656.054 Claim
of injured worker of noncomplying employer; procedure for disputing acceptance
of claim; recovery of costs from noncomplying employer; restrictions. (1) A compensable injury to a
subject worker while in the employ of a noncomplying employer is compensable to
the same extent as if the employer had complied with this chapter. The Director
of the Department of Consumer and Business Services shall refer the claim for
such an injury to an assigned claims agent within 60 days of the date the
director has notice of the claim. At the time of referral of the claim, the
director shall notify the employer in writing regarding the referral of the
claim and the employer’s right to object to the claim. A claim for compensation
made by such a worker shall be processed by the assigned claims agent in the
same manner as a claim made by a worker employed by a carrier-insured employer,
except that the time within which the first installment of compensation is to
be paid, pursuant to ORS 656.262 (4), shall not begin to run until the director
has referred the claim to the assigned claims agent. At any time within which
the claim may be accepted or denied as provided in ORS 656.262, the employer
may request a hearing to object to the claim. If an order becomes final holding
the claim to be compensable, the employer is liable for all costs imposed by
this chapter, including reasonable attorney fees to be paid to the worker’s
attorney for services rendered in connection with the employer’s objection to
the claim.
(2) In addition
to, and not in lieu of, any civil penalties assessed pursuant to ORS 656.735,
all costs to the Workers’ Benefit Fund incurred under subsection (1) of this
section shall be a liability of the noncomplying employer. Such costs include
compensation, disputed claim settlements pursuant to ORS 656.289 and claim
disposition agreements pursuant to ORS 656.236, whether or not the noncomplying
employer agrees and executes such documents, reasonable administrative costs
and claims processing costs provided by contract, attorney fees related to
compensability issues and any attorney fees awarded to the claimant, but do not
include assessments for reserves in the Workers’ Benefit Fund. The director
shall recover such costs from the employer. The director periodically shall pay
the assigned claims agent from the Workers’ Benefit Fund for any costs the
assigned claims agent incurs under this section in accordance with the terms of
the contract. When the director prevails in any action brought pursuant to this
subsection, the director is entitled to recover from the noncomplying employer
court costs and attorney fees incurred by the director.
(3) Periodically,
or upon the request of a noncomplying employer in a particular claim, the
director shall audit the files of the State Accident Insurance Fund Corporation
and any assigned claims agents to validate the amount reimbursed pursuant to
subsection (2) of this section. The conditions for granting or denying of
reimbursement shall be specified in the contract with the assigned claims
agent. The contract at least shall provide for denial of reimbursement if, upon
such audit, any of the following are found to apply:
(a) Compensation
has been paid as a result of untimely, inaccurate, or improper claims
processing;
(b) Compensation
has been paid negligently for treatment of any condition unrelated to the
compensable condition;
(c) The
compensability of an accepted claim is questionable and the rationale for
acceptance has not been reasonably documented in accordance with generally
accepted claims management procedures;
(d) The separate
payments of compensation have not been documented in accordance with generally
accepted accounting procedures; or
(e) The payments
were made pursuant to a disposition agreement as provided by ORS 656.236
without the prior approval of the director.
(4) The State
Accident Insurance Fund Corporation and any assigned claims agent may request
review under ORS 656.704 of any disapproval of reimbursement made by the
director under this section.
(5) Claims of
injured workers of noncomplying employers may be assigned and reassigned by the
director for claims processing regardless of the date of the worker’s injury.
(6) In selecting
an assigned claims agent, the director must consider the assigned claims agent’s
ability to deliver timely and appropriate benefits to injured workers, the
ability to control both claims cost and administrative cost and such other
factors as the director considers appropriate.
(7) If no
qualified entity agrees to be an assigned claims agent, the director may
require one or more of the three highest premium producing insurers to be
assigned claims agents. Notwithstanding any other provision of law, the
director’s selection of assigned claims agents shall be made at the sole
discretion of the director. Such selections shall not be subject to review by
any court or other administrative body.
(8) Any assigned
claims agent, except the State Accident Insurance Fund Corporation, may employ
legal counsel of its choice for representation under this section.
(9) As used in
this section, “assigned claims agent” means an insurer, casualty adjuster or a
third party administrator with whom the director contracts to manage claims of
injured workers of noncomplying employers. [Amended by 1959 c.448 §9; 1965
c.285 §15; 1967 c.341 §5; 1971 c.72 §1; 1973 c.447 §2; 1979 c.839 §2; 1981
c.854 §8; 1983 c.816 §2; 1987 c.234 §2; 1987 c.250 §3; 1991 c.679 §1; 1995
c.332 §7; 1995 c.641 §17; 1999 c.1020 §1; 2003 c.14 §399; 2003 c.170 §1; 2005
c.26 §1]
Notes of Decisions
Vasquez v. Double Press Mfg., Inc., 437 P.3d 1107 (Or. 2019).
· cites it 2× “018 (1985) ; (2) a claim for workers' compensation benefits from the State Accident Insurance Fund Corporation (SAIF), which could then seek reimbursement from a noncomplying employer, ORS 656.054 (1985) ; (3) an action against a noncomplying employer for damages, ORS 656.”
Green v. Beaman (In Re Beaman), 9 B.R. 539 (Bankr. D. Or. 1980).
· cites it 4× “I find that the obligation of an employer to reimburse the Director of the Workers Compensation Department for payments made by the State Accident Insurance Fund Corporation under ORS 656.”
Dep't of Consum. & Bus. Servs. v. Zurich Am., 268 P.3d 671 (Or. Ct. App. 2011).
· cites it 17× “850 for providing workers’ compensation insurance for claimant even though claimant was not leased to On-Time by NW Staffing, and, consequently, Zurich, as NW Staffing’s insurer, is responsible for paying the compensation due claimant on her claim; and (5) Zurich’s…”
Astleford v. SAIF Corp., 874 P.2d 1329 (Or. 1994).
· cites it 3× “Pursuant to ORS 656.054(1), DIF referred the claim to the State Accident Insurance Fund Corporation (SAIF), which accepted it and notified Employer of its right to request a hearing.”
Astleford v. Saif Corp., 858 P.2d 877 (Or. Ct. App. 1993).
· cites it 11× “TCCA and SAIF nonetheless argue that they can settle without employer’s consent pursuant to ORS 656.054, which provides, in part: “(1) A compensable injury to a subject worker while in the employ of a noncomplying employer is compensable to the same extent as if the employer had…”
Volk v. Am. West Airlines, 899 P.2d 746 (Or. Ct. App. 1995).
““(3) Sections 8 and 9 of this Act and the amendments to ORS 656.054, 656.232 and 656.248 by sections 7, 23 and 26 of this Act become operative January 1, 1996.”
SAIF Corp. v. Wright, 817 P.2d 1317 (Or. 1991).
· cites it 2× “ORS 656.054(1). 2 In June 1985, SAIF denied all three claims, on the ground that claimant was not a subject worker of any of the employers.”
Bell v. Brown (In Re Payne), 27 B.R. 809 (Bankr. D. Kan. 1983).
“, Or.Rev.Stat. § 656.054 (1981), or the Kansas Insurance Commissioner.”
Bell v. Hartman, 615 P.2d 314 (Or. 1980).
· cites it 2× “The Court of Appeals agreed with this ruling. 3 ORS 656.”
Armstrong v. Rogue Fed. Credit Union, 969 P.2d 382 (Or. 1998).
“ORS 656.054(2) provides: “Whenever a subject worker suffers a compensable injury while in the employ of a noncomplying employer, the director shall, after an order closing the claim has become final, serve upon the employer a notice of proposed penalty to be assessed pursuant to…”
Garcia v. SAIF Corp., 816 P.2d 1188 (Or. Ct. App. 1991).
· cites it 4× “Claimant seeks review of an order of the Workers’ Compensation Board reversing the referee and holding that SAIF could properly deny an injury claim that it had processed and accepted for an alleged noncomplying employer pursuant to ORS 656.054. 1 On December 7, 1987, claimant…”
— Or. Rev. Stat. § 656.054(1) — 29 cases
Astleford v. SAIF Corp., 874 P.2d 1329 (Or. 1994).
“Pursuant to ORS 656.054(1), DIF referred the claim to the State Accident Insurance Fund Corporation (SAIF), which accepted it and notified Employer of its right to request a hearing.”
Astleford v. Saif Corp., 858 P.2d 877 (Or. Ct. App. 1993).
“TCCA and SAIF nonetheless argue that they can settle without employer’s consent pursuant to ORS 656.054, which provides, in part: “(1) A compensable injury to a subject worker while in the employ of a noncomplying employer is compensable to the same extent as if the employer had…”
SAIF Corp. v. Wright, 817 P.2d 1317 (Or. 1991).
“ORS 656.054(1). 2 In June 1985, SAIF denied all three claims, on the ground that claimant was not a subject worker of any of the employers.”
Green v. Beaman (In Re Beaman), 9 B.R. 539 (Bankr. D. Or. 1980).
“I find that the obligation of an employer to reimburse the Director of the Workers Compensation Department for payments made by the State Accident Insurance Fund Corporation under ORS 656.”
Dep't of Consum. & Bus. Servs. v. Zurich Am., 268 P.3d 671 (Or. Ct. App. 2011).
“850 for providing workers’ compensation insurance for claimant even though claimant was not leased to On-Time by NW Staffing, and, consequently, Zurich, as NW Staffing’s insurer, is responsible for paying the compensation due claimant on her claim; and (5) Zurich’s…”
— Or. Rev. Stat. § 656.054(2) — 4 cases
Armstrong v. Rogue Fed. Credit Union, 969 P.2d 382 (Or. 1998).
“ORS 656.054(2) provides: “Whenever a subject worker suffers a compensable injury while in the employ of a noncomplying employer, the director shall, after an order closing the claim has become final, serve upon the employer a notice of proposed penalty to be assessed pursuant to…”
Dep't of Consum. & Bus. Servs. v. Zurich Am., 268 P.3d 671 (Or. Ct. App. 2011).
“850 for providing workers’ compensation insurance for claimant even though claimant was not leased to On-Time by NW Staffing, and, consequently, Zurich, as NW Staffing’s insurer, is responsible for paying the compensation due claimant on her claim; and (5) Zurich’s…”
— Or. Rev. Stat. § 656.054(3) — 10 cases
Green v. Beaman (In Re Beaman), 9 B.R. 539 (Bankr. D. Or. 1980).
“I find that the obligation of an employer to reimburse the Director of the Workers Compensation Department for payments made by the State Accident Insurance Fund Corporation under ORS 656.”
Dep't of Consum. & Bus. Servs. v. Zurich Am., 268 P.3d 671 (Or. Ct. App. 2011).
“850 for providing workers’ compensation insurance for claimant even though claimant was not leased to On-Time by NW Staffing, and, consequently, Zurich, as NW Staffing’s insurer, is responsible for paying the compensation due claimant on her claim; and (5) Zurich’s…”
— Or. Rev. Stat. § 656.054(4) — 1 case
— Or. Rev. Stat. § 656.054(9) — 1 case
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