EXPEDITED CLAIMS SERVICE
Expedited Claims Service Established
Pursuant to the mandate of 1987 Oregon Laws, Chapter 884, Section 18, there is established within the Hearings Division the Expedited Claims Service. The purpose of the Expedited Claims Service is to provide for prompt, informal dispute resolution and to insure fair and just treatment of workers in all proceedings.
Referral of Request for Hearing to Expedited Claim Service
(1) A request for hearing shall be referred to the Expedited Claims Service if:
(a) The request does not involve the compensability of or responsibility for a claim, and the total amount in controversy, exclusive of penalties and/or related attorney fees, is $1,000 or less;
(b) The only issue in the case is entitlement to penalties and/or related attorney fees; or
(c) The request is for an expedited hearing to appeal a denial under ORS 656.262(15) for a worker's failure to cooperate in a claim investigation.
(2) If an Administrative Law Judge finds at the hearing or at any time prior to the hearing that the case should not have been referred to the Expedited Claims Service, the Administrative Law Judge shall refer the case for decision under the ordinary hearing process. With the consent of the Administrative Law Judge, the parties may agree on the oral record to proceed with the hearing as referred to the ordinary hearing process without further delay. Such an agreement to proceed is a waiver of any claim of defect as to notice of hearing or issues.
Stat. Auth.: ORS 656.726(5)
Stats. Implemented: ORS 656.291(2)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 2-1989, f. 3-3-89, ef. 4-1-89; WCB 2-1995, f. 11-13-95, cert. ef. 1-1-96; WCB 3-2001, f. 11-14-01, cert. ef. 1-1-02
Determination of Amount in Controversy
For the purpose of referral to the Expedited Claims Service, the total amount in controversy shall be presumed to be $1,000 or less if the party requesting the hearing so states on a form prescribed by the Board or in the request for hearing.
Representation of Parties in Expedited Claims
(1) A claimant need not be represented by any other person in proceedings before the Expedited Claims Service.
(2) A claimant may be represented by an attorney or by an individual who is not an attorney in proceedings before the Expedited Claims Service.
(3) Notwithstanding OAR 438-006-0100, an insurer, self-insured employer or claim processing agent for an insurer or self-insured employer may be represented by an authorized claims representative at any proceeding under the Expedited Claims Service.
Notice of Hearing Date
The Hearings Division shall mail a notice of hearing date to all parties and to all other individuals who represent the parties. The hearing shall be scheduled for a date that is not less than 15 days from the mailing of the notice of hearing nor more than 30 days from the date of receipt of the request for hearing by the Hearings Division .
Hearings in Expedited Claims; Informal Dispute Resolution
(1) OAR 438-007-0018 does not apply to the Expedited Claim Service. The insurer's representative shall bring all medical and vocational reports, records of compensation paid, and all other documents pertaining to the claim to the hearing. The Administrative Law Judge shall, before convening the hearing, determine whether the case may be resolved informally or decided on agreed facts.
(2) If the case can be decided on agreed facts, the agreement of the facts shall be stated on the oral record. No testimony shall be taken and the record shall be closed upon oral argument, if any, on behalf of the parties.
(3) If the case cannot be decided on agreed facts, the Administrative Law Judge shall so state on the oral record of the hearing or in the order. The Administrative Law Judge shall admit into evidence those documents furnished by the insurer that are relevant to a determination of the dispute, along with any other relevant documents offered by the claimant.
(4) It is the intent of the Board in adopting these rules that all cases under the Expedited Claim Service be heard and decided quickly and fairly. Administrative Law Judges shall take an active role in the hearing.
(5) Unless more time is allowed in advance after a showing of good cause, no hearing under the expedited Claims Service shall be scheduled to exceed one hour in duration.
Stat. Auth.: ORS 656.307, ORS 656.388, ORS 656.593 & ORS 656.726(4)
Stats. Implemented: ORS 656.291(4)(6)
Hist.: WCB 5-1987, f. 12-18-87, ef. 1-1-88; WCB 3-1990(Temp), f. & cert. ef. 3-1-90; WCB 11-1990, f. 12-13-90, cert. ef 12-31-90
Postponements and Continuances
(1) A hearing under the Expedited Claims Service shall not be postponed except upon a showing of extraordinary circumstances beyond the control of the party requesting the postponement. "Extraordinary circumstances" shall be as defined in OAR 438-006-0081 except that unavailability of an individual who represents an insurer shall not be a reason to postpone a hearing under any circumstances and unavailability of an individual who represents a claimant shall not be a reason to postpone a hearing under the Expedited Claims Service unless the Administrative Law Judge finds that the claimant is physically or mentally incapable of representing himself or herself at the hearing.
(2) A hearing under the Expedited Claims Service may be continued for further proceedings only if the Administrative Law Judge finds and states on the oral record that a continuance is required to achieve substantial justice.
Order of Administrative Law Judge; Review
(1) The Administrative Law Judge shall issue an order deciding the case not later than ten days after the closing of the record. The order may adopt by reference findings and conclusions stated on the oral record.
(2) The Administrative Law Judge's order shall include a notice of rights of review by the Workers' Compensation Board under the provisions of ORS 656.295.
Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • firstname.lastname@example.org
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