Oklahoma Workers’ Compensation Claims: Eligibility, Filing, and Appeals
Learn Oklahoma's rules for receiving workers' compensation.
As in every other state, the workers’ compensation system in Oklahoma is a no-fault system designed to compensate injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must take certain steps required by Oklahoma law.
Which Employers Must Have Workers’ Comp Insurance?
Until recently, nearly all employers in Oklahoma were required to carry workers’ compensation insurance for their employees. However, in 2014, a new law went into effect that gave employers another choice. Qualified employers may now opt out of the workers’ comp system and create an alternative benefit plan, with the approval of the Oklahoma Insurance Commissioner. The alternative benefit plan must comply with the Employee Retirement Income Security Act (ERISA)—a federal law governing employer benefit plans—and it must provide the same amount and duration of benefits as the Oklahoma workers’ comp system (benefit amounts are described below). However, employers have more leeway in setting reporting requirements, controlling medical care, and defining covered injuries and illnesses.
The rules described in this article apply to employers that have not opted out of the Oklahoma workers’ compensation system. If your employer has opted out, ask your supervisor or HR department for the rules of its alternative benefit plan.
Who Is Eligible for Workers’ Comp Benefits?
Workers’ compensation covers all injuries or illnesses that happen in the course of employment. In general, injuries that happen while you are performing your work duties or running work errands are covered by workers’ comp. On the other hand, injuries that occur while you’re off-duty are generally not compensated through workers’ comp. For example, if you were injured during your lunch break or during your commute to and from work, you will typically not be covered by workers’ comp. For more information, see our article on what types of injuries are covered by workers’ comp.
Workers’ comp covers both traumatic injuries and occupational diseases. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, such as injuries caused by repetitive movements at work (such as carpal tunnel syndrome) or illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).
What Should I Do if I’m Injured at Work?
If you’re injured at work, you should notify your employer and get medical treatment right away. In Oklahoma, if you suffered a traumatic injury from a one-time event, you must give your employer notice within 30 days of the incident. Otherwise, you risk losing your right to collect workers’ compensation benefits. For occupational diseases and repetitive motion injuries, you must give notice to your employer within 30 days of separating from your employer. In most cases, though, it’s best to give notice immediately after your injuries occur.
Once you give notice of your injuries, your employer must fill out a form called the “Employer’s First Notice of Injury” within ten days, file it with the state workers’ compensation agency, and send it to its insurance company. The insurance company has 15 days to provide you with notice if it is denying your claim.
How Do I Get Medical Treatment?
In an emergency, you can choose which doctor or hospital to seek treatment from. At your initial appointment, be sure to explain how your injuries happened and that they are work-related. For all non-emergency care, your employer has the right to select the treating physician. However, if your employer fails to get you treatment within seven days of receiving notice of your injuries, you may select your own treating physician.
What Benefits Can I Receive?
All reasonable and necessary medical treatment will be covered through workers’ comp, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You’ll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive temporary disability payments and a permanent disability award.
You will be eligible to receive compensation for wage loss during the time you are temporarily disabled and unable to work. Temporary total disability payments are 70% of your average weekly wages, subject to a maximum weekly amount set by law.
Prior to February 1, 2014, the maximum weekly amount was 100% of the state average weekly wage. However, for injuries occurring on or after February 1, 2014, the maximum weekly amount is 70% of the state average weekly wage, which is a significant decrease. This amounts to a maximum weekly benefit of $589.33 (as of November 1, 2015). For a list of state average weekly wages in previous years, see the Oklahoma Employment Security Commission website.
You can continue to receive temporary total disability benefits until your doctor finds that you’ve reached maximum medical improvement (MMI), meaning that your condition has plateaued and is not expected to improve. Prior to February 1, 2014, these benefits were available for a maximum of 156 weeks. For injuries on or after February 1, 2014, these benefits are capped at 104 weeks.
If you’re able to return to part-time or light-duty work while you’re recovering, but earn less than your normal wages, you will eligible for temporary partial disability benefits if your weekly wage for the alternative work is less than what you would receive in temporary total disability benefits. Temporary partial disability benefits are 70% of the difference in your average weekly wages.
Permanent total disability benefits are available only to workers with severely debilitating injuries. In general, workers are considered totally disabled only if they cannot return to their jobs and other work is not reasonably available to them. If you are found to be totally and permanent disabled, you will receive 70% of your average weekly wages. Permanent disability is subject to weekly maximum of 100% of the state average weekly wage. As of November 1, 2015, the weekly maximum is $841.90.
Permanent total disability benefits are available for as long as your disability continues and until you reach the age of maximum social security retirement benefits or 15 years, whichever is longer.
For most other workers, permanent partial disability benefits are available. In Oklahoma, these benefits are called “permanent partial impairment” (PPI) benefits. PPI benefits are 70% of your average weekly wages, up to a maximum of $323 per week. The duration of benefits depends on the body part affected and the impairment rating assigned to you by your doctor. For injuries to certain body parts, such as arms, legs, fingers, toes, eyes, and ears, Oklahoma has a state schedule, which lists the maximum number of weeks that a worker can receive PPI benefits for each body part. For example, the state schedule lists that a worker can receive 66 weeks for total loss of use of a thumb. If your doctor finds that you a have a 100% impairment to the left thumb, you can receive benefits for 66 weeks
For injuries that are not listed on the schedule, such as injuries to the spine or organs, the number of weeks is measured by impairment to the body as a whole. Prior to February 1, 2014, the maximum number of weeks for a 100% whole body impairment was 500 weeks. For injuries on or after February 1, 2014, the maximum is 350 weeks.
Workers can also receive up to $50,000 for serious and permanent disfigurement to a body part that has not already been compensated through a PPI award.
What if My Claim Is Denied?
If your workers’ comp claim has been denied, or the insurance company is disputing any portion of your claim, you have the right appeal. For injuries prior to February 1, 2014, you must file an appeal with the Oklahoma Workers’ Compensation Court of Existing Claims. For injuries on or after February 1, 2014, you must file your appeal with the Oklahoma Workers’ Compensation Commission.
For more information on the appeals process, see our article on appealing a denial of your Oklahoma workers’ comp claim.