| What is workers’ compensation? |
| Oregon workers’ compensation laws protect your rights, provide for the payment of benefits, help you return to work, and protect employers from liability lawsuits. This is a "no-fault" system in which both workers and employers are protected. Oregon employees have a right to medical and disability benefits for work-related injuries and illnesses. In return, workers usually cannot sue employers for job-injury compensation. |
| Ombudsman for Injured Workers |
| Workers’ Compensation Division (WCD) |
| Workers’ Compensation Board (WCB) and WCB Hearings Division |
| Accepting or denying your claim |
| Nondisabling claim |
| Dispute claim settlement |
| Claim disposition agreement |
| Appeals |
| Public records and your claim |
| Medical benefits |
| Who can be your attending physician? |
| Managed care organizations (MCO) |
| Medical bills, prescriptions, travel and other expenses |
| Disability benefits |
| Waiting period for temporary disability benefits |
| Temporary total disability (TTD) |
| Temporary partial disability (TPD) |
| Permanent partial disability (PPD) |
| Permanent total disability (PTD) |
| Fatality |
| Claim closure |
| Reconsideration of closure |
| Medical benefits after claim closure |
| Reopening of claim for a new condition |
| Reopening of claim if your accepted conditions worsens |
| Return to work |
| Vocational assistance |
| Help from WCD reemployment assistance programs |
| State of Oregon Vocational Rehabilitation Division (VRD) |
| Workers’ compensation reference websites |
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| Ombudsman for Injured Workers |
The role of Ombudsman is to inform you of your rights and help you solve problems and to educate and advise regarding claim disposition agreements, disputed claim settlements, hearings and appeals. The Ombudsman acts as your advocate in all claim-related problems. You my contact an Ombudsman Worker Advocate at (503) 378-3351 or toll free 800-927-1271. TTY access at (503) 378-4100.
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| Workers’ Compensation Division (WCD) |
WCD’s staff can explain your rights and answer your questions about medical benefits, disability benefits, vocational assistance, and re-employment assistance.
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| Workers’ Compensation Board (WCB) and WCB Hearings Division |
| The Workers’ Compensation Board is the state agency responsible for conducting hearings and appeals and reviewing legal decisions and agreements affecting injured workers’ benefits. |
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| Accepting or denying your claim |
Your insurer must accept or deny your claim within 90 days from the day you tell your employer about the injury or illness. If your claim is denied, the insurer will tell you about your appeal rights in the denial letter they send to you. Denials have a 60-day time limit to file the necessary appeal with the Workers’ Compensation Board.
If your claim is accepted, your insurer will send you a Notice of Acceptance. The Notice of Acceptance will name the medical conditions accepted for coverage by your insurer. If you believe that a condition has been omitted from the notice, or the notice is otherwise incomplete or incorrect, you must notify your insurer of the error in writing.
If you develop a new medical condition after your claim is accepted, write to your insurer, identify the condition as being a new condition, and request formal written acceptance of the condition. Your insurer has 90 days to accept or deny the new condition claim. |
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| Nondisabling claim |
If your injury or illness is non-disabling and your non-disabling claim (also called medical-only claim) is accepted, your medical bills will be paid, but you won’t receive disability (time-loss) payments.
Contact your insurer if you believe your claim was mistakenly classified as non-disabling. You have one year from the date of injury to appeal this issue. Your appeal must first be in writing to the insurer. Within 14 days of receipt of your request, the insurer must issue a Modified Notice of Acceptance reclassifying your claim to disabling status. |
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A claim is non-disabling if all the following are true:
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You are able to return to work at full wages on or before the fourth calendar day after leaving work or losing wages as a result of your injury
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You don’t lose work time or wages later as a result of your injury |
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You won’t have any permanent disability as a result of your injury |
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| Dispute claim settlement |
When there is a disagreement between you and your insurer about whether you have a valid workers’ compensation claim, you and your insurer may agree to a cash settlement for the claim. If you agree to a cash settlement, your claim will be denied, and you give up all rights to future benefits for the denied medical conditions of the claim. If you have questions regarding disputed claim settlements, call the Workers’ Compensation Division or the Ombudsman for Injured Workers.
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| Claim disposition agreement |
| On an accepted claim, you may agree to accept money instead of present and future workers’ compensation benefits (with the exception of medical benefits, which cannot be given up). Accepting money instead of benefits from your insurer is called "compromise and release." The agreement you sign that tells you what benefits you’ve given up is called a "claim disposition agreement." Claim disposition agreements are reviewed by the Workers’ Compensation Board. The Board will notify you of its decision, usually after a 30-day waiting period. If you are represented by an attorney, the claim disposition agreement may include a provision to waive this 30-day "cooling-off" period; if so, you may expect approval within about 14 days after the Board receives the agreement. If you have questions regarding compromise and release or claims disposition agreements, call the Ombudsman for Injured Workers. Monies payable from a Claim Disposition Agreement are due within 14 days from the date approved by the Workers Compensation Board. |
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| Appeals |
| Many disagreements may be resolved informally. Some of the decisions made by your insurer, the WCD, or others may be appealed if you disagree with them. The documents you receive will have instructions on how to appeal the decisions. There are time limits for most appeals, and you will lose your appeal rights if you don’t appeal within those limits. If you need more information about hearings or special appeal rights under the workers’ compensation law, call the WCD or the Ombudsman for Injured Workers. The Workers’ Compensation Board Hearings Division also provides mediation services. |
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| Public records and your claim |
The claim your insurer has filed with the WCD isn’t open to the public under Oregon law; however, your insurer can get information about your past claims, including relevant medical information, in order to make decisions about your current claim. Government agencies also may use claim information as needed. You and your attorney have access to WCD claim information. Release of information about your claim for any other reason requires your written permission.
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| Medical benefits |
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| Who can be your attending physician? |
Your attending physician is in charge of your medical treatment. Only your attending physician can authorize your time-loss benefits. (In some rural areas, a nurse practitioner or physician’s assistant may authorize time-loss for a period not to exceed 30 days from the first visit).
Tell the doctor on your first visit that your injury or illness is job-related. The doctor must tell you if there are limits to the medical services he or she can provide under the Oregon workers’ compensation system.
You may select as your attending physician: a physician at the hospital or clinic treating you, your regular doctor, or another provider. In any case, the person you select must be qualified as an attending physician and must agree to direct your treatment. (If your employer is enrolled in a managed care organization, see Managed care organizations, below.)
Ask the doctor for Form 827, First Medical Report for Workers’ Compensation Claims. You and the doctor complete the form together and your doctor sends it to your insurer.
You may choose to change your attending physician two times. Generally, changes outside your control do not count toward your limit of three attending physicians. Additional changes require permission from your insurer or the WCD. If you are enrolled in a managed care organization (MCO), you may choose and change attending physicians as allowed by the MCO contract. (See Managed care organizations below.)
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| Managed care organizations (MCO) |
An MCO is health care provider (or group of medical service providers) who contracts to provide medical care to injured employees.
o If your employer is covered by an MCO contract, the insurer may enroll you with the MCO at any time after your injury, and you may be required to select an MCO physician. Your insurer will send you a notice of enrollment and give you a list of providers.
o Your regular doctor may or may not be authorized to treat you after you are enrolled with the MCO. However, until you receive a notice of enrollment, you may continue treatment with your regular doctor and your doctor is licensed in family practice, general practice, or internal medicine, your doctor may continue to treat you if he or she agrees to treat you according to the terms and conditions of the MCO.
If you have questions about your medical care, call your insurer.
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| Medical bills, prescriptions, travel and other expenses |
The insurer will refund some of your out-of-pocket expenses, including prescriptions and reasonable transportation costs, meals, lodging, and other charges for claim-related treatment. There are maximum amounts the insurer will refund. You must ask for this money in writing and provide receipts or other proof of expenses. If your claim has been accepted, your insurer is required to pay you within 30 days of receipt of your bill. In most cases, your request for reimbursement must be sent to your insurer within two years of the service.
Your insurer will pay for all necessary medical services during your recovery; however:
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Medical bills are not required to be paid until your claim is accepted. |
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Medical bills are usually not paid if your claim is denied, treatments are not related to your accepted condition, or treatments aren’t prescribed by your attending physician |
See below for information about medical benefits after claim closure. |
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| Disability benefits |
If you’re temporarily or permanently disabled due to your injury, you will receive payment from your insurer.
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Disability benefits usually are not taxable income. |
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You won’t have to repay benefits if your claim is denied. |
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If your insurer overpays you, the insurer may recover the overpayment by reducing your current or future disability payments, permanent partial disability benefits, or out-of-pocket expense payments. |
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If your wage varied prior to your injury, your insurer will average 52 weeks of wages paid to you by your employer to determine temporary disability payment rates. |
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Your insurer will mail a time-loss payment to you within 14 calendar days of the date you reported the claim to your employer. If you do not lose time from work right after your injury, but later become disabled, your time-loss check will be mailed within 14 calendar days from the date your insurer receives authorization from your doctor. |
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Your time-loss benefits will continue every two weeks until one of the following happens: |
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Your attending physician fails to provide the insurer with time-loss authorization.* |
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Your claim is denied. |
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You return to your regular job or a modified, light-duty job at full wages. |
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Your doctor gives you a written release to return to your regular job. |
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Your doctor approves a written offer of modified work at full wages that you are physically able to do, but you refuse to take it. |
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Your claim has been closed by a Notice of Closure or Determination Order. |
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Important: Your attending physician must provide the insurer with time-loss authorization before your insurer is required to make a payment of temporary disability to you. Time-loss cannot be authorized for more than two weeks in the past. If your attending physician tells you that you are unable to work as a result of your injury, you should ask your physician at each visit if time-loss authorization continues to be provided to the insurer. It would be of benefit to get something in writing from your doctor at each and every visit, even if the doctor states he/she is providing information to the insurer. |
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If your employer is self-insured, it may continue to pay your wages instead of temporary disability (time-loss) benefits. |
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| Waiting period for temporary disability benefits |
You will not be paid for the first three calendar days of total disability unless you remain totally unable to work for 14 days in a row or are admitted to a hospital as an inpatient within 14 days of the first onset of total disability.
You will not be paid for partial disability suffered during the first three calendar days after leaving work or losing wages. (See Temporary Partial Disability (TPD)). |
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| Temporary total disability (TTD) |
If your doctor says you are unable to work because of your injury, you may be eligible for temporary total disability benefits, also known as time-loss benefits. These benefits are based on your gross weekly wage, which is the amount you earn before deductions.
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TTD benefits must be authorized by your attending physician. |
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TTD benefit payments will equal two-thirds of your gross weekly wage at the time of your injury, up to a maximum equal to Oregon’s average weekly wage for all workers. If your weekly wage was $75 or less, your TTD rate will be 90 percent of your gross weekly wage or $50, whichever is less. |
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| Temporary partial disability (TPD) |
If you return to a modified light-duty or a part-time job that pays less than your regular job, you may receive temporary partial disability (TPD) payments while your claim is open.
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TPD payments will equal the percentage of gross wages lost multiplied by the TTD rate described above. |
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Your insurer will begin paying you TPD benefits instead of TTD benefits when your attending physician approves employment in a modified job that results in a reduced gross weekly wage and any of the following apply: |
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Your employer has provided you a written offer of modified work and has been approved by your treating physician. |
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Your employer would have offered you modified work if you hadn’t been terminated for cause (and your employer has a written policy of offering modified work to injured workers). |
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You are present in the United States in violation of federal immigration laws (and can’t legal work in the United States). |
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| Permanent partial disability (PPD) |
Permanent partial disability (PPD) means your injury caused a condition that hasn’t returned to your normal (pre-injury status), although you aren’t permanently and totally disabled. An award of permanent partial disability will be determined using standards set by the Oregon Legislature and WCD.
Scheduled disability is the loss of use or function of an arm, hand, leg, or foot, or the loss of visual or hearing ability. These body parts and functions are listed on a schedule with specific dollar amounts allowed for each part or for a percentage of loss of use for each part. All Oregon injured workers receive the same dollar amount per degree of disability for a given body part, depending on the date of injury, no matter what job they performed.
Unscheduled disability involves impairment of body parts or systems such as the back, hip, or respiratory system. In addition to impairment, unscheduled disability is determined by considering factors such as age, education, work history, and current ability to perform work.
If your PPD award is $6000 or less, your insurer will pay you a lump sum (a single payment) within 30 days of the date of the order.
If your PPD award exceeds $6000, your insurer will make monthly payments, the first due within 30 days of the date of the order. PPD monthly payments equal 4.35 times your weekly TTD rate at the time of the order. You may also request a lump sum of monies over $6,000. However, in doing so you give up your right to appeal the accuracy of the award and for increased impairment. Contact your insurer to request a lump sum payment. If your insurer objects to paying a lump sum, the Workers’ Compensation Division will decide the matter.
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| Permanent total disability (PTD) |
| Permanent total disability (PTD) means that due to your work injury or illness, you are permanently unable to do suitable and gainful work. You will receive monthly disability payments for the rest of your life if you remain totally disabled. Your insurer will re-examine your claim at least once every two years to see if you remain unable to work. |
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| Fatality |
| When a worker dies due to an on-the-job injury or illness, Oregon workers’ compensation law requires insurers to make monthly payments to the workers’ spouse and children. Additional benefits (including burial expenses are paid according to set standards. The insurer, the WCD, and the Ombudsman for Injured Workers can answer your questions about these benefits. |
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| Claim closure |
Your claim will be closed when your doctor finds that you are medically stationary, the work injury is no longer the major cause of your disability, or you fail to keep medical appointments. (If you are enrolled in a vocational training program your claim won’t be closed until your training ends.)
You will receive a document from the insurer closing your claim called a Notice of Closure. Your insurer will also send you an updated notice of acceptance, listing all of the medical conditions that your insurer has accepted, at the time your claim is ready to close. If you believe that a condition has been omitted from the notice, or the notice is otherwise incomplete or incorrect, you must notify your insurer of the error in writing.
The Notice of Closure will tell you the period of time for which you qualified for TTD or TPD benefits, the extent of your permanent disability, your medically stationary date, and the amount of your award, if any.
If you disagree with the Notice of Closure, you may appeal within 60 days from the issue date. The notice will explain your appeal rights, deadlines and forum for filing an appeal. |
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| Reconsideration of closure |
If your claim was closed on or after 6-7-95, and you disagree with the Notice of Closure, you must contact the Workers’ Compensation Division Appellate Unit and ask for a reconsideration within 60 days of the mailing date printed on the notice. Mail your appeal to the address shown on your notice of order.
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| Medical benefits after claim closure |
After claim closure, your insurer will continue to cover the costs of prescription medications, diagnostic care, curative care, life-preserving care, and some other services. You will also be covered for services provided if you are permanently and totally disabled. However, some medical costs are not covered after you are medically stationary.
Palliative care, a medical service that makes you feel better but doesn’t heal a medical condition, is covered only if one of the following applies:
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You are currently working and need the palliative care to continue working or to attend a vocational training program. Remember that palliative care must be preauthorized by the insurer before the services begin. |
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WCD preapproves the requested palliative care after your insurer has denied the requested care. |
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| Reopening of claim for a new condition |
| If your insurer accepts a new medical condition (related to your original injury) after your claim has closed, your insurer may be required to reopen your claim. If the newly accepted condition is not medically stationary, your claim will remain open until closed by a Notice of Closure or Determination Order. If the newly accepted condition is medically stationary, your claim will be closed immediately by the notice of order. |
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| Reopening of claim if your accepted conditions worsens |
If your condition gets worse after your claim is closed, you may file a claim for aggravation within five years of the first closure of your claim.
If your injury was originally non-disabling and remains non-disabling for more than one year, you may file an aggravation claim within five years after the date of your injury. To file an aggravation claim, you and your doctor must sign and complete Form 827 marking the aggravation box. Your physician must send this form along with his medical reports.
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| Return to work |
Your physician will tell you and your insurer when you are released to return to work. Your insurer will send you written notice that your physician has released you to go back to work. By law, you must ask your employer for your job or another suitable job within seven calendar days after you receive this notice from your insurer. If you don’t do this, you may lose your right to re-employment with your employer.
Your employer may be breaking the law if he or she fires you or refuses to take you back because of your on-the-job injury or illness.
Oregon civil rights laws may require the employer to give you back your regular job. If your regular job no longer exists or you can no longer do that job, your employer may be required to offer you another suitable job. If you have questions about reinstatement rights or believe you have been unfairly treated by your employer because of your injury, call the Bureau of Labor & Industries at 503-731-4075 (Portland area) or 541-686-7623 (outside the Portland area). |
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| Vocational assistance |
You may qualify for vocational assistance if all of the following are true:
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You have permanent disability. |
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You cannot return to your regular job or any other job that pays at least 80 percent of your wage at the time of your injury or aggravation. |
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You are authorized to work in the United States. |
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Your insurer will decide if you are eligible for vocational assistance within 35 days of the date you become medically stationary and tell you its decision in writing. If you disagree with your insurer’s decision, or if your insurer does not determine your eligibility, you may contact the Workers’ Compensation Division, Rehabilitation Review Section. Vocational assistance may include job placement services and training. If you need help getting back to work, call your insurer and ask for vocational assistance.
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| Help from WCD reemployment assistance programs |
Oregon has two other programs to help you go back to work:
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The Employer-at-Injury Program helps Oregon’s qualified injured workers stay on the job or get back to work with the employer at injury. Because of your injury, your employer may be eligible for financial assistance to return you to light-duty work while your claim is open. To find out whether you qualify, contact your insurer or the Workers’ Compensation Division at 1-800-445-3948 (in Oregon only), (503) 947-7588 or (503) 947-7993 (TTY). |
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The Preferred Worker Program helps Oregon’s eligible injured workers get back to work. If you have permanent disability as a result of an Oregon compensable injury and your attending physician had determined you won’t be able to return to the job you performed at the time of your most recent claim opening, you may qualify as a Preferred Worker. Preferred Workers may receive re-employment assistance that includes premium exemption, wage subsidy, worksite modification, and obtained employment purchases. If you qualify, you will receive a Preferred Worker identification card that’s valid for three years. Contact the Preferred Worker Program by calling 1-800-445-3948 (in Oregon only), (503) 947-7588 or (503) 947-7993 (TTY). In Southern Oregon call the Medford area representative at (541) 7746-6032. |
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| State of Oregon Vocational Rehabilitation Division (VRD) |
| If you are not eligible for vocational retraining assistance by the workers’ compensation insurer, you may be eligible for services from the State of Oregon Vocational Rehabilitation Division. Contact your local State of Oregon VRD branch. You can find them in the government pages of your telephone directory. Lane County (541) 726-3541; Marion/Polk County (503) 378-2483; Linn County (541) 967-2022; Douglas County (541) 440-3371 Coos County (541) 269-4560. |
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| Workers’ compensation reference websites: |
| WCD: http://www.cbs.state.or.us/external/wcd/ |
| DCBS: http://www.cbs.state.or.us/ |
| WCB: http://www.cbs.state.or.us/external/wcb/ |
| Ombudsman for injured workers: http://www.cbs.state.or.us/external/wco/ |
| VRD: http://vrdweb.hr.state.or.us/ |
| State of Oregon: http://www.state.or.us/ |
| BOLI: http://www.boli.state.or.us/ |
| OR-OSHA: http://www.cbs.state.or.us/external/osha/ |
| Oregon Employment Division: http://www.emp.state.or.us/ |
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