from, and ordinarily exercised by, a person who seeks to satisfy a legal requirement or to discharge an obligation.
[(9)] (8) "Hearings Division" means the Hearings Division of the Workers' Compensation Board.
[(10)] (9) "Insurer" means the State Accident Insurance Fund Corporation, an insurer authorized under ORS Chapter 731 to transact workers' compensation insurance in this state, or, except where the context requires otherwise, an assigned claims agent in cases under ORS 656.054.
[(11)] (10) "Party" means a claimant, an employer, including a noncomplying employer, an assigned claims agent in cases under ORS 656.054, and an insurer.
[(12)] (11) "Self-insured employer" means an employer or group of employers certified under ORS 656.430 as meeting the qualifications set out in ORS 656.407.
(12) "Workers’ Compensation Division" means the Workers’ Compensation Division of the Department of Consumer and Business Services.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.726(5) & ORS 656.054
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; 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 3-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 1-2003, f. 2-21-03, cert. ef. 5-1-03; WCB 1-2004,
f. 6-29-04, cert. ef. 9-1-04

EXHIBIT B

438-005-0050
Notice of Claim Acceptance and Hearing Rights Under ORS 656.262(6)(d)
(1) Every notice of claim acceptance shall include all of the information prescribed by
ORS 656.262(6)(b) and OAR Chapter 436.
(2) In the event that the insurer or self-insured employer disagrees with all or any portion of a worker's objections to a notice of claim acceptance under ORS 656.262(6)(d), the insurer's or self-insured employer's written response shall specify the reasons for the disagreement, and shall contain a notice, in prominent or bold-face type, as follows:
"IF YOU DISAGREE WITH THIS DECISION, YOU MAY FILE A LETTER WITH THE WORKERS' COMPENSATION BOARD, 2601 25TH STREET SE, SUITE 150, SALEM, OREGON 97302-1282. YOUR LETTER SHOULD STATE THAT YOU WANT A HEARING, YOUR ADDRESS, THE DATE OF YOUR INJURY, AND YOUR CLAIM NUMBER.
"IF YOUR CLAIM QUALIFIES, YOU MAY RECEIVE AN EXPEDITED HEARING WITHIN 30 DAYS. YOUR REQUEST CANNOT, BY LAW, AFFECT YOUR EMPLOYMENT. 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 [BENEFITS SECTION] WORKERS’ COMPENSATION DIVISION TOLL FREE IN OREGON 1-800-452-0288 OR IN SALEM OR FROM OUTSIDE OREGON AT (503) 945-7585."
Stat. Auth: ORS 656.307, ORS 656.388 & ORS 656.726(5)
Stats. Implemented: ORS 656.262(6)
Hist.: WCB 1-1984, f. 4-5-84, ef. 5-1-84; WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 2-1995, f. 11-13-95, cert.
ef. 1-1-96; WCB 1-1999, f. 8-24-99, cert. ef. 11-1-99; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

EXHIBIT C

438-005-0055
Notice of Claim Denial and Hearing Rights
(1) Except for a denial issued under ORS 656.262(15), in addition to the requirements of
ORS 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 97302-1282. 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 [BENEFITS SECTION] WORKERS’ COMPENSATION DIVISION TOLL FREE IN OREGON 1-800-452-0288 OR IN SALEM OR FROM OUTSIDE OREGON AT (503) 947-7585."
(2) If an insurer or self-insured employer intends to deny a claim under ORS 656.262(15) because of a worker's failure to cooperate in the investigation of the claim, in addition to the requirements of ORS 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 97302-1282. 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 [BENEFITS SECTION] WORKERS’ COMPENSATION DIVISION TOLL FREE IN OREGON 1-800-452-0288 OR IN SALEM OR FROM OUTSIDE OREGON AT (503) 947-7585."
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.262(6), ORS 656.262(15) & ORS 656.325
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. 6-29-04, cert. ef. 9-1-04

EXHIBIT D

438-009-0010
Disputed Claim Settlements
(1) Any document submitted for approval by the Board or the Hearings Division as a settlement of a denied or disputed claim shall be in the form specified by this rule.
(2) A disputed claim settlement shall recite, at a minimum:
(a) The date and nature of the claim;
(b) That the claim has been denied and the date of the denial;
(c) That a bona fide dispute as to the compensability of all or part of the claim exists and that the parties have agreed to compromise and settle all or part of the denied and disputed claim under the provisions of ORS 656.289(4);
(d) The factual allegations and legal positions in support of the claim;
(e) The factual allegations and legal positions in support of the denial of the claim;
(f) That each of the parties has substantial evidence to support the factual allegations of that party;
(g) A list of medical service providers who shall receive reimbursement in accordance with
ORS 656.313(4), including the specific amount each provider shall be reimbursed, and the parties’ acknowledgment that this reimbursement allocation complies with the reimbursement formula prescribed in ORS 656.313(4)(d); and
(h) The terms of the settlement, including the specific date on which those terms were agreed.
(3) If an accepted claim is later denied entirely at any time based on fraud, misrepresentation or other illegal activity by the worker, the disputed claim settlement shall further recite the specific factual allegations and legal positions of the parties concerning the fraud, misrepresentation or other illegal activity.
(4) If a claim was previously accepted in good faith but later denied, in whole or in part, based on later obtained evidence that the claim is not compensable or evidence that the paying agent is not responsible for the claim, the disputed claim settlement shall further recite:
(a) If the accepted claim is later denied entirely at any time up to two years from the date of claim acceptance, an allegation that the self-insured employer or insurer has obtained later evidence that the claim is not compensable or that the paying agent is not responsible for the claim; or
(b) If the denial is a denial of aggravation, current need for medical services or a partial denial of a medical condition on the ground that the condition is not related to the accepted injury, that the claimant retains all rights that may later arise under ORS 656.245, 656.273, 656.278 and 656.340, insofar as these rights may be related to the original accepted claim.
(5) If the claimant is unrepresented, the denial of the claim which is being settled by any document described in section (1) of this rule shall not be contained within that document, but rather shall be issued separately. In addition, any document described in section (1) of this rule shall recite that the unrepresented claimant has been orally advised of the following matters:
(a) The right to an attorney of the claimant’s choice at no cost to the claimant for attorney fees;
(b) The existence of the office of the Ombudsman pursuant to ORS 656.709;
(c) Except with the consent of the worker, reimbursement made to medical service providers from the proceeds of a disputed claim settlement shall not exceed 40 percent of the total present value of the settlement amount; and
(d) Reimbursement from the proceeds of a disputed claim settlement made to medical service providers shall not prevent a medical service provider or health insurance provider from recovering the balance of amounts owing for such services directly from the worker.
(6) Any document described in section (1) of this rule shall also recite that the claimant has been orally advised that:
(a) The claimant has the right to request a hearing concerning the claim, after which an Administrative Law Judge will determine whether the claimant will receive workers’ compensation benefits;
(b) If, following the hearing, the claim is finally determined compensable, the claimant would be entitled to workers’ compensation benefits, which could include temporary disability, permanent disability, medical treatment, and vocational rehabilitation;
(c) If, following the hearing, the claim is finally determined not compensable, the claimant would not be entitled to workers’ compensation benefits;
(d) As a result of this agreement, the claimant’s rights to seek workers’ compensation benefits concerning this claim would be extinguished;
(e) Both parties agree that the terms of the agreement are reasonable; and
(f) The agreement shall not be binding upon the parties unless and until the agreement is [signed] approved by an Administrative Law Judge or the Board, depending upon which forum is considering the dispute.
(7) No document described in section (1) of this rule shall be approved unless the document submitted by the parties establishes that a bona fide dispute as to compensability exists and the proposed disposition of the dispute is reasonable. If an Administrative Law Judge or the Board is not satisfied that a bona fide dispute exists or that disposition of the dispute is reasonable, the Administrative Law Judge or Board may reject the agreement or specify the manner in which objection(s) can be cured.
(8) All disputed claim settlements shall recite whether a claim disposition agreement in the claim has been filed for approval by the Board. All disputed claim settlements shall be in a separate document from a claim disposition agreement.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.236, 656.289(4); 656.313(4); 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 5-1990, f. 4-19-90. cert. ef. 5-21-90; WCB 7-1990 (Temp), f. 6-14-90. cert. ef. 7-1-90; WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90; WCB 3-1993, f. 10-27-93. cert. ef. 11-4-93; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 3-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

EXHIBIT E

438-009-0015
Notice Of Settlement; Submission Of Documents
(1) The party that requested the hearing shall promptly notify the Presiding Administrative Law Judge, or his or her delegate, when a case is settled in whole or in part.
(2) The party that requested Board review shall promptly notify the Board’s Closing and Appeals Division in writing when a case is settled in whole or in part.
(3) The Presiding Administrative Law Judge, or his or her delegate, may require written notice of settlement as a condition of cancellation of a scheduled hearing.
(4) With the consent of the assigned Administrative Law Judge, the parties may enter a settlement on the oral record at the time and place scheduled for the hearing. With the exception of a disputed claim settlement, the Administrative Law Judge may enter an order reciting and approving the settlement in such cases, without the submission of documents by the parties. With the consent of the parties, the official oral record, including the Administrative Law Judge’s approval, which is subject to transcription if necessary, is sufficient authority for the payment of settlement amounts in advance of the formal written order.
(5) Notwithstanding OAR 438-005-0046(1)(d), in all cases settled by disputed claim settlement or written stipulation of the parties, the original and [six] one legible [copies] copy of the settlement document shall be mailed or delivered to the Administrative Law Judge or the Board for approval. If the disputed claim settlement or written stipulation pertains to the resolution of disputes pending before both the Hearings Division and the Board, the settlement document shall recite the issues resolved by the Opinion and Order that is pending before the Board. If the disputed claim settlement or written stipulation is mailed or delivered to the Hearings Division for approval and the agreement either formally or effectively modifies a dispute which is pending before the Board, the disputed claim settlement or stipulation shall be submitted in a format to provide for both Hearings Division and Board approval. [The original document shall be retained in the Board’s file and necessary copies shall be conformed and distributed to the parties, their attorneys and the Director.]
(6) Unless a party has filed prior written notice with the Hearings Division or the Board that the party wants an exhibit returned to them, all exhibits (with the exception of exhibit lists) may be discarded from the record following:
(a) Administrative Law Judge or Board approval of a settlement stipulation or disputed claim settlement;
(b) An Administrative Law Judge order dismissing a party’s hearing request in response to that party’s withdrawal of the request; or
(c) A Board order dismissing a party’s request for Board review in response to that party’s withdrawal of the request for Board review.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.236, 656.289(4), 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 1-1990, f. 1-24-90, cert. ef. 2-28-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95; WCB 1-1999, f. 8-24-99, cert. ef. 11-1-99; WCB 3-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

EXHIBIT F

DIVISION 012

BOARD'S OWN MOTION JURISDICTION

438-012-0001
Definitions
(1) "Own Motion Board" and "Board" mean the Workers' Compensation Board acting under is authority pursuant to ORS 656.278 and these rules.
(2) "Own Motion Claim" means:
(a) A written request by or on behalf of a claimant for temporary disability compensation or claim reopening regarding a worsened condition claim where claimant's aggravation rights have expired;
(b) A request by a claimant to an Own Motion Insurer that clearly requests formal written acceptance of a new medical condition or an omitted medical condition that is related to an initially accepted claim that is initiated after the rights under ORS 656.273 have expired (i.e., a "post-aggravation rights" new medical condition or omitted medical condition claim); and/or
(c) A written request by or on behalf of a claimant for medical benefits for a compensable injury that occurred before January 1, 1966, unless the injury occurred from August 5, 1959 through December 31, 1965 and resulted in an award of permanent total disability.
(3) "Own Motion Insurer," "Insurer" and "Paying Agent" mean a guaranty contract insurer or self-insured employer that is or may be responsible for payment of compensation under the provisions of ORS 656.278.
(4) "Own Motion Order" means an order of the Own Motion Board other than an order following an appeal pursuant to OAR 438-012-0090.
(a) "Proposed and Final Own Motion Order" means an order of an Administrative Law Judge issued pursuant to OAR 438-012-0090 on behalf of the Own Motion Board, subject to timely filing of appeal to the Own Motion Board.
(b) "Final Own Motion Order" means either:
(i) A "Proposed and Final Own Motion Order" issued by an Administrative Law Judge pursuant to OAR 438-012-0090 on behalf of the Own Motion Board that was not timely appealed and has become final by operation of law; or
(ii) An order of the Own Motion Board following appeal to the Own Motion Board of a "Proposed and Final Own Motion Order."
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.267(1), (3), ORS 656.278(1) & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 2-1989, f. 3-3-89, ef. 4-1-89; 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 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0016
Communication with Board and Parties in Own Motion Cases
A copy of any document in an Own Motion proceeding, including correspondence, directed to the Board or to a party in the claim shall be simultaneously mailed to all other parties involved in the claim or, if a party is currently represented by an attorney, to the party's attorney.
Stat. Auth.: ORS 656.278(1) & ORS 656.726(5)
Stats. Implemented: ORS 656.278(1) & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96

438-012-0017
Written Argument and Other Documents
(1) Timely compliance with Board requests for written argument and/or timely responses to inquiries from the Board is necessary to the Board’s decision making process.
(2) Unless otherwise allowed by the Board, extensions of time for the filing of written arguments/responses will be allowed only on written request filed no later than the date the argument/response is due. A statement whether opposing counsel (or a party, if the party is not represented by counsel) objects to, concurs in or has no comment regarding the extension of time requested should be furnished with the extension request.

Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278 & ORS 656.726(5)
Hist.: WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0018
Applicability of Rules; Effective Date
(1) These rules apply to claims in which a request for compensation under the Board's Own Motion jurisdiction is in existence or arose on or after the effective date of these rules.
(2) These rules in division 012 are effective September 1, [2003] 2004, to be applied in the manner prescribed in the Board’s Order of Adoption.
Stat. Auth.: ORS 656.278 & ORS 656.726(5)
Stats. Implemented: ORS 656.278(1) & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 8-1990(Temp), f. 8-23-90, cert. ef. 9-15-90; WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0020
Insurer to Process Own Motion Claim: Notice and Contents of Claim; Worsened Condition Claim; "Post-aggravation Rights" New Medical Condition or Omitted Medical Condition Claim; Pre-1966 Injury Claim
(1) All Own Motion claims, including "post-aggravation rights" new medical condition or omitted medical condition claims, shall first be directed to and processed by the insurer. An Own Motion claim shall be legibly date-stamped on the date it is received by the insurer.
(2) An Own Motion claim shall contain sufficient information to identify the claimant and the claim.
(3) An insurer is deemed to have notice of an Own Motion claim for a worsened condition when one of the following documents is submitted to the insurer by or on behalf of the claimant:
(a) A written request for temporary disability compensation or claim reopening regarding a compensable injury for which aggravation rights have expired; or
(b) Any document submitted to the insurer after the expiration of aggravation rights that reasonably notifies the insurer that the compensable injury results in the claimant's inability to work and requires hospitalization or inpatient or outpatient surgery, or other curative treatment prescribed in lieu of hospitalization that is necessary to enable the claimant to return to work.
(4) An insurer is deemed to have notice of a "post-aggravation rights" new medical condition or omitted medical condition claim when the insurer receives from the claimant any document that clearly requests formal written acceptance of a new medical condition or an omitted medical condition initiated after expiration of aggravation rights under ORS 656.273 as required by ORS 656.267(1) and (3).
(5) Except as provided in section [(6)] (7) of this rule, an insurer is deemed to have notice of an Own Motion claim for medical benefits and/or temporary disability compensation relating to a compensable injury that occurred before January 1, 1966, when one of the following documents is submitted to the insurer by or on behalf of the claimant:
(a) A written request for medical benefits relating to the compensable injury;
(b) Any document that reasonably notifies the insurer that the claimant is seeking medical benefits for the compensable injury;
(c) A written request for temporary disability compensation or claim reopening; or
(d) Any document that reasonably notifies the insurer that the compensable injury results in the inability of the claimant to work and requires surgery or hospitalization or other curative treatment prescribed in lieu of hospitalization that is necessary to enable the claimant to return to work.
(6) An insurer is deemed to have notice of a "post-aggravation rights" new medical condition or omitted medical condition claim related to a compensable injury that occurred before January 1, 1966, when the insurer receives from the claimant any document that clearly requests formal written acceptance of a new medical condition or an omitted medical condition initiated after expiration of aggravation rights under ORS 656.273 as required by ORS 656.267(1) and (3).
[(6)] (7) An Own Motion claim for medical benefits does not include a claim for medical benefits relating to a compensable injury that occurred from August 5, 1959 through December 31, 1965 and resulted in an award of permanent total disability. Such claims shall be processed as a claim for medical services under ORS 656.245.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.278(2) & ORS 656.726(5)
Hist.: WCB
a compensable injury that occurred before January 1, 1966, a compensable injury that occurred before January 1, 1966, a compensable injury that occurred before January 1, 1966, 5-1987, f. 12-18-87, ef. 1-1-88; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0024
"Post-Aggravation Rights" New Medical Condition or Omitted Medical Condition Claim: Insurer Modified Acceptance; Denial; Notice of Clarification; Notice of Incomplete Claim
(1) For claims with a date of injury before January 1, 2002, the Own Motion insurer shall, within 90 days after receiving a "post-aggravation rights" new medical condition or omitted medical condition claim, either:
(a) Accept the claim by specifying the condition(s) that have been accepted by issuing a Modified Notice of Acceptance under ORS 656.262(6) and OAR 436-060-0140 to the claimant with a copy to the claimant's attorney, if any, and the Workers' Compensation Division;
(b) Deny the claim by specifying the factual and legal reasons for denying the condition(s) as provided in OAR 438-012-0070 and/or 438-012-0075, including a notice as prescribed in
OAR 438-012-0070, in a letter mailed to the claimant with a copy to the claimant's attorney, if any; (c) Issue a Notice of Clarification, as described in OAR 438-012-0080, that is mailed to the claimant and the claimant's attorney, if any, if no acceptance of the claim is required because the previously issued Notice(s) of Acceptance reasonably apprises the claimant and the medical providers of the nature of the compensable conditions; or
(d) Issue a Notice of Incomplete Claim, as described in OAR 438-012-0085, that is mailed to the claimant and the claimant's attorney, if any, if no acceptance or denial of the claim is required because the document received by the insurer from the claimant does not clearly request formal written acceptance of a new medical condition or omitted medical condition.
(2) For claims with a date of injury on or after January 1, 2002, the Own Motion insurer shall, within 60 days after receiving a "post-aggravation rights" new medical condition or omitted medical condition claim, either:
(a) Accept the claim by specifying the condition(s) that have been accepted by issuing a Modified Notice of Acceptance under ORS 656.262(6) and OAR 436-060-0140 to the claimant with a copy to the claimant's attorney, if any, and the Workers' Compensation Division;
(b) Deny the claim by specifying the factual and legal reasons for denying the condition(s) as provided in OAR 438-012-0070 and/or 438-012-0075, including a notice as prescribed in OAR 438-012-0070, in a letter mailed to the claimant with a copy to the claimant's attorney, if any;
(c) Issue a Notice of Clarification, as described in OAR 438-012-0080, that is mailed to the claimant and the claimant's attorney, if any, if no acceptance of the claim is required because the previously issued Notice(s) of Acceptance reasonably apprises the claimant and the medical providers of the nature of the compensable conditions; or
(d) Issue a Notice of Incomplete Claim, as described in OAR 438-012-0085, that is mailed to the claimant and the claimant's attorney, if any, if no acceptance or denial of the claim is required because the document received by the insurer from the claimant does not clearly request formal written acceptance of a new medical condition or omitted medical condition.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.267(1), (3), ORS 656.278(1)(b) & ORS 656.726(5)
Hist.: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0030
Insurer Recommendation of Reopening or Denial of Claim; Voluntarily Reopening
(1) For all Own Motion claims, including "post-aggravation rights" new medical condition or omitted medical condition claims, with a date of injury before January 1, 2002, except as provided in section [(3)] (4) of this rule, the Own Motion insurer shall, within 90 days after receiving an Own Motion claim, either:
(a) Voluntarily reopen the Own Motion claim, including any "post-aggravation rights" new medical condition or omitted medical condition claim, under ORS 656.278(5) to provide benefits allowable under ORS 656.278 or to grant additional medical or hospital care to the claimant; or
(b) Submit to the Board a written recommendation as to whether the Own Motion claim, including any "post-aggravation rights" new medical condition or omitted medical condition claim, should be reopened or not reopened, on a form prescribed by the Board, accompanied by the required evidence supporting the recommendation. The Own Motion insurer shall supply all information and evidence required by the form, which should be marked as exhibits, arranged in chronological order, and accompanied by an exhibit list. Copies of the recommendation form and any supporting evidence shall be mailed to the claimant and the claimant's attorney, if any.
(2) For all Own Motion claims, including "post-aggravation rights" new medical condition or omitted medical condition claims, with a date of injury on or after January 1, 2002, except as provided in section [(3)] (4) of this rule, the Own Motion insurer shall, within 60 days after receiving an Own Motion claim, either:
(a) Voluntarily reopen the Own Motion claim, including any "post-aggravation rights" new medical condition or omitted medical condition claim, under ORS 656.278(5) to provide benefits allowable under ORS 656.278 or to grant additional medical or hospital care to the claimant; or
(b) Submit to the Board a written recommendation as to whether the Own Motion claim, including any "post-aggravation rights" new medical condition or omitted medical condition claim, should be reopened or not reopened, on a form prescribed by the Board, accompanied by the required evidence supporting the recommendation. The Own Motion insurer shall supply all information and evidence required by the form, which should be marked as exhibits, arranged in chronological order, and accompanied by an exhibit list. Copies of the recommendation form and any supporting evidence shall be mailed to the claimant and the claimant's attorney, if any.
(3) For "post-aggravation rights" new medical condition or omitted medical condition claims, in addition to the processing required in OAR 438-012-0024, the Own Motion insurer must also comply with subsections (1) and (2) of this rule; i.e., either voluntarily reopen the claim or submit to the Board a written recommendation as to whether the "post-aggravation rights" new medical condition or omitted medical condition claim should be reopened or not reopened, on a form prescribed by the Board, accompanied by the required evidence supporting the recommendation.
[(3)] (4) In extraordinary circumstances, the Board may grant the insurer an extension for submission of its recommendation.
[(4)] (5) In all cases when the Own Motion insurer voluntarily reopens the claim under ORS 656.278(5), the insurer shall issue a 3501 Form to the claimant with copies to the claimant's attorney, if any, and the Workers' Compensation Division[, Benefits and Policy Services Section]. The form shall be as prescribed by the Director.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1), ORS 656.278(5) & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 7-1990(Temp), f. 6-14-90, cert. ef. 7-1-90; WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0031
Notification of Pending Proceedings
Parties to an Own Motion proceeding shall notify the Board of any pending proceeding involving a contested case under ORS 656.283 to 656.295, ORS 656.307, or ORS 656.308, an arbitration or mediation proceeding under ORS 656.307, or a Director's medical review under ORS 656.245, 656.260, or 656.327. The parties shall also specify the issues raised in that proceeding.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1) & ORS 656.726(5)
Hist.: WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96

438-012-0032
Consent to Designation of Paying Agent
(1) Except as provided in section (2) of this rule, when the [Benefits Section] Workers’ Compensation Division notifies the Board that it is prepared to issue an order designating a paying agent under ORS 656.307 and OAR 436-060-0180 if the Board consents to the order where one or more insurers involved in the proceeding is subject to ORS 656.278, the Board shall notify the Benefits Section within ten days whether it consents to the order.
(2) If the Board is unable to determine from the available evidence whether the claimant would be entitled to Own Motion relief if the Own Motion insurer was determined to be the responsible insurer, the Board may require the parties to state their positions in writing and submit any supporting evidence to the Board within ten days. The time for the Board's response to the [Benefits Section] Workers’ Compensation Division is suspended during this process.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1) & ORS 656.307
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0035
Temporary Disability Compensation
(1) The insurer may pay temporary disability compensation in accordance with the provisions of ORS 656.210, 656.212(2) and 656.262(4) from the time the attending physician authorizes temporary disability compensation for the hospitalization, surgery, or other curative treatment until the claimant's condition becomes medically stationary in those cases where:
(a) The Own Motion claim for temporary disability compensation is filed after the aggravation rights have expired;
(b) There is a worsening of a compensable injury that results in the inability of the worker to work and requires hospitalization or inpatient or outpatient surgery, or other curative treatment prescribed in lieu of hospitalization that is necessary to enable the claimant to return to work; and
(c) The claimant qualifies as a "worker" pursuant to ORS 656.005(30). "Worker" does not include a person who has withdrawn from the work force during the period for which such benefits are sought.
(2) The insurer may pay temporary disability compensation in accordance with the provisions of ORS 656.210, 656.212(2) and 656.262(4) from the time the attending physician authorizes temporary disability compensation for the hospitalization, surgery, or other curative treatment until the claimant's condition becomes medically stationary in those cases where:
(a) The claimant submits and obtains acceptance of a claim for a compensable new medical condition or an omitted medical condition and the claim is initiated after the aggravation rights under ORS 656.273 have expired; and
(b) The claimant qualifies as a "worker" pursuant to ORS 656.005(30). "Worker" does not include a person who has withdrawn from the work force during the period for which such benefits are sought.
(3) The claimant is deemed to be in the work force if:
(a) The claimant is engaged in regular employment;
(b) The claimant, although not employed, is willing to work and is making reasonable efforts to obtain employment; or
(c) The claimant is willing to work, but the claimant is not employed, and the claimant is not making reasonable efforts to obtain employment because such efforts would be futile as a result of the effects of the compensable injury.
(4) The insurer shall make the first payment of temporary disability compensation in accordance with ORS 656.210, 656.212(2) and 656.262(4) within 14 days from:
(a) The date of an order of the Board reopening the claim; or
(b) The date the insurer voluntarily reopened the claim.
(5) Temporary disability compensation shall be paid until one of the following events first occurs:
(a) The claimant is medically stationary pursuant to ORS 656.005(17);
[(a)] (b) The claim is closed pursuant to OAR 438-012-0055;
[(b)] (c) A claim disposition agreement is submitted to the Board pursuant to ORS 656.236(1), unless the claim disposition agreement provides for the continued payment of temporary disability compensation; or
[(c)] (d) Termination of such benefits is authorized by the terms of ORS 656.268(4)(a) through (d).
(6)(a) An Own Motion insurer may unilaterally suspend compensation under the circumstances provided in ORS 656.262(4)(e), (4)(h), and (4)(i). If the Own Motion insurer believes that temporary disability compensation should be suspended for any reason other than those provided in ORS 656.262(4)(e), (4)(h), and (4)(i), the insurer may make a written request to the Board for such suspension. This request shall:
(i) State the reasons the insurer is requesting that the Board suspend the claimant's temporary disability compensation;
(ii) Include copies of supporting documentation; and
(iii) Be mailed to the claimant and the claimant's attorney, if any, by certified or registered mail.
(b) Unless an extension is granted by the Board, claimant or claimant's attorney shall have 14 days to respond to the Board in writing to the request.
(c) Unless an extension is granted by the Board, the insurer shall have 14 days to reply in writing to claimant's response.
(d) The insurer shall not suspend compensation under this section without prior written authorization by the Board, except as provided in ORS 656.262(4)(e), (4)(h), and (4)(i).
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.005(30), ORS 656.262(4), ORS 656.268(4), ORS 656.278(1), ORS 656.278(2) & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 8-1990(Temp), f. 8-23-90, cert. ef. 9-15-90; WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 1-1997, f. 3-20-97, cert. ef. 7-1-97; WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0036
Permanent Disability Compensation
(1) Where the claimant has submitted and obtained acceptance of a claim for a compensable
new medical condition or an omitted medical condition and the claim was initiated after the aggravation rights under ORS 656.273 have expired, the insurer may provide any permanent disability benefits to which the claimant is entitled under application of the Standards adopted
by the Director under ORS 656.726 when the insurer closes the claim pursuant to OAR 438-012-0055.
(2) Pursuant to ORS 656.278(2)(d), an insurer may include permanent disability benefits for additional impairment to an injured body part that has previously been the basis of a permanent partial disability award, but only to the extent that the permanent partial disability rating exceeds the permanent partial disability rated by the prior award or awards.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1), ORS 656.278(2) & ORS 656.726(5)
Hist.: WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02

 438-012-0037
Payment of Medical Benefits
Except as otherwise provided in OAR 438-012-0020(5), for every condition resulting from a compensable injury occurring before January 1, 1966, the Own Motion insurer may pay for reasonable and necessary medical services when:
(1) Undertaken for curative purposes;
(2) Provided to a claimant who has been determined to have permanent total disability;
(3) Provided in the form of prescription medications;
(4) Necessary to administer prescription medication or to monitor administration of prescription medication;
(5) Provided in the form of prosthetic devices, braces and supports;
(6) Necessary to maintain and monitor the status, replacement or repair of a prosthetic device, brace or support;
(7) Necessary to diagnose the claimant's condition;
(8) Necessary to enable the claimant to continue current employment;
(9) Provided in the form of life-preserving modalities similar to insulin therapy, dialysis and transfusions; or
(10) The Board determines that special circumstances justify the provision of further medical services.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1)(c), ORS 656.278(2)(c) & ORS 656.726(5)
Hist.: WCB 8-1990(Temp), f. 8-23-90, cert. ef. 9-15-90; WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02

438-012-0040
Action by Board after Insurer Recommendation
Except as provided in OAR 438-012-0050, within a reasonable time after receipt of the insurer's recommendation and supporting evidence and any additional evidence and argument from the claimant the Board may:
(1) Issue its order based upon the evidence and argument submitted by the parties;
(2) Request additional evidence from one or more of the parties; or
(3) Refer the matter to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions.
Stat. Auth.: ORS 654.025(2) & ORS 656.726(4)
Stats. Implemented: ORS 656.278(1) & ORS 656.726(4)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96

438-012-0050
Board Will Act Unless Claimant Has Not Exhausted Other Available Remedies
(1) The Board will act promptly upon a request for relief under the provisions of ORS 656.278 and these rules unless:
(a) The claimant has available administrative remedies under the provisions of ORS 656.273;
(b) The claimant's condition is the subject of a contested case under ORS 656.283 to 656.298, 656.307 or 656.308, or an arbitration or mediation proceeding under ORS 656.307; or
(c) The claimant's request for payment of temporary disability compensation is based on surgery or hospitalization or other curative treatment prescribed in lieu of hospitalization that is necessary to enable the claimant to return to work that is the subject of either a managed care dispute resolution review process or a Director's medical review under ORS 656.245, 656.260 or 656.327;
(d) The claimant's condition is the subject of litigation under OAR 438-012-0090 or 438-012-0095.
(2) The Board may postpone its review of the merits of the claimant's request for relief if the available remedies set forth in section (1) of this rule could affect the Board's authority to award compensation under the provisions of ORS 656.278.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1) & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0055
Closure of Claims Reopened Under ORS 656.278
When a claim has been voluntarily reopened or ordered reopened by the Board and the medical reports indicate to the insurer that the claimant's condition has become medically stationary, the claim shall be closed by the insurer without the issuance of a Board order. In all such cases the insurer shall issue a Notice of Closure (Form 2066) to the claimant with copies to the claimant's attorney, if any, and [Benefits Section] the Workers’ Compensation Division. The notice shall be on the form prescribed by the Director and shall inform the claimant of the amount and duration of temporary disability compensation, the amount of any permanent disability award determined under ORS 656.278(1)(b) and (2)(d), and the medically stationary date, and shall include the following notice in prominent or bold face type:
"IF YOU THINK THIS CLAIM CLOSURE IS WRONG, YOU MAY ASK THE WORKERS' COMPENSATION BOARD TO REVIEW IT AND DECIDE WHETHER YOU ARE ENTITLED TO MORE COMPENSATION. IF YOU DO NOT ASK FOR REVIEW WITHIN 60 DAYS OF THE DATE OF THIS NOTICE YOU WILL LOSE ANY RIGHT YOU MAY HAVE TO CONTEST THIS NOTICE UNLESS YOU CAN SHOW GOOD CAUSE FOR DELAY BEYOND 60 DAYS. AFTER 180 DAYS ALL RIGHTS WILL BE LOST. YOU MAY ASK FOR A REVIEW BY WRITING TO THE BOARD AT 2601 25TH STREET SE, SUITE 150, SALEM, OREGON 97302-1282. YOU MAY HAVE AN ATTORNEY OF YOUR CHOICE, WHOSE FEE WILL BE LIMITED TO A PERCENTAGE OF ANY MORE COMPENSATION YOU MAY BE AWARDED."
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1), ORS 656.278(2), ORS 656.278(6) & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 3-1988(Temp), f. 10-20-88, ef. 11-1-88; WCB 2-1989, f. 3-3-89, ef. 4-1-89; WCB 8-1990(Temp), f. 8-23-90, cert. ef. 9-15-90; WCB 11-1990, f. 12-13-90, cert. ef. 12-31-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, 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. 6-29-04, cert. ef. 9-1-04

438-012-0060
Board Review of Insurer Closure
(1) The request for Board review of the insurer's claim closure pursuant to OAR 438-012-0055(1) shall be in writing, signed by the claimant or the claimant's attorney, and shall include, but is not limited to, the following information:
(a) The claimant's name and mailing address;
(b) A statement that Board review is requested, and the reason(s) for the request for review; reasons for requesting review may include, but are not limited to:
(i) Disagreement with the medically stationary determination;
(ii) Disagreement with the temporary disability compensation awarded, including rate of payment and/or dates awarded; and/or
(iii) Disagreement with permanent disability compensation awarded, if the claim was reopened for a "post-aggravation rights" new medical condition claim and/or omitted medical condition claim. If the claimant disagrees with the impairment used in rating of the claimant's permanent disability for such a claim, the claimant may request appointment of a medical arbiter;
(c) The name of the insurer; and
(d) A copy of the Notice of Closure (Form 2066).
(2) To be considered, the request must be filed with the Board within 60 days after the mailing date of the notice of closure, or within 180 days after the mailing date if the claimant establishes good cause for the failure to file the request within 60 days after the mailing date. The Board shall notify all parties that review has been requested.
(3) Within 14 days after notification from the Board that a review has been requested, the insurer shall submit to the Board and to the claimant and the claimant's attorney, if any, legible copies of all evidence [which] that pertains to the claimant's compensable condition at the time of closure, including any evidence relating to permanent disability. Such evidence should be marked as exhibits, arranged in chronological order, and accompanied by an exhibit list. The insurer may also submit written arguments at this time, with copies to the claimant or the claimant's attorney, if any.
(4) The claimant may submit additional evidence and written argument to the Board, with copies to the insurer or its attorney, if any. To be considered, such evidence and argument must be submitted within 21 days from the date the insurer mails the evidence pursuant to section (3) of this rule.
(5) No additional written argument may be submitted unless authorized by the Board.
(6) The Board may refer a matter to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions.
(7) The Board may refer a disagreement regarding the rating of the claimant's permanent disability for a "post-aggravation rights" new or omitted medical condition to the Workers' Compensation Division for an evaluation and recommendation based on the record presented to the Board.
[(7)] (8) The Board shall issue its order within a reasonable time after receipt of all evidence and argument from the parties and any recommendations from the Hearings Division.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1), ORS 656.278(6) & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 2-1989, f. 3-3-89, ef. 4-1-89; WCB 2-1990, f. 1-24-90, cert. ef. 2-28-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 1-1997, f. 3-20-97, cert. ef. 7-1-97; WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0061
Board Review of Voluntary Reopening of an Own Motion Claim
(1) If a dispute arises out of a voluntary reopening of a claim under ORS 656.278(5), a party may file a written request for Board review, with copies to the other party.
(2) Within 14 days after notification from the Board that a review has been requested, the insurer shall submit to the Board and to the claimant or the claimant's attorney, if any, legible copies of all evidence which pertains to the claimant's compensable condition at the time of the voluntary reopening. The insurer may also submit written arguments at this time, with copies to the claimant or the claimant's attorney, if any.
(3) The claimant may submit additional evidence and written argument to the Board, with copies to the insurer or its attorney, if any. To be considered, such evidence and argument must be submitted within 21 days from the date the insurer mails the evidence and argument pursuant to section (2) of this rule.
(4) The Board may refer a matter to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions.
(5) The Board shall issue its order within a reasonable time after receipt of all evidence and argument from the parties and any recommendations from the Hearings Division.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1), ORS 656.278(5) & ORS 656.726(5)
Hist.: WCB 2-2001, f. 11-14-01, cert. ef. 1-1-02; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0062
Referral of Request for Enforcement of Board's Own Motion Order and Request for Suspension of Temporary Disability Compensation to Hearings Division
(1) The Board may refer a request to enforce an Own Motion order to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions.
(2) The Board may refer a request for suspension of temporary disability compensation under OAR 438-012-0035(6) to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions.
(3) The Board shall issue its order within a reasonable time after receipt of all evidence and argument from the parties and any recommendations from the Hearings Division.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278(1) & ORS 656.726(5)
Hist.: WCB 2-1989, f. 3-3-89, ef. 4-1-89; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995,
f. 11-13-95, cert. ef. 1-1-96; WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0065
Reconsideration of Own Motion Orders
(1) All final orders issued by the Board under the provisions of ORS 656.278 shall set forth the parties, the request for relief, the Board's decision and shall advise all parties of appeal rights.
(2) A motion for reconsideration of a final order issued by the Board under the provisions of ORS 656.278 shall be filed within 30 days after the date of mailing of the order, or within 60 days after the mailing date if the party requesting reconsideration establishes good cause for the failure to file the request within 30 days after the mailing date.
(3) Notwithstanding section (2) of this rule, in extraordinary circumstances the Board may, on its own motion, reconsider any prior Board order.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.278 & ORS 656.726(5)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 2-1989, f. 3-3-89, ef. 4-1-89; WCB 2-1990, f. 1-24-90, cert. ef. 2-28-90; WCB 1-1994, f. 11-1-94, cert. ef. 1-1-95, cert. ef. 1-1-95; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96
 

438-012-0070
Notice of Denial of "Post-Aggravation Rights" New Medical Condition or Omitted Medical Condition Claim
When an Own Motion insurer denies a "post-aggravation rights" new medical condition or omitted medical condition claim, the notice of denial shall:
(1) Specify the factual and legal reasons for denial;
(2) Be mailed to the claimant and the claimant's attorney, if any; and
(3) 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 97302-1282. YOUR LETTER MUST STATE THAT YOU WANT A HEARING, YOUR ADDRESS AND THE DATE OF YOUR ACCIDENT IF YOU KNOW THE DATE. 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 FOR THE DENIED CLAIM 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 IN OREGON 1-800-452-0288 OR IN SALEM OR FROM OUTSIDE OREGON AT (503)947-7585."
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.267(1)(3), ORS 656.278(1)(b) & ORS 656.726(5)
Hist.: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0075
Notice of Denial of Responsibility for "Post-Aggravation Rights" New Medical Condition or Omitted Medical Condition Claim
(1) If an Own Motion insurer intends to deny responsibility for a "post-aggravation rights" new medical condition or omitted medical condition claim, the insurer shall, within the time prescribed in OAR 438-012-0024 for processing the claim, so indicate in or as part of a denial otherwise meeting the requirements of OAR 438-012-0070.
(2) The notice shall:
(a) Identify the condition(s) for which responsibility is being denied;
(b) State the factual and legal reasons for the denial; and
(c) Advise the claimant to file separate, timely claims against other potentially responsible insurers or self-insured employers, including other insurers for the same employer, in order to protect the claimant's rights to obtain benefits on the claim.
(3) The denial may:
(a) List the names and addresses of other insurers or self-insured employers who may be responsible for the claimant's condition; and
(b) State whether the Own Motion insurer has requested the appointment of a paying agent pursuant to ORS 656.307.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.267(1), (3), ORS 656.278(1)(b) & ORS 656.726(5)
Hist.: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0080
Notice of Clarification in Response to "Post-Aggravation Rights" New Medical Condition or Omitted Medical Condition Claim
A Notice of Clarification under OAR 438-012-0024(1)(c) and (2)(c) shall:
(1) Specify the factual and legal reasons for the Own Motion insurer's decision that no acceptance of a "post-aggravation rights" new medical condition or omitted medical condition claim is required;
(2) Be mailed to the claimant and the claimant's attorney, if any; and
(3) Contain a notice, in prominent or bold face type, as follows:
"IF YOU THINK THIS NOTICE OF CLARIFICATION IS NOT RIGHT, WITHIN 60 DAYS AFTER THE MAILING OF THIS NOTICE, YOU MUST FILE A LETTER WITH THE WORKERS' COMPENSATION BOARD, 2601 25TH STREET SE, SUITE 150, SALEM OREGON 97302-1282. YOUR LETTER MUST STATE THAT YOU WANT A HEARING, YOUR ADDRESS AND THE DATE OF YOUR ACCIDENT IF YOU KNOW THE DATE. 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 APPEAL THE NOTICE UNLESS YOU CAN SHOW GOOD CAUSE FOR DELAY BEYOND 60 DAYS. AFTER 180 DAYS ALL YOUR RIGHTS WILL BE LOST. IF YOU HAVE QUESTIONS YOU MAY CALL THE WORKERS' COMPENSATION DIVISION TOLL FREE IN OREGON 1-800-452-0288 OR IN SALEM OR FROM OUTSIDE OREGON AT (503)947-7585."
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.267(1)(3), ORS 656.278(1)(b) & ORS 656.726(5)
Hist.: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0085
Notice of Incomplete Claim in Response to "Post-Aggravation Rights" New Medical Condition or Omitted Medical Condition Claim
A Notice of Incomplete Claim under OAR 438-012-0024(1)(d) and (2)(d) shall:
(1) Specify the factual and legal reasons for the Own Motion insurer's decision that no acceptance or denial of a "post-aggravation rights" new medical condition or omitted medical condition claim is required;
(2) Be mailed to the claimant and the claimant's attorney, if any; and
(3) Contain a notice, in prominent or bold face type, as follows:
"IF YOU THINK THIS NOTICE OF INCOMPLETE CLAIM IS NOT RIGHT, WITHIN 60 DAYS AFTER THE MAILING OF THIS NOTICE, YOU MAY FILE A LETTER WITH THE WORKERS' COMPENSATION BOARD (ATTENTION: OWN MOTION SECTION), 2601 25TH STREET SE, SUITE 150, SALEM OREGON 97302-1282. YOUR LETTER MUST STATE THAT YOU WANT BOARD REVIEW, YOUR ADDRESS AND THE DATE OF YOUR ACCIDENT IF YOU KNOW THE DATE. YOUR REQUEST CANNOT, BY LAW, AFFECT YOUR EMPLOYMENT. IF YOU HAVE QUESTIONS YOU MAY CALL THE WORKERS' COMPENSATION DIVISION TOLL FREE IN OREGON 1-800-452-0288 OR IN SALEM OR FROM OUTSIDE OREGON AT (503)947-7585."
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.267(1)(3), ORS 656.278(1)(b) & ORS 656.726(5)
Hist.: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03

438-012-0090
Hearing Procedures Regarding Denial and/or Clarification Notice of "Post-Aggravation Rights" New Medical Condition or Omitted Medical Condition Claims; Proposed and Final Own Motion Order; Notice of Appeal Rights
(1) Requests for hearing regarding a denial under OAR 438-012-0070 and/or 438-012-0075 or a Notice of Clarification under OAR 438-012-0080 of a "post-aggravation rights" new medical condition or omitted medical condition claim shall be processed by the Hearings Division pursuant to the procedures for ordinary cases prescribed in divisions 006, [and] 007, and 009.
(2) Within 30 days of closure of the hearing record, the Administrative Law Judge shall decide the issues arising from the hearing request(s) from a denial and/or clarification notice of a "post-aggravation rights" new medical condition or omitted medical condition claim(s) by issuing a "Proposed and Final Own Motion Order," including the following written statement, in prominent or bold face type, concerning the parties' rights of appeal:
NOTICE TO ALL PARTIES: IF YOU ARE DISSATISFIED WITH THIS PROPOSED AND FINAL OWN MOTION ORDER, YOU MAY, WITHIN THIRTY (30) DAYS AFTER THE MAILING DATE ON THIS ORDER, REQUEST REVIEW BY THE WORKERS' COMPENSATION BOARD [(OWN MOTION SECTION)], 2601 25TH ST. SE, SUITE 150, SALEM, OR 97302-1282. ANY SUCH REQUEST SHALL EITHER BE DELIVERED OR MAILED TO THE BOARD AT THE ABOVE ADDRESS. COPIES OF THE REQUEST SHOULD ALSO BE MAILED TO ALL OTHER PARTIES TO THIS PROCEEDING.
FAILURE TO DELIVER OR MAIL THE REQUEST FOR REVIEW TO THE BOARD WITHIN THE TIME ALLOWED WILL RESULT IN THE LOSS OF YOUR RIGHT TO APPEAL THIS OWN MOTION ORDER AND THE BOARD WILL BE UNABLE TO REVIEW THE ADMINISTRATIVE LAW JUDGE'S DECISION, WHICH SHALL, AS A MATTER OF LAW, CONSTITUTE A FINAL OWN MOTION ORDER OF THE BOARD.
(3) If a request for review of an Administrative Law Judge's "Proposed and Final Own Motion Order" is not filed with the Board within 30 days of the mailing of the order, the order shall, as a matter of law, constitute a Final Own Motion Order of the Board.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.267(1)(3), ORS 656.278(1)(b) & ORS 656.726(5)
Hist.: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0095
Board Review of Administrative Law Judge's Proposed and Final Own Motion Order
(1) Within a reasonable time after receiving a timely-filed request for review of an Administrative Law Judge's "Proposed and Final Own Motion Order," the Board will, by mail, acknowledge the request(s) for review, provide copies of the hearing transcript to the parties or their attorneys, and announce a briefing schedule.
(2) The briefing schedule will provide that the requesting party's appellant's brief will be due within 21 days from the date of the Board's letter. The respondent's/cross-appellant's brief will be due within 21 days from the date of mailing of the appellant's brief. The appellant's / cross-respondent's brief will be due within 14 days from the date of mailing of the respondent's/cross-appellant's brief. The cross-appellant's reply brief will be due within 14 days from the date of mailing of the cross-respondent's brief. Unless otherwise authorized by the Board, no other briefs will be considered. Extensions to the briefing schedule may be granted by the Board in the manner described in OAR 438-011-0020(3). The Board may waive its briefing schedule rules on a finding that extraordinary circumstances justify such an action.
(3) Review by the Board of the Administrative Law Judge's "Proposed and Final Own Motion Order" is de novo based on the entire record developed at the Hearings Division. If the record is improperly, incompletely, or otherwise insufficiently developed, the Board may:
(a) Admit additional documentary evidence into the record; or
(b) Remand the case to the Administrative Law Judge to take additional evidence and issue a "Proposed and Final Own Motion Order on Remand."
(4) Within 30 days after completing its review of the record, the Board shall issue its order deciding the issues arising from the request for Board review.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.267(1), (3), ORS 656.278(1)(b) & ORS 656.726(5)
Hist.: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0100
Board Review of Request for Review of Notice of Incomplete Claim
(1) Within a reasonable time after receiving a request for review of an Own Motion insurer's Notice of Incomplete Claim under OAR 438-012-0085, the Board will, by mail, acknowledge the request.
(2) Within 14 days after notification from the Board that a review has been requested, the Own Motion insurer shall submit to the Board and to the claimant or the claimant's attorney, if any, legible copies of all evidence which pertains to the claimant's compensable condition at the time of the insurer's Notice of Incomplete Claim. The insurer's submission may also include its written position regarding the request for review, with copies to the claimant or the claimant's attorney, if any.
(3) The claimant or the claimant's attorney may submit additional evidence and written argument to the Board, with copies to the Own Motion insurer or its attorney, if any. To be considered, such evidence and argument must be submitted within 21 days from the date the Own Motion insurer mails the evidence and its written position to the Board pursuant to section (2).
(4) The Board may refer a matter to the Hearings Division for an evidentiary hearing and recommended findings of fact and conclusions.
(5) Within 30 days after completing its review of the record, t[T]he Board shall issue its order [within a reasonable time after receipt of all evidence and argument from the parties and any recommendations from the Hearings Division] deciding the issues arising from the request for Board review.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.267(1), (3), ORS 656.278(1)(b) & ORS 656.726(5)
Hist.: WCB 2-2003, f. 7-10-03, cert. ef. 9-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-012-0110
Penalty for Unreasonable Failure to Comply or Untimely Compliance with Board Own Motion Rules
(1) Failure to comply with the Board’s Own Motion rules by the insurer, if found unreasonable or unjustified, may result in the imposition of penalties and attorney fees pursuant to ORS 656.262(11) and OAR 438-015-0110, exclusion of evidence, and/or referral for a fact-finding hearing.
(2) Failure to comply with the Board’s Own Motion rules by the claimant, if found unreasonable or unjustified, may result in the exclusion of evidence, referral for a fact-finding hearing, and/or dismissal of the request for benefits.

Stat. Auth.: ORS 656.726(5)
Stats. Implemented.: ORS 656.262(11), ORS 656.278, ORS 656.726(5)
Hist.: WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

EXHIBIT G

438-015-0011
Attorney Retainer Agreement
(1) Except as provided in subsection (2), every executed attorney retainer agreement filed with the Administrative Law Judge or Board shall be in English.
(2) Any English language attorney retainer agreement filed with the Administrative Law Judge or Board may be accompanied by a translation into a foreign language that is certified by the translator to be an accurate and true translation of the English writing. Either the English or the foreign language writing must be signed.

Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 1.150, ORS 656.726(5)
Hist.: WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

EXHIBIT H

DIVISION 022

RULEMAKING PROCEDURES

438-022-0005
Adoption of Attorney General's Model Rules[; Notice of Rulemaking]
To the extent that the following rules are applicable to the Workers' Compensation Law (Chapter 656), the Board hereby adopts by reference OAR 137-001-0005 through [137-001-0085] 137-001-0080 (Attorney General's Model Rules [of Procedure] for Rulemaking), as adopted by the Department of Justice effective [January 1, 2000] December 9, 2003.
Stat. Auth.: ORS 656.726(5) & ORS 654.025(2)
Stats. Implemented: ORS 183.341(4)
Hist.: WCB 1-2003, f. 2-21-03, cert. ef. 5-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04

438-022-0010
Notice of Rulemaking
(1) Prior to adoption, amendment or repeal of any administrative rule, other than a temporary rule adopted under ORS 183.3[5]35(5), the Board shall give notice of the intended action:
(a) In the Secretary of State's Bulletin referred to in ORS 183.360 at least 21 days before the effective date of the intended action;
(b) By mailing a copy of the notice to persons on the Board's mailing list established pursuant to ORS 183.335([7]8) at least 28 days before the effective date of the intended action; [and]
(c) By mailing a copy of the notice to the legislators specified in ORS 183.335(15) at least
49 days before the effective date of the intended action; and

[(c)] (d) By mailing or furnishing a copy of the notice to:
(A) The Oregonian;
(B) The Associated Press; and
(C) The Capitol Press Room.
(2) The Board shall give notice of any administrative rulemaking hearing:
(a) In the Secretary of State's Bulletin referred to in ORS 183.360 at least 14 days before the hearing; and
(b) By mailing notice of the hearing to any person requesting the hearing and to the persons on the Board's mailing list established pursuant to ORS 183.335([7]8) at least 21 days before the hearing.
Stat. Auth.: ORS 656.726(5) & ORS 654.025(2)
Stats. Implemented: ORS 183.341(4)
Hist.: WCB 1-2003, f. 2-21-03, cert. ef. 5-1-03; WCB 1-2004, f. 6-29-04, cert. ef. 9-1-04