Workersā Compensation Attorney in Medford, Oregon
Workersā compensation insurance covers almost all the workers in Oregon. The exceptions include federal government employees and those working in the maritime industry.
While you may not be eligible for state workersā compensation benefits if you work in either of these worker groups, you would still be eligible for other benefits.
Your medical expenses as well as compensation for lost time from work and permanent disability due to a work related illness or disability are covered under the Oregon workersā compensation insurance. In some situations, you might also be eligible for vocational assistance.
In most cases, death benefits (which include funeral expenses) are available to the deceased employeeās spouse and minor children in the event a work related injury or illness results in death. College attending children may also be eligible for death benefits.
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How Does the Oregon Workersā Comp System Operate?
Oregon workersā comp claims are overseen by the Workersā Compensation Division. Most employers are required by law to have workersā compensation coverage. Usually, a workersā comp policy is purchased from an insurance company to meet the requirements of coverage.
In some situations, an Oregon employer might also apply for certification from the state to self-insure. Nearly half of Oregonās employers are insured by a not-for-profit, state-chartered insurance company called the State Accident Insurance Fund (SAIF).
Oregon follows a no-fault workersā compensation system, which means that you do not have to bear the burden of proof to place your employer at fault to receive benefits. You are eligible for benefits as long as your injury was caused during the course of your job activities.
Workers are eligible for a variety of benefits, such as:
- permanent disability benefits (for permanent impairments)
- temporary disability benefits (for time off from work)
- vocational assistance (which includes training for a new line of work)
- reasonable and necessary medical care
- death benefits
You cannot ordinarily sue your employer to claim any other compensation (like āpain and sufferingā) apart from workersā compensation, which makes it an exclusive remedy against your employer and the insurance company.
However, if your injury was caused due to someone elseās carelessness other than a co-worker, then you could have grounds for a āthird partyā lawsuit.
Reporting a Workplace Injury in Oregon
An injury must be reported to the employer within 90 days of a work-related accident to qualify for workersā compensation in Oregon. Occupational illnesses due to your line of work need to be reported within a year of discovery after making the connection.
You could potentially lose your rights to collect benefits if you exceed these deadlines. It is always a salient idea to report your work-related injuries as soon as possible for a faster claim processing.
Your notice about your work injury must be written and not provided verbally in Oregon. Form 801 ā Report of Job Injury or Illness is completed by injured workers. This form can be obtained from the employer.
Any written and signed notice is acceptable if it describes the details of when, where and how the injury occurred.
Obtaining Medical Treatment for an Injured Worker
Your employer must inform you about the ways of getting necessary medical treatment once you notify them about your injury. You have the option to select your own doctor or pick one under the insurance companyās managed care organization (MCO), as per Oregon laws.
Whichever doctor you choose must complete Form 827 ā Workersā and Physicianās Report for Workersā Compensation Claims at the first appointment and send it across to the insurance provider.
It is important that you provide your doctor with accurate information regarding the severity of your symptoms and the cause of injury. Insurance companies scrutinize the initial medical records while evaluating claims and any falsification or exaggeration may result in a denial of benefits.
Claim Process for Workersā Compensation in Oregon
Your completed Form 801 should be sent to the insurance company by your employer within five days of receipt. The insurance company will determine your eligibility for benefits after a thorough investigation which may involve:
- review of your medical records
- scrutiny of your education, work experience, and wages
- a medical examination to better assess your claims
- setting you up for a functional capacity evaluation with work restrictions
Typically, an insurance company in Oregon must pay all necessary medical expenses within reason and temporary disability benefits during investigation.
It has 60 days to either approve or deny your claim. A Notice of Acceptance is issued which lists all your accepted medical conditions and injuries upon approval. You will receive a written notice of denial if your claim is denied. This shall include an explanation of your appeal rights.
Remember, you have a right to file claim and your employer cannot refuse you this right. Also, the law prohibits employers from discriminating against employees who file a claim.
Your employer with the insurer will have an established MCO from where you can select a doctor or you may choose your own doctor.
āMCOā includes those medical providers that have been certified by the Oregon Workersā Compensation Division. The MCO is employed to provide medical care to workers suffering from work-related injuries after they have entered into a contract with the insurer.
Reasonable and necessary medical expenses related to your injury will be paid by your workersā compensation insurance. The insurance company has 60 days, from the day you gave notice of your injury to your employer, to accept or deny your claim.
You are entitled to receive compensation for lost wages within 14 days of your employer receiving notice of your claim if you are hospitalized or lose more than three days in a row from work.
Your average weekly wages including commissions, regularly worked overtime, room and board, and other similar factors are taken into consideration while calculating the amount of compensation. (You may also be entitled to time loss payments or supplementary wage loss if you have a second job.)
Your wage reimbursement checks shall be paid every fortnight till your doctor finds you fit and allows you to return to work. Your time loss payments will cease if your claim is denied, or you return to regular work without doctorās release, or the workersā compensation department issues an order of your insurer closing your claim.
How to Appeal a Denied Workersā Comp Claim in Oregon
You have the legal right to appeal if your claim is denied by filing a request with the Division for hearing. You risk losing all your rights under the Workersā Compensation Act if you do not ask for a hearing within 60 days.
You should consider the fact that the insurance company will have a lawyer at this hearing. Therefore, you are likely to be at a serious disadvantage without a competent Oregon workersā compensation attorney at your side because these laws can get complicated.
Contact a Reliable Oregon Workersā Comp Lawyer
If you have been injured at your workplace in Oregon, you do not have to fight for your rightful workersā comp benefits alone. Dwyer Williams Cherkoss has team of experienced and hard hitting attorneys who are committed to helping injured workers maximize their benefits. Call 1-800-285-8678 today to schedule your consultation.