WCD Designation and Responsibility of a Paying Agent training - YouTube

Welcome to the Workers' Compensation Division  training about the designation and responsibility

of a paying agent. During this training we're  going to talk about how the Workers Compensation

Division designates a paying agent and what  the designated agent's responsibilities are.

We will also talk about how to request  a designation from the director.

This training will take about 15 minutes. This  is a great training for insurance companies

and their claims adjusters  who process claims in Oregon.

When two or more employers or their  insurers find that there is an

issue about which employer or insurer  is responsible for a compensable claim,

the parties must request a temporary designation  of paying agent as required under Oregon Revised

Statute, chapter 656, section 307. The temporary  designation expedites benefits to injured

workers while waiting for a hearing  with the Workers' Compensation Board.

This designation is necessary only for compensable  claims with issues about responsibility.

The Workers' Compensation Division's Benefit  Consultation Unit (or BCU) will process the request

and issue an order designating a temporary paying  agent. The temporary paying agent is responsible

for processing the claim and paying for benefits  until relieved by an administrative law judge.

The BCU makes its decision based  on Oregon Administrative Rule,

chapter 436, division 60, rule 180. Typically, the  designated paying agent is the insurer with the

lowest cost of disability or the earliest  claim filed for the compensable condition.

The designated insurer must process the claim  through claim closure as if it's an accepted claim.

The temporary designation can be lifted by an  administrative law judge through hearing, mediation,

or settlement. When an employer and its insurer  request that the director designate a paying agent,

it is not an admission that the insurer  is responsible for the compensable injury;

it is solely an assertion that the injury is  compensable against a subject Oregon employer.

Any time an insurer decides that a claim is  compensable but is the responsibility of

another subject Oregon employer, the insurer must  request a designation of paying agent from the

Workers' Compensation Division. An insurer's  legal representative can make the request

on its behalf. WCD often receives requests for  designation from the injured worker's attorney.

When these requests come in, we will notify the  affected insurers of the request and inform them

of their next steps to request designation so  WCD can determine the temporary paying agent.

The affected insurers should work together to  try to determine which party is responsible.

Working among themselves gives the insurers  an opportunity to decide which is responsible

without involving WCD or the director. When a  responsibility issue is discovered, whether it's

from the director's notice, notice from another  insurer, or from an internal responsibility denial,

the first step is to notify all other  affected insurers of the responsibility issue.

It's important that once each party is notified,  the affected insurers expedite processing

by immediately investigating the claim  to decide if the claim is compensable

and determine their responsibility. Once it's  decided that the responsibility for an otherwise

compensable injury cannot be determined, the  affected insurers should request a designation

of paying agent from the director. We will come  back to how to make that request in a few moments.

Now we'll discuss some examples to help  better understand the four situations

in which the paying agent may be unknown and a  designation should be requested from the director.

There are four responsibility issues that will  result in the director ordering a temporary

paying agent. These include: determining the true  employer, considering which insurer is responsible,

figuring out which of a series of employers is  responsible, and deciding who should pay in case

of joint employment. The first situation is an  issue about which employer is the true employer

of an injured worker. In this example, John is  injured while employed by a construction company

that is working on a sportswear manufacturer's  campus. The construction company and sportswear

manufacturer each disagree on who the  true employer is for the injured worker.

Each believe the other is responsible. Because  there is a disagreement on which employer is

the true employer for the worker, the insurers  should request a designation of paying agent.

In this example, the employer has  had multiple insurers over the years.

Which insurer is responsible for the compensation?  Joe has worked at Bravo Saw Mill for 30 years.

He recently filed a claim for hearing  loss, which is an occupational disease.

In the course of those 30 years, Bravo Saw Mill has  had three insurers. Insurer A covered them for the first 10

years. Insurer B covered them for the next eight  years. They're currently covered by insurer C.

In this instance, there's no question that  the occupational disease is related to work.

However, each insurer believes the claim is not  its responsibility. Because the insurers couldn't

agree among themselves, they should request  a designation of paying agent from the BCU.

For the third responsibility issue, let's talk  about Becky. She has worked in accounting for

16 years, and is suffering from carpal tunnel  syndrome due to keyboarding. Becky has worked

for three different employers over the 16 years  she's been typing. Each job may have contributed to

the occupational disease, but the insurers are not  able to determine which employer is responsible.

This is an example of a claim in which  two or more employers or their insurers

could not make the determination a responsibility.  In this instance, all affected insurers should

request designation from the director. The  fourth responsibility issue is determining

which of two or more employers is responsible  when there is joint employment. Business owner

Will gets all of his employees through a  worker leasing company. The contract states

that the worker leasing company will provide  workers' compensation insurance for their workers.

Will hires an employee named Tim, but not through  the worker leasing company. Tim gets injured and

the worker leasing company denies responsibility.  The worker leasing company says that the business

owner, Will, is responsible for the claim since  the new employee was not hired through them.

Will disagrees and thinks the worker  leasing company should be responsible

since it's responsible for the rest of  his staff. This is a complicated situation,

and because an agreement could not be made between  Will and the worker leasing company's insurer,

a request for designation of paying agents  should be sent to WCD. Now that we understand

some of the scenarios that would prompt an  insurer to make a request for designation,

we can talk more about the request requirements.  When an insurer is requesting designation from WCD,

the insurer must send the request in writing  to the division, the worker, and the worker's

attorney, if they have one. The written request  must list all of the compensable conditions,

and state that the claim is otherwise compensable  and that responsibility is the only issue. The

request should also list all of the claims for the  worker related to the dispute: including employer

and insurer information, the date of injury,  and claim number. Finally the request should

confirm that relevant medical documents have been  sent to the other insurance companies involved

and that the worker is aware of the designation  request. Oregon Administrative Rule, chapter 436,

division 60, rule 180, section 6 describes what  is required in a request for designation of a

paying agent. If any information is missing it  can slow down the designation process for BCU.

The director won't designate if compensability has  not been determined on any of the involved claims.

For example, if one of the involved insurers or  employers state that the claim is not compensable

or issue a compensability denial, the  director cannot designate a paying agent.

If an involved insurer opposes designation  because it has not received a claim,

the director won't be able  to designate a paying agent.

As an example, insurer A requests a designation  of a paying agent from WCD and copies the other

insurers involved (insurer B and insurer C.)  Insurer C has not yet received a claim from the

worker, so it cannot determine responsibility  or compensability. Insurer C can respond to

WCD,copying all other parties, stating that it  opposes the designation. Because insurer C has

not received a claim or determined responsibility  and compensability, the director won't designate.

If the 60-day appeal period of a responsibility  denial expired and no request for hearing has

been received by the board OR no request for  designation has been received by the director,

the director cannot designate a paying agent. For  example, Lisa received a responsibility denial, and

has only 60 days from the date of the denial to  appeal it with the Workers' Compensation Board.

It has been 65 days and the Workers' Compensation  Board has not received an appeal. Her appeal time

frame has expired, which means the denial is final  and the director cannot designate a paying agent.

Earlier in the training we mentioned that WCD regularly gets requests for designation from the

worker's attorney. When WCD receives requests from  the worker or the worker's attorney instead of the

insurer, the director will send a letter to all of  the affected insurers. Once the insurer receives

the notice, it must immediately process the request  to determine compensability and responsibility,

and request designation of paying agent only if  the insurers cannot determine responsibility on

its own. Oregon Administrative Rule, chapter  436, division 60, rule 180, section 6 requires

the insurer to make the request for designation  of a temporary paying agent. Once WCD receives a

request for a temporary designation of a paying  agent, the director will immediately investigate

the request and determine if the designation  is appropriate. The director may then send a

letter demanding the affected insurers respond  within 21 days with more information if WCD needs

clarification on the intent of the denials or  wage information to help identify the lowest costs.

A response to this request for information is  required under Oregon Administrative Rule, chapter

436 division 60 rule 200. Failure to reply within  21 days with all required information may result

in sanctions or civil penalties. When designating  the paying agent, the director will first determine

which insurer has the lowest compensation  for the temporary total disability rate.

If the rates of temporary total disability are the  same, the director will then look next at the rate

of permanent disability. For occupational disease  claims, the rates of temporary total disability

and permanent disability should all be equal. When  rates of disability are equal, the director will

designate the insurer with the earliest claim  as the temporary paying agent. Remember, this is

a temporary designation. The goal of this process  is to expedite benefits to the injured worker

while waiting for the determination of  responsibility of the compensable injury.

The designated insurer must process  the claim through claim closure

or until relieved by an administrative law  judge, mediation, or arbitration. This means

the designated insurer must take all of the  same steps that it would for an accepted claim,

including issuing a notice of  acceptance and form 1502 to the director.

If, after designation, any of the insurer's  determined compensability may be an issue

at hearing, or if there's a change in acceptance  of a claim, the insurer must notify the director.

When the director receives  notification, BCU will order

termination of any further benefits due from  the original order designating a paying agent.

Once a designation has been made or terminated,  BCU is no longer part of the process.

All parties will wait for the Workers' Compensation Board to make a determination.

The designation of paying  agent process can be confusing,

but BCU is here to help. We are happy to  answer any questions you have about this topic.

If you have any questions about the designation  and responsibility of a paying agent,

call or email us for help. If you want more  in-depth training on this topic, we're happy

to meet with you via conference call, webinar, or  in person. Thank you for watching this training.