Dwyer Williams Workers Comp Lawyers Can Help if You Have Been Injured at Work.
In the state of Oregon, the process of claiming workers’ compensation is relatively simple. When you are hurt on the job, you file an Oregon Report of Job Injury or Illness Worker’s Compensation Claim prior to being issued your official workers’ compensation determination order. In reality, however, despite the deceptively simple process of submitting a workers’ compensation claim, many problems can arise when you file for workers’ compensation. Potential problems include but are not limited to:
- Your entire workers’ compensation claim being denied.
- Your workplace injuries being denied because of a preexisting condition.
- Your time-loss payments being calculated incorrectly or cut off wrongly.
- Medical bills related to your workplace injury not being paid.
For more information on Oregon’s workers’ compensation program, download this brochure: “What Happens if I’m Hurt on The Job? A Guide to Oregon’s Workers’ Compensation Benefits, Rights, and Responsibilities”.
We highly recommend that you contact an experienced Oregon workers’ compensation attorney if you have been injured on the job. These professionals will be able to tell you what your rights are and to see your workers’ compensation claims through from start to finish.
Dwyer Williams Personal Injury Attorneys can help you with your workers’ compensation claim. We have offices conveniently located throughout the state, in:
Oregon Workers’ Compensation: Benefits, Rights, and Responsibilities
“How to file a worker compensation injury claim:
- Tell your employer or direct supervisor about your workplace injury as soon as possible. When you are injured on the job, you should report your injury no less than 30 days after the date on which it occurred.
- Ask your employer for Form 801, “Report of Job Injury or Illness.” Your employer is required to provide this to you within 5 days of being informed of your workplace injury. Complete the “worker” portion of this form and return it to your employer as soon as possible so that your employer can complete the “employer” portion and then file the fully completed form. You can also obtain Form 801 by calling Oregon’s Ombudsman office. The workers’ compensation attorneys at Dwyer Williams, LLP can help you avoid mistakes that may compromise your workers’ compensation claim. It is advisable to seek legal advice from an experienced Oregon workers’ compensation attorney prior to completing this accident form or being referred to a doctor for evaluation. Employers are notorious for referring injured workers to industrial accident or injury clinics that underestimate the seriousness of worker injuries and which provide extremely optimistic prognoses.
- Ask your employer for the name and contact information for your workers’ compensation insurer.
- Obtain medical treatment from a healthcare provider of your choice and explain that you were injured at work. Your employer does not have the right to select your healthcare provider for you.
- Your healthcare provider should ask you to complete Oregon Form 827 entitled “Worker’s and Physician’s Report for Workers’ Compensation Claims.”
- Keep copies of all forms and any medical treatment paperwork for your records.
Make sure to keep copies of all of these forms and any medical treatment paperwork for your records. It is important to provide all of these documents to your Oregon workers’ compensation attorney who can ensure that they are completed correctly and in a timely manner.
How to Obtain Medical Treatment for Your Workplace Injury:
- If your workers’ compensation claim is accepted, then the insurer will have to pay for all medical treatment related to the conditions listed on your official notice of acceptance.
- If your workers’ compensation claim is denied, then you may have to pay for your medical treatment related to your workplace injuries.
- The insurance company may enroll you in a managed care organization (MCO). MCOs are organizations that contract with an insurer to coordinate medical services for injured workers. If your insurer is covered by an MCO contract, the insurer may enroll you with the managed care organization at any point preceding your injury. You may also be required to select an MCO healthcare provider from a list of providers the insurer sends with your enrollment notice
If I Cannot Work as a Result of My Workplace Injury, Will I be Compensated for Lost Wages?
Oregon Workers’ Compensation Provides the Following Benefits:
- Payment of your medical bills and payment of your lost wages at a rate of two-thirds your gross wage. Your average wages are calculated over a 52-week period or less, then that number is divided by the number of weeks you worked and multiplied by two-thirds.
- Your mileage to and from your illness or injury-related doctor visits can be paid at approximately $.39 per mile.
- If you cannot return to work, vocational training might be available.
Your health care provider must authorize your absence from work. Under Oregon law, you will not be paid for the first three days that you do not return to work, unless you are off work for 14 consecutive days or hospitalized overnight as an inpatient within those initial 14 days. If your claim is denied during the 14 days following the date on which you reported the accident, then you will not be compensated for any lost wages.
Your Workers’ Compensation Claim Status
What is an Interim Period?
The time period between when your employer is first informed of your accident and the date when workers’ compensation insurance companies decide to accept or reject your claim is called an interim period. During this period, the insurer will pay only for limited medical treatment.
Acceptance or Denial of a Claim.
The insurance company has 60 days to accept your claim. If your claim is accepted, then the insurer will send you a “Notice of Acceptance” listing the specific medical conditions that it has approved covering with workers’ compensation benefits. The insurance company only has to pay for medical treatment related to the accepted conditions listed on your “Notice of Acceptance”.
The insurance company may also enroll you in a managed care organization (MCO) at any point. An MCO is an organization that contracts with an insurer to coordinate medical services to subgroups of injured workers. If your insurer is covered by an MCO contract, they may enroll you with the MCO at any time after your accident or injury. You will usually be sent a list of providers with your enrollment notice.
What If My Healthcare Provider Recommends Elective Surgery?
Elective surgery is any surgery which is not emergency surgery. Before scheduling elective surgery, your healthcare provider must notify the workers’ compensation insurer, which may request a second opinion. If the insurer disagrees about the need for surgery, the insurer must ask State of Oregon’s Workers’ Compensation Division to review the request for surgery in order to determine whether or not it is appropriate and truly necessary.
Independent Medical Examination
An independent medical examination (IME) is a medical exam of an injured worker that is administered by a physician other than that worker’s attending physician, at the request of the workers’ compensation insurer. The insurer may require an injured worker to attend up to three medical examinations with IMEs of their choice. If a worker fails to attend the requested IME, he or she can be penalized $100 or his or her workers’ compensation benefits may be stopped.
What you should know about independent medical examiners:
- IMEs do not provide treatment.
- IMEs only prepare a report based on examining you in order to answer questions asked by the insurance company about your injury or occupational disease.
- IMEs perform a physical or a “work-capacity evaluation”.
What Are My Rights When Returning to Work After Sustaining an Injury?
Most Oregon employers that employ more than 20 workers are required to return an injured worker to that worker’s previous-occupied job or to another, equivalent, and suitable job after the worker returns to work. The workers’ compensation insurer will send you written notice when your healthcare provider releases you to go back to work. Within seven calendar days of receiving that notice, you must ask your employer for your job back or you forfeit your right to be reinstated by your employer. If you return to modified or lighter duty work at a lower rate of pay or with fewer hours than you previously earned, you will receive time-loss payments (temporary disability) for the portion of your former wages that was lost.
What Reemployment Assistance is Available from Oregon’s Workers’ Compensation Division?
Oregon’s Employer-at-Injury Program helps workers stay on the job or get back to work as soon as they have been injured on the job due to some fault of the employer. Due to your injury, your employer may be eligible for benefits to assist it in returning you to light-duty work while your claim is open. The state of Oregon’s Preferred Worker Program helps injured workers get back to work by subsidizing employers throughout Oregon who help injured workers get back in the workforce. If you are eligible for the Preferred Worker Program then you will receive an identification card and program materials shortly after your claim is closed.
Workers’ Compensation Claim Closure
Workers’ compensation claims are called “open” or “active” while you are recovering from your injury and they are called “closed” or “inactive” once you are medically stable. Your claim will also be closed if your injury is no longer the major cause of your disability or if you fail to attend medical appointments associated with your compensated workplace injuries. The following important documents will be sent to you by your insurer once your claim is closed:
- A legal document called a “Notice of Closure”, which officially closes your claim and lists the periods for which time-loss benefits were authorized. This closure notice also indicates how much permanent disability you may have and how to appeal the closure of your claim.
- An “Updated Notice of Acceptance at Closure” that lists the medical conditions which the insurer accepted and covered for the worker.
- A brochure, entitled “Understanding Claim Closure and Your Rights” that explains your appeal rights and the types of care that are covered by the workers’ compensation insurer after claim closure.
As a general note, once your time-loss payments end, you may be entitled to unemployment benefits. You must apply for these benefits within four weeks of the date of the notice ordering claim closure. If your Notice of Closure indicates permanent partial disability (PPD), this means that your injury resulted in a condition that has not returned to its normal or pre-injury status. Permanent partial disability payments are based on a formula set by law and the amount that you receive depends on the severity of the disability. Keep in mind that permanent partial disability award payments are due to start 30 days from the mailing date of closure. If your award is $6,000 or less, the insurer will pay you a lump sum; if it is more than $6,000 then the insurer will pay you in monthly installments. You may ask the insurer to pay you a lump sum; however, if you apply for and accept lump-sum payment of any part of your permanent partial disability award, then you give up your right to appeal the amount of the award. Permanent total disability (PTD), on the other hand, means that you are permanently unable to perform gainful and suitable employment. You will receive monthly disability payments as long as you remain totally disabled. The insurer will reexamine your claim at least every two years to see if you remain unable to work.
Helpful Tips for Oregon Worker’s Compensation Claims:
- If you fail to take action or if you miss a deadline to appeal claim decisions, then you may lose your right to worker’s compensation benefits.
- Attend all medical appointments related to your workers’ compensation claim.
- Contact your employer immediately when your healthcare provider releases you to return to work.
- Keep in contact with your doctor and inform your employer about all your work restrictions. If your employer offers you a modified job or light duty when you return to the workplace, you must cooperate with their efforts to return you to work.
- The Oregon State Employment Act (OSEA) codifies the common-law duty to provide safe places of employment. The purposes of the OSEA are to assure safe and healthful working conditions for every working man and woman in Oregon, to preserve Oregon’s human resources, and to reduce the expenses and human suffering created by occupational injury and disease.
- Every employer must furnish employment and a place of employment that are safe and healthful for employees. The OSEA requires employers and owners to not “construct or cause to be constructed or maintained any place of employment that is unsafe or detrimental to health.”
- In addition to recovery for physical injuries, psychological injuries are also compensable if attributable to the employer’s negligence.
Can I Sue My Employer Directly?
If your employer has workers’ compensation insurance, you generally cannot sue it directly, even if the accident is the employer’s fault. However, if your employer does not have workers’ compensation insurance and your employer is at fault for your accident, then you can sue your employer directly. If the accident by which you are injured occurs as a result of a third party and that party is not your employer, then you can sue the third party. You may sue third parties for personal injury damages while pursuing a workers’ compensation claim against your employer. Personal accident or injury claims against third parties will typically permit the recovery of more significant damages, but they require proving fault.
If you or a loved one has contracted a work-related illness or has been injured in a work-related accident, contact the compassionate and experienced attorneys at Dwyer Williams, LLP. Call us today for a free consultation at 541-617-0555. We can help you.