1. (1) An insurer, self-insured employer, service company, or managed care organization (MCO) that sends a document to a worker that is required by OAR chapter 436 must simultaneously send Form 5377, “Workers’ Compensation Multilingual Help Page,” if the document includes:

   1. (a) Appeal rights;
   2. (b) A deadline for action required to obtain or preserve a right or benefit, including dates of required medical examinations or vocational evaluations; or
   3. (c) Notice of action required to prevent or reverse a suspension or reduction of benefits.
2. (2) Form 5377 is published under Bulletin 379.
3. (3) Bulletin 379 lists the notices described by subsections (1)(a) through (c).
4. (4) Failure to send Form 5377 with a document as required by this rule does not affect the validity of the document, but may subject the insurer, self-insured employer, service company, or MCO to civil penalties under ORS 656.745.
5. (5) Form 5377 must be sent as provided by section (1) of this rule for documents sent to a worker on or after June 1, 2019.

Statutory/Other Authority

ORS 656.726(4) & 656.260

Statutes/Other Implemented

ORS 656.726(4) & 656.260

History

WCD 1-2019, adopt filed 03/11/2019, effective 04/01/2019