Workers’ compensation insurance pays benefits when a worker is injured on the job. Injured workers may receive several types of benefits, including payment of medical bills and compensation for lost wages. Oregon law requires employers to carry workers’ compensation insurance or be self-insured if they have one or more employees. Employers are responsible for paying workers’ compensation insurance premiums for their employees.
How Do Businesses Handle Workers’ Compensation Claims in Oregon?
Workers’ compensation laws protect employees injured on the job by setting the procedures employers must follow when a worker files a claim. Businesses must follow specific steps when they are notified of a workplace accident, injury, or occupational illness.
Generally, the steps involved in a workers’ compensation claim are:
Report of Injury or Workplace Accident
Employees have 90 days to report an injury or accident to their employer. With an occupational disease or overuse injury, the employee must report the condition as soon as possible after receiving a diagnosis or gaining knowledge of the work-related condition.
If the employee has not already done so, the employer should instruct the employee to seek medical treatment. Employees have the right to choose a medical provider.
Complete Workers’ Compensation Claim Forms
An employer should provide their employee with a Report of Job Injury or Illness (Form 801) to complete. The employee may request a Workers’ and Physician’s Report for Workers’ Compensation (Form 827) from their physician. Either form, upon submission, begins the claims process with the insurance provider. Employers must notify their insurance provider within five days of becoming aware of the claim.
Acceptance or Denial of Workers’ Compensation Claim
The insurance company has up to 60 days to accept or deny a workers’ comp claim. If the claim is accepted, the company will send the employee a Notice of Acceptance letter explaining the medical conditions covered by the claim.
If a workers’ compensation insurance company denies a claim, it must send the employee a letter explaining why the claim is denied. The letter must also inform the employee about their right to appeal the denial to the Oregon Workers’ Compensation Board (WCB).
Payment of Workers’ Compensation Benefits
The insurance company pays for the employee’s medical treatment by sending payments directly to the medical providers. If a worker’s injuries prevent them from working or restrict their work during their recovery, the insurance company has to pay the worker for lost wages.
Workers are not paid for the first three days they miss work unless they are totally disabled for a minimum of 14 consecutive calendar days or they are admitted to a hospital for inpatient treatment within 14 days of their injury. Loss of income benefits equal about 2/3 of the employee’s average weekly wages up to a maximum amount set by Oregon law.
Maximum Medical Improvement
The employee continues treatment until the doctor states they have reached maximum medical improvement (MMI). When the worker completes medical treatment, the doctor will generally issue an impairment rating. An impairment rating of zero means the employee has recovered fully from their injuries and is not suffering from any lasting impairments or disabilities.
If work-related injuries cause impairment or disability, the doctor will determine the extent of the disability. Disability payments are based on the statewide average weekly wage and the percentage of the impairment.
The insurance company or employer may request an independent medical examination (IME) to confirm the worker’s disability and impairment rating. The insurance company gets to choose the physician they want to perform the IME. Many disputes arise because the employee and the insurance company disagree on the degree of impairment and the benefit amount.
Do Workers Need an Attorney to File a Workers’ Compensation Claim in Oregon?
Hiring an attorney is not required to file a claim. However, workers have the right to consult and hire counsel to represent them in a workers’ compensation case. Hiring an experienced Portland workers’ compensation lawyer can help injured workers receive the benefits and compensation they are entitled to.
A lawyer will ensure that the paperwork is completed correctly and filed in a timely manner to prevent losing benefits. An attorney also helps injured workers by securing medical experts to assist in evaluating impairments to obtain the maximum disability benefit allowed by law.
Contact an attorney for a free consultation if you have questions about a workers’ compensation claim.