If you are injured at work in Oregon, you can file a workers' compensation claim. Your workers' comp claim, if allowed, will entitle you to various benefits depending on your circumstances, including payment for medical treatment, lost wages, and physical impairment resulting from your workplace injury.
Workers' compensation covers all injuries and illness that happen in the course of employment. This includes sudden events—such as a slip and fall or a strain while lifting—and occupational diseases, such as cancer from exposure to asbestos. Basically, if you require medical treatment for an injury or condition resulting from your employment, you likely have a workers' compensation claim. (For more information, see What Injuries Aren't Covered by Workers' Comp?)
If you have sustained a workplace injury, you should immediately notify your employer. You will also need to file a workers' compensation claim. Ask your employer for Form 801, which you can use to report your workplace injury. If your employer does not provide it, you can download a copy online at the Oregon Division of Workers' Compensation website.
When you get treatment for your work injury, tell your doctor that your injury is work-related. You and your doctor will then complete Form 827, and your doctor will send it to your employer or its workers' comp insurer. Your doctor must report your workplace injury within three days.
Your employer must accept or deny your claim within 60 days of receiving notice of your claim. If your claim is accepted, the insurance company will send you a "Notice of Acceptance," listing the medical conditions accepted under your industrial claim. If your claim is denied, the insurance company will notify you of the denial.
If your claim is accepted, you can receive a variety of benefits, including temporary disability benefits for your time off work and permanent disability benefits for any permanent impairment caused by your work injury.
If you need time off while recovering from your workplace injury, you can receive weekly temporary disability payments. Temporary disability benefits are two-thirds of your gross average weekly wages, up to a maximum set by state law each year. As of July 1, 2016, the weekly maximum is $1,295.69 per week.
To determine your average weekly wage, the insurance company will add up your wages from the previous 52 weeks and divide by 52.
If you are permanently disabled due to your industrial injury, you will receive additional workers' compensation benefits.
If you have a permanent disability that prevents you from working in any capacity, you have a permanent and total disability. You will receive two-thirds of your average wages, up to a maximum of $974.20 per week (as of July 1, 2016) for as long as you remain totally disabled. However, your employer will reexamine your claim about every other year to verify that you are not able to work.
If you are partially disabled, meaning that you have a permanent impairment but are still able to return to work in some capacity, you will receive a permanent partial disability award. The amount of your award depends on the severity of your injury and the impairment rating assigned by your doctor. (To learn more, see How Are Permanent Partial Disability Benefits Calculated?)
If the insurance company is disputing the severity of your injuries, you may request a worker-requested medical examination from the Oregon Workers' Compensation Division. These examinations are typically allowed only when your claim was denied on the basis of an independent medical examination (IME)—an examination requested and paid for by the employer or its insurance company.
Your request for a worker-requested medical examination must be in writing and sent to the Oregon Workers' Compensation Division, with a copy to your employer or its insurance company. The request must include:
The results of this examination, if favorable to you, may result in your claim being accepted. You should strongly consider retaining an attorney to assist you in this process.
When your claim is closed, you will receive a Notice of Closure. If you disagree with your claim being closed, you may appeal to the Workers' Compensation Division within 60 days of the mailing date on the notice. Send a Request for Reconsideration Form stating the reasons you disagree with the claim closure to the address on the back of the Notice of Closure.
The Appellate Review Unit of the Workers' Compensation Division will send a letter to all parties stating the review process has been initiated. You may submit, in writing, a statement of your position to your reviewer. If you choose to do so, state the reasons you believe your claim should not be closed, along with the specific medical evidence to support your position.
The Workers' Compensation Division will then issue an Order on Reconsideration. If you are not happy with the result, you may appeal with the Workers' Compensation Board (see Appealing a Workers' Compensation Denial below).
If your claim is accepted, you and your employer may enter into a Claim Disposition Agreement. This is a settlement agreement in which you agree to a lump sum of money in exchange for giving up certain rights to workers' compensation benefits.
Alternatively, if your claim is denied, you and your employer may agree to a Disputed Claim Settlement. This involves accepting a lump-sum payment in exchange for your giving up all rights to future benefits for the denied claim. If you have questions, you may contact the Ombudsman for Injured workers at (800) 927-1271.
To appeal a denial, you must file a Request for Hearing form with the Workers' Compensation Board within 60 days of the denial. An administrative law judge (ALJ) will review evidence, hear testimony, and make a decision in your case. While you are not required to have an attorney, the Workers' Compensation Board strongly recommends that workers hire attorneys for their hearings. (For more information, see Do I Need a Lawyer to Get Workers' Compensation Benefits?)
If you disagree with the ALJ's decision, you can file an appeal with the Court of Appeal within 30 days. The Court of Appeal will not accept new evidence. Rather, it will review the record of your initial hearing and review the ALJ's decision for any errors of law. If you are not satisfied with the Court of Appeal's decision, you may appeal to the Oregon Supreme Court. This final level of review is discretionary, meaning that the Supreme Court can decline to hear your case. A lawyer is also strongly recommended for court appeals.