Oregon Workers' Compensation: Frequently Asked Questions

Oregon Workers’

Compensation:

Frequently

Asked

Questions

This brochure is intended only as a general

guide on Oregon workers’ compensation

and is not intended to represent ofcial

interpretations of the law.

Workers’ compensation

insurance pays for

workers’ medical

treatment and

lost wages on

accepted claims

when workers

suffer work-

injuries and illnesses. By law,

Oregon employers that have

one or more employees, full or

part time, must carry workers’

compensation insurance

or be self-insured. Workers’

compensation insurance not

only protects workers, but also

protects employers by shielding

them from liability lawsuits that

might result from work-related

injuries or illnesses.

What is workers’ compensation

insurance?

Employers pay

premiums to workers’

compensation

insurance

companies, and

those premiums

nance most

of the

benets

received by workers if they are

injured or suffer an occupational

disease on the job.

Who pays for workers’

compensation?

The Workers’

Compensation

Division (WCD)

administers and

regulates laws and

rules that affect

the

participants

in the

Oregon workers’ compensation

system. The division oversees

programs and services that help

ensure timely and appropriate

medical treatment and time-loss

benets to injured workers, while

helping keep costs and burdens

low for Oregon employers.

The division also administers

return-to-work programs that

help injured workers return to

their previous job or nd new

employment.

Who regulates workers’

compensation?

All employers

in Oregon that

are required to

provide workers’

compensation

coverage must

display a

Notice of

Compliance

poster in a central gathering

area such as a break room where

workers will see it.

What information does an

employer have to display to

comply with workers’

compensation?

Workers who have

work-related injuries

or illnesses may

elect to le a claim

to receive workers’

compensation

benets. They

must ll out

the Report

of Job Injury or Illness (Form

801) from their employers or the

Worker’s and Physician’s Report

for Workers’ Compensation (Form

827) from their doctors. Either

If a work injury or illness occurs,

how is it reported?

form begins the claim process

and is sent by the employer or

doctor to the insurer.

Employers should notify

their workers’ compensation

insurance company within ve

days of knowledge of the claim.

Employers cannot prohibit

workers from ling a claim. Even

if a worker does not want to le a

claim, the employer should offer

the Form 801 and maintain a

copy of it.

An employer cannot

direct care, even if the

worker is enrolled

in a managed care

organization

(MCO). The

worker may

go to a

medical

facility or doctor of his or her

choice. In the case of an MCO, the

worker may still select a doctor

within the MCO.

Can an employer direct an injured

worker to a particular doctor or

facility?

An insurer must accept

or deny a claim

within 60 days

and, subsequently,

notify WCD

within 14 days of

acceptance or

denial.

When

an insurer denies a claim, it

must send the worker a letter

explaining why the claim was

denied and provide information

about the right to appeal the

denial to the Hearings Division of

the Workers’ Compensation Board

(WCB).

When an insurer accepts a claim,

What is the time frame to accept

or deny a workers’ compensation

claim?

it must send the worker a Notice

of Acceptance letter specifying

the medical conditions that will

be covered under the claim. WCD

oversees claims handling by

auditing insurers’ les to see if

claims were processed accurately

and in a timely manner.

Workers temporarily or

permanently disabled by accepted

work-related injuries or illnesses

may receive payment from the

workers’ compensation insurer

for lost wages and permanent

disability. Some workers may

qualify for vocational services.

Oregon’s workers’ compensation

benets also include death

benets.

In order for injured

workers to receive

payments for

time lost from

work, health

care providers

must notify

insurers or

self-insured

employers of the injured workers’

inability to work. After the

original injury, workers will not be

paid for the rst three calendar

days they are unable to work

unless they are totally disabled

for at least 14 consecutive

calendar days or are admitted to

What are benet payments?

a hospital as an inpatient within

14 days of the rst onset of total

disability.

Workers will receive a

compensation check every two

weeks during the recovery period

as long as health care providers

verify the workers’ inability to

work. These checks will continue

until the workers return to work

or are considered medically

stationary. Time-loss benets are

two-thirds of a worker’s gross

weekly wage at the time of injury

up to a maximum set by Oregon

law.

When an injured

worker’s doctor

determines that

the worker’s work-

related injury or

illness is not

expected to

improve

with further

treatment or the passage of

time, the worker is considered

medically stationary. The insurer

will notify the worker that the

claim will be closed and how

much, if any, permanent disability

payment is due.

What does medically stationary

mean?

When claims are

accepted, insurers

or self-insured

employers will pay

medical bills

due to medical

conditions

the insurers

accept in

writing, including reimbursement

for prescription medications,

transportation, meals, lodging,

and other expenses up to

a maximum established

rate. Injured workers must

make a written request for

reimbursement and attach copies

of receipts. Medical bills are not

paid before claim acceptance.

Bills are not paid if a claim is

denied, with some exceptions.

Contact the insurer or self-

insured employer for questions

about medical bill payment.

What medical treatments will

workers’ compensation insurance

pay for?

WCD administers two

programs that help

injured workers

return to work:

the Employer-at-

Injury Program,

which offers

incentives

employers to provide light-duty

work during a worker’s recovery,

and the Preferred Worker

Program, which offers employers

incentives, such as worksite

modication and wage subsidies

to hire injured workers. Contact

the division for more information

at 800-445-3948 (toll-free).

What if an injury prevents a

worker from returning to his or

her job?

An insurer or injured

worker may request

mediation services

from WCD or

the Workers’

Compensation

Board (WCB)

if there is a

dispute

about a claim issue, or request

a hearing or an administrative

review. There are time limits for

most appeals and some issues

must be appealed to WCD before

going to WCB.

What if the insurer or worker

disagrees with a decision?

Workers may represent

themselves.

However, workers’

compensation

is complex and

injured workers

may want to

hire an

attorney

to handle the appeals process.

Attorney fees are paid out of or

in addition to any compensation

that may be awarded to the

injured worker. For more

information, contact the Oregon

State Bar referral service at

800-452-7636 (toll-free) or visit

www.oregonstatebar.org.

Do workers need an attorney?

Service