Text Size:   A+ A- A   •   Text Only

    Mary Schwabe   
503-947-7651   


Compliance Section

 

Overview

The Compliance Section is one of five sections within Workers' Compensation Division: Policy & Communications, Compliance, Medical, Benefit Services, and Operations. The section is comprised of four units and one team.


Benefits & Certifications Unit responds to inquiries from injured workers, insurers, employers, medical providers, and attorneys in an effort to resolve misunderstandings and differences which could otherwise result in sanctions or litigation, and provides information to parties about their rights and responsibilities. Reviews and authorizes reimbursements to insurers and self-insured employers from the Workers' Benefit fund. Coordinates claim payments to insured workers from the Self-Insured Employer Adjustment Reserve or security deposits of self-insured employers who are insolvent. Coordinates and ensures continued claim payments to injured workers when a workers' compensation insurance company is bankrupt until the accounts can be transferred to the Oregon Insurance Guarantee Association. Certifies employers to become self-insured for workers' compensation purposes. Monitors certified self-insured employers to ensure appropriate levels and types of security are maintained and that excess insurance policies are in place.

Contested Cases Team represents the division at administrative hearings before the Workers' Compensation Board, negotiates settlements between the division and interested parties, and advises internal staff on issues being contested.

Employer Compliance Unit provides initial employer indexing information, investigates reports of employers not carrying workers' compensation insurance on their employees, assesses sanctions against non-complying employers, initiates proceedings to permanently enjoin a non-complying employer from employing without workers' compensation insurance, assesses sanctions against insurers when coverage filings are not timely, and provides education on Oregon workers' compensation coverage requirements. Certifies and monitors worker leasing companies.

Field Audit Unit determines if compensation benefits are paid and claim reports are submitted timely and accurately, assesses penalties, validates that expenditures from the Workers' Benefit Fund meet eligibility requirements, determines if self-insurers are maintaining adequate security deposits to meet liabilities, and determines self-insurer loss experience and accurate payments of assessments.

Investigations & Sanctions Unit sanctions insurers or self-insured employers who unreasonably delay or refuse to pay compensation to workers, or unreasonably delay acceptance or denial of a claim. Ensures the worker's cooperation with insurer investigation, medical examinations or medical requirements essential to their recovery. Ensures compliance with medical reporting requirements by medical providers. Ensures compliance with claim processing requirements and coverage reporting requirements. Conducts investigation of system abuse in response to complaints of rule and statute violations. If indicated during the investigation process, the unit will arrange onsite audits of health care providers, employers, vocational rehabilitation counselors and others.


For more information contact:
     Compliance Section: 503-947-7652
     FAX: 503-947-7725

 
 
 

If you have questions about this webpage, please contact Mary Schwabe, 503-947-7651.