Current through Register Vol. 63, No. 3, March 1, 2024
(1)
Records
insurers must maintain. Each insurer is required to maintain the
following records of Oregon workers' compensation claims, to make the records
available at an Oregon claims processing location, and to provide the director
access to the records upon request:
(a)
Written records used and relied upon in processing each claim;
(b) A written record of all payments made as
a result of any claim including documentation of:
(A) The amount of the payment;
(B) The date the payment was
issued;
(C) The date the payment
was mailed or delivered; and
(D) An
explanation of the time period between the date the payment was issued and the
date the payment was mailed or delivered, if any;
(c) Written records of the approval or denial
of claims for supplemental temporary disability benefits under ORS
656.210(5);
(d) Written records that show its insured
employers have complied with ORS
656.017;
and
(e) Written records, or copies
of records, of claims processed by prior service companies.
(2)
Availability of records. An
insurer must make records available by one or more of the following methods:
(a) By making the records electronically
accessible from an Oregon claims processing location in real time.
(b) By keeping physical copies of the records
at an Oregon claims processing location; or
(c) By archiving physical copies of the
records at a location other than an Oregon claims processing location, under
the following conditions:
(A) Records of a
denied claim may be archived after all appellate procedures have been exhausted
and the denial is final by operation of law; and
(B) Records of any claim for a compensable
injury, including a denied claim that is found to be compensable, may be
archived after the expiration of the aggravation rights or not less than one
year following the final payment of compensation, whichever is the last to
occur.
(3)
Destruction of claims records. The insurer may destroy claims
records when the insurer can verify that all potential for benefits to the
worker or the worker's beneficiaries is gone.
(4)
Proof of coverage records insurer
must keep in Oregon. The records relating to proof of coverage that
insurers are required to make available in Oregon include:
(a) A written record of each workers'
compensation insurance policy and related endorsements, reinstatements, or
cancellations issued as required under the workers' compensation law;
(b) Written records of premiums due and
premiums collected by the insurer from its insured employers as a result of
coverage issued under the workers' compensation law; and
(c) Written records that segregate and show
specifically for each employer the amounts due from the employer and all money
collected and paid by the insurer for premiums for insurance coverage, premium
assessments, and any other moneys due the director or required to be paid to
the director.
(5)
Disposal of proof of coverage records. If all payments have been
made, proof of coverage records may be disposed of after the later of:
(a) The next examination of the insurer by
the Division of Financial Regulation under ORS
731.300;
or
(b) January 1 of the year
following three calendar years after the cancellation or nonrenewal of the
workers' compensation insurance policy.
Statutory/Other Authority: ORS
731.475
& ORS
656.726(4)
Statutes/Other Implemented: ORS
731.475
