Insurer Notice Of Closure Summary {1503}

1503 - INSURER NOTICE OF CLOSURE SUMMARY. This form is used in Oregon’s workers’ compensation system to provide a detailed summary of the closure of a worker’s compensation claim. It is completed and filed by the insurer when a worker’s claim is closed, either through an original Notice of Closure, a corrected Notice of Closure, or a rescinded closure. This summary includes critical information such as the worker’s identity, date of injury, insurer and employer details, medical costs paid, time-loss benefits issued (temporary total and partial disability), and any overpayments. It also outlines the worker’s employment and medical status at the time of closure, which helps determine eligibility for preferred worker or vocational rehabilitation benefits. The form indicates whether the worker returned to work, what type of work was resumed (if any), and the nature of any work restrictions. Although this notice is informational and requires no action if correct, it allows the worker to identify and report errors. www.FormsWorkflow.com