Oregon WCD Issues Revised Temporary Rule on Claims for COVID-19 or Exposure to COVID-19
The Workers’ Compensation Division has issued OAR 436-060-0141, a temporary rule addressing claims for COVID-19 and claims for exposure to COVID-19. The rule will remain in effect for 180 days while the Department works on a permanent rule.
The rule covers claims for COVID-19 as well as presumptive cases where a worker has not tested positive but has certain symptoms with no more likely alternative explanation and where the worker has been in close contact with a confirmed case of COVID-19.
The rule requires insurers to conduct a “reasonable investigation” before denying any claim for COVID-19 or exposure to COVID-19. For claims filed after October 1, 2020, the rule provides extra steps the insurer must follow prior to denying a claim. The insurer must investigate whether or not the nature of the workers’ employment resulted in likely exposure to COVID-19; determine whether the worker did not work for a period of quarantine or isolation at the direction of a medical service provider, the Oregon Health Authority Public Health division, or the employer; obtain a medical or other expert opinion if, before the compensability denial is issued the worker tests positive for COVID-19 or a medical service provider diagnosis a presumptive case of COVID-19, the insurer is aware of the test results or presumptive diagnosis, and the source of the exposure is unclear; and determine whether medical services were required as a result of potential workplace exposure to COVID-19 even if the worker ultimately did not test positive for COVID-19.
Additionally, the rule requires that if an insurer has reported to the director, five or more claims for COVID-19 or exposure to COVID-19, regardless of whether those claims have been accepted or denied, the director will audit the insurer’s files for all denied claims for COVID-19 or exposure to COVID-19, where the denial has become final by operation of law by the date of audit. Failure to comply with the new rule or with decisions by the director may result civil penalties under ORS 656.745(2).
If you would like to know more about the new temporary rule on COVID-19 and other recent updates in the law, please register here for our Oregon Virtual Workshop, set to happen on November 6, 2020. We have an excellent lineup of speakers and topics, you will not want to miss! You can also contact me at or 503-595-6108.
