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    Shelly Cochran   
503-947-7623   

Bulletins


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Signed copies of bulletins are on file at the Oregon Workers' Compensation Division. To get a signed copy, contact Publications at 503-947-7627.
How to order rules, bulletins, and the law book
 
 

Search Bulletins
Bulletin General Subject Form Number
8

Extraterritorial coverage information

Extraterritorial agreement with North Dakota

Extraterritorial agreement with Washington

 
101

Word: 101

Forms required for processing initial claims of occupational injury or disease -- Effective 1/1/10

Form 1138, "What happens if I'm hurt on the job?" (English version)

Form 1138r, "What happens if I'm hurt on the job?" (Russian version)

Form 1138s, "What happens if I'm hurt on the job?" (Spanish version)

Relates to OAR 436-060 effective 4/1/11
801 | 3283 | 3283s | 3283r | 3283v |

Word or Excel:
801 | 3283 | 3283s | 3283r | 3283v |
102

Word: 102

Reimbursement from the Retroactive Program -- Revised 9/06

Example of Form 3285

Form 3285 Worksheet

Relates to OAR 436-075 effective 1/1/10
3285 |

Word or Excel:
3285 |
111

Word: 111

Computation of temporary disability, permanent disability, and fatal benefits based on Oregon's average weekly wage -- Revised 6/14

No related rule
   
112

Word: 112

Reimbursement of injured workers' travel, food, and lodging costs

Relates to OAR 436-009 effective 1/1/15
Relates to OAR 436-009 effective 7/1/14
3921 | 3921s |

Word or Excel:
3921 | 3921s |
124

Word: 124

Required forms and procedures under rules governing vocational assistance to injured workers -- Revised 10/10/12; Addendum to Bulletin 124 -- Revised 5/28/14

Addendum to Bulletin 124

Time Frames to Determine Eligibility and Develop Return-to-Work Plans chart - Rev. 12/07

Relates to OAR 436-120 effective 1/1/14
1081 | 1083 | 2800 |

Word or Excel:
1081 | 1083 | 2800 |
139

Word: 139

Claim closure -- Effective 1/1/10

Body part codes chart (Dates of injury on or after Jan. 1, 2005)

Body part codes chart (Dates of injury prior to Jan. 1, 2005)

Combining impairment values (chart)

Conversions from percent to degrees of disability (chart)

Permanent disability combining calculator (Excel)

PPD Benefits (chart)

Time frames for appeal of claim closures (chart)

Relates to OAR 436-030 effective 1/1/12
Relates to OAR 436-035 effective 1/1/13
1503 | 1644 | 1644c | 1644p | 1644r | 1644s | 2807 | 2807a |

Word or Excel:
1503 | 1644 | 1644c | 1644p | 1644r | 1644s | 2807 | 2807a |
144

Word: 144

Premium assessments -- Revised 5/11

Relates to OAR 436-085 effective 7/1/11
910 |

Word or Excel:
910 |
147

Word: 147

Self-insured surety deposits -- 1/10

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
824 | 1810 | 3529 | 3640a | 3640b |

Word or Excel:
824 | 1810 | 3529 | 3640a | 3640b |
151

Word: 151

List of registered vocational rehabilitation providers

Relates to OAR 436-120 effective 1/1/14
   
162

Word: 162

Oregon workers' compensation proof of coverage (Guaranty Contract) -- Revised 5/09

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
Relates to OAR 436-162 effective 1/1/11
Relates to OAR 436-162 effective 4/1/15
821 | 3215 | 3216 | 3217 |

Word or Excel:
821 | 3215 | 3216 | 3217 |
170

Word: 170

Lump sum payment of permanent partial disability awards -- Revised 12/07

Relates to OAR 436-060 effective 4/1/11
1174 |

Word or Excel:
1174 |
189

Word: 189

Preferred Worker Program -- Revised 2/21/12

Relates to OAR 436-110 effective 6/7/13
2190 | 2190s | 2350 | 2350s | 2968 | 3014 | 3014-extra page | 3293 | 4122 | 4875 | 4903 |

Word or Excel:
2190 | 2190s | 2350 | 2350s | 2968 | 3014 | 3014-extra page | 3293 | 4122 | 4875 | 4903 |
195

Word: 195

Reopening of "Own Motion" claims under ORS 656.278, closure of Own Motion claims, and reimbursement from the Reopened Claims Program -- Effective 1/1/06

Relates to OAR 436-045 effective 7/1/08
1966 | 2066 | 3501 |

Word or Excel:
1966 | 2066 | 3501 |
209

Word: 209

Report of losses instructions and reserving guidelines - Effective 1/1/15

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
2808 | 2809 | 2810 | 2937 |

Word or Excel:
2808 | 2809 | 2810 | 2937 |
227

Word: 227

Request for reconsideration forms -- Revised 1/12

Relates to OAR 436-030 effective 1/1/12
2223a | 2223b | 2223a-s |

Word or Excel:
2223a | 2223b | 2223a-s |
232

Word: 232

Notice of claim acceptance pursuant to ORS 656.262(6) -- Revised 10/24/11

Relates to OAR 436-030 effective 1/1/12
Relates to OAR 436-060 effective 4/1/11
3058 | 3058s |

Word or Excel:
3058 | 3058s |
237

Word: 237

Insurer's report -- Revised 1/10

Relates to OAR 436-060 effective 4/1/11
1502 |

Word or Excel:
1502 |
239

Word: 239

Claim closing and other impairment-focused examinations and forms for reporting impairments - Effective 6/1/10

Relates to OAR 436-035 effective 1/1/13
2278c | 2278L | 2278T | 2279 | 2312 | 4841 | 4842 |

Word or Excel:
2278c | 2278L | 2278T | 2279 | 2312 | 4841 | 4842 |
247

Word: 247

MCO quarterly reports -- Revised 9/09

Relates to OAR 436-015 effective 1/1/14
   
248

Word: 248

MCO geographical service areas -- Revised 1/07

Relates to OAR 436-015 effective 1/1/14
   
251

Word: 251

Form and format for worker's request for director approval to change attending physician or authorized nurse practitioner -- Revised 12/13

Relates to OAR 436-010 effective 4/1/14
2332 |

Word or Excel:
2332 |
252

Word: 252

Additional independent medical exam request -- Revised 8/07

Relates to OAR 436-010 effective 4/1/14
2333 |

Word or Excel:
2333 |
260

Word: 260

Employer-at-Injury Program Reimbursement Request Form -- Revised 6/10/13

Relates to OAR 436-105 effective 7/1/13
2360 |

Word or Excel:
2360 |
271

Word: 271

Application for Oregon worker leasing license -- Revised 1/7/13

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
2466 | 2466a | 2466b | 2466c |

Word or Excel:
2466 | 2466a | 2466b | 2466c |
273

Word: 273

Workers' compensation insurance coverage and reporting requirements for worker leasing companies -- Revised 9/7/12

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
2465 | 3270 | 3271 |

Word or Excel:
2465 | 3270 | 3271 |
281

Word: 281

Form 440-2476, "Request for release of medical records for Oregon Workers' compensation claim" -- Revised 3/12

Relates to OAR 436-010 effective 4/1/14
Relates to OAR 436-060 effective 4/1/11
2476 | 2476s |

Word or Excel:
2476 | 2476s |
285

Word: 285

Workers' Compensation Division Request for Hearing, Form 440-2839 -- Revised 11/21/12

Request for hearing - online

Relates to OAR 436-001 effective 3/28/14
2839 |

Word or Excel:
2839 |
290

Word: 290

Hospital fee schedule - adjusted cost-to-charge ratios for Oregon hospitals -- Revised 9/14

Relates to OAR 436-009 effective 1/1/15
Relates to OAR 436-009 effective 7/1/14
   
292

Word: 292

Workers' compensation medical reporting forms -- Revised 7/17/14

Relates to OAR 436-010 effective 4/1/14
827 | 3245 |

Word or Excel:
827 | 3245 |
293

Word: 293

Form and format for request for administrative review of medical disputes -- Revised 3/14

Relates to OAR 436-009 effective 1/1/15
Relates to OAR 436-009 effective 7/1/14
Relates to OAR 436-010 effective 4/1/14
2842 | 2842a |

Word or Excel:
2842 | 2842a |
294

Word: 294

Overpayment recoveries on reimbursable claims -- Issued 8/96

No related rule
   
307

Word: 307

Spanish translation, Form 440-827S

Relates to OAR 436-010 effective 4/1/14
827s |

Word or Excel:
827s |
308

Word: 308

Invasive medical procedures during an independent medical examination (IME) -- Effective 1/1/06

Relates to OAR 436-010 effective 4/1/14
3227 |

Word or Excel:
3227 |
309

Word: 309

Elective surgery notification form -- Revised 11/12

Relates to OAR 436-010 effective 4/1/14
3228 |

Word or Excel:
3228 |
310

Word: 310

Spanish language Forms 440-801S (801S), "Reporte de Lesión o Enfermedad en el Trabajo" ("Report of Job Injury or Illness") and 440-3283S (3283S) "Una guia para trabajadores lesionados recientemente en el trabajo" ("A Guide for Workers Recently Hurt on the Job") -- Revised 2/10

Form 1138s, "What happens if I'm hurt on the job?" (Spanish version)

Relates to OAR 436-060 effective 4/1/11
801s | 3283s |

Word or Excel:
801s | 3283s |
315

Word: 315

Spanish translations available for correspondence with injured workers -- Revised 12/10

Spanish translation of selected text from Oregon Administrative Rules, Chapter 436

Relates to OAR 436-060 effective 4/1/11
   
316

Word: 316

Claims processing administrative cost factor -- Effective 1/1/15

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
Relates to OAR 436-060 effective 4/1/11
Relates to OAR 436-110 effective 6/7/13
   
325

Word: 325

Supplemental disability payment and reimbursement -- Revised 11/09

Calculation sample

Relates to OAR 436-060 effective 4/1/11
3504 | 3530 | 3531 |

Word or Excel:
3504 | 3530 | 3531 |
329

Word: 329

Retention of claims records by insurers and self-insured employers -- Issued 3/24/03

Bulletin 211, "Change in Retention of Workers' Compensation Division Claim Records, Effective July 2, 1990"

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
   
337

Word: 337

Provides form to request review of an insurer's classification of a claim as nondisabling -- Effective 2/14/08

Relates to OAR 436-060 effective 4/1/11
2943 | 2943s |

Word or Excel:
2943 | 2943s |
342

Word: 342

Determination of "gainful occupation" for permanent total disability (PTD) evaluations -- Revised 2/14

Relates to OAR 436-030 effective 1/1/12
   
345

Word: 345

Employer-paid medical reimbursement claims costs - Effective 1/1/15

Relates to OAR 436-060 effective 4/1/11
   
352

Word: 352

Fee Discount Agreement form and reporting - Effective 1/1/09

Relates to OAR 436-009 effective 1/1/15
Relates to OAR 436-009 effective 7/1/14
3659 |

Word or Excel:
3659 |
356

Word: 356

Attorney fees -- Effective 7/1/14

Relates to OAR 436-001 effective 3/28/14
   
359

Word: 359

Insurers and self-insured employers required to report medical bill payment data -- Revised 3/14

Relates to OAR 436-160 effective 10/1/14
   
361

Word: 361

Clinical justification for certain drugs -- Revised 4/3/14

Relates to OAR 436-009 effective 1/1/15
Relates to OAR 436-009 effective 7/1/14
4909 |

Word or Excel:
4909 |
367

Word: 367

2015 premium assessment rate - Effective 1/1/15

No related rule
   
368

Word: 368

Self-insured base rates and election of method used for determination of premium - Effective 7/1/13 - 6/30/14

Amended Exhibit B - Self-insured base rates and hazard groups for fiscal year 7/1/13 - 6/30/14

Example of completed Form 900

Example of completed Form 937

Exhibit A - Retrospective rating methods

Plan comparison worksheet (Excel)

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
Relates to OAR 436-085 effective 7/1/11
900 | 937 |

Word or Excel:
900 | 937 |
369

Word: 369

Retroactive Program benefits effective 10/1/13

Relates to OAR 436-075 effective 1/1/10
   
370

Word: 370

Self-insured base rates and election of method used for determination of premium - Effective 7/1/14 - 6/30/15

Example of completed form 900

Example of completed form 937

Exhibit A - Retrospective rating methods (Excel)

Exhibit B - Self-insured base rates for fiscal year 7/1/14 - 6/30/15

Plan comparison worksheet (Excel)

Relates to OAR 436-050 effective 1/1/15
Relates to OAR 436-050 effective 9/15/14
Relates to OAR 436-085 effective 7/1/11
900 | 937 |

Word or Excel:
900 | 937 |
371

Word: 371

Retroactive Program benefits effective 10/1/14

Relates to OAR 436-075 effective 1/1/10
   




If you have questions about this webpage, please contact Shelly Cochran, 503-947-7623.