Welcome to our Oregon Workers Compensation blog. First, a little bit about us. As Butch said to Sundance "Who are those guys?" I have been representing injured workers in Oregon since 1976. The new addition to the firm Evohl Malagon, has more experience than I do.
Enough about us, you are reading this to learn about the Oregon Workers Compensation law. Let's start with some basics
It is mandatory.
Oregon has a mandatory law. That means your employer has to comply with the law that requires them to have workers compensation coverage. An employer can comply by one of three ways:
- First, they can buy workers compensation insurance from a private insurance company, Liberty Mutual, Travelers, etc.
- Second, they can insure themselves e.g. Weyerhaeuser, Georgia Pacific, Legacy, etc. and either administer their own claims or hire a company to administer them for them (Pinnacle, Sedgwick, Esis, etc.) or they can buy insurance from SAIF.
(SAIF is a state owned insurance company because it is the "State" doesn't mean anything. It doesn't have any more rights, responsibilities or power than other insurance company in Oregon.) These days employers sometimes go without workers compensation coverage. They are non-complying employers. They have not complied with the law. If you are hurt working for a non-complying employer, no worries, just a few more steps to get the claim going.
How to file a claim
All claims start the same. You give your employer an 801 form that can be found online at the Oregon Workers Compensation Departments website.
You can also fill out a form 827 at the medical providers office. You fill out the top part they fill out the rest send it to your employers workers comp insurer or claims processor, and as the French say; voila' you have filed a claim.
If your employer is a non- complying employer or (NCE) then the claim is send to the Oregon Workers Compensation Division Compliance section . They contact you and determine that you are a covered worker, and your employer should have workers comp insurance and they then send it to their processing company to process it, you are paid benefits out of a state fund. You get the same benefits as if your employer was covered.
For your employer being an NCE is a very bad thing, because they get penalized by the state for not having coverage. They have to pay all the costs of the claim that the state paid. An NCE also loses its immunity from suit. The general rule is that if an employer has workers compensation coverage, they can be as negligent as they want in injuring you and you cannot sue them. You get workers compensation benefits regardless of fault and in return have given up your right to sue your employer.
This Oregon Workers compensation law I am talking about. If you are member of a crew of a vessel you can sue your employer under the Jones Act and the general maritime law for un-seaworthiness. If you are working for a railroad you can sue your employer under the Federal Employers Liability Act or FELA.
So there are exceptions to not being able to sue your employer. There are also some exceptions for workers covered under the Oregon Workers Compensation law that we will discuss in future blogs when your employer intentionally injures you or the employer is negligent in injuring you and your claim is denied because you cannot prove the major contributing cause (51%) was the employment injury or exposure.
Claim Processing
Posted by: euser
December 06, 2012
Topic: Workers Compensation
You have filed the claim by either giving a copy of the 801 form to your employer, or filling out an 827 form at the doctor's office.
The insurer, or claims processor, has 60 days to accept or deny the claim. If your doctor has taken you off work, be sure you get an off work slip or that the off work authorization is filled out on the 827 form. Give either one to the insurer and your employer. If you are off work for more than 3 days while they are processing the claim, the insurer has to pay you interim compensation benefits. They have 14 days to pay you 2/3rds of what you were making at the time you were hurt. They will pay you every two weeks. Workers' compensation benefits are tax free. If they have the time loss authorization and don't pay on time they can be subject to a penalty that is paid to you of up to 25% of what is paid late, and they have to pay your attorney a reasonable. fee.
During the initial 60 days the insurer will usually want to take your statement seeking information about what caused you to file a claim. You do not have a right to remain silent. Yes, criminals have more rights than injured workers. If you do not cooperate with their claims investigation they can deny your claim for non-cooperation. You do have the right to be represented by a lawyer at any time at no cost to you. The statement will be recorded. Sometimes employers or insurers hire lawyers and want to take your deposition. A deposition is a sworn statement under oath in front of a court reporter.
They may also send you to an "Independent" Medical Exam or IME for short. Again you have no right to refuse. The IME doctor will take your history, have you fill out paperwork and examine you. You can bring someone along as a witness unless it is a psychological IME. If you want to learn more about the IME process see http://www.cbs.state.or.us/wcd/communications/publications/3923.pdf .
Within 60 days the insurer or claim processor must accept or deny your claim. You will receive a letter, both regular mail, and certified mail if the claim is denied. On the bottom of the letter it will in bold print tell you have the right to request a hearing before the hearings division of the Workers Compensation Board. You only have 60 days to request a hearing on a denied claim. If by your claim has been denied and you have not contacted a lawyer to represent you do it now. It doesn't cost you any more to have a lawyer the day after you are hurt than it does after the claim is denied. Lawyers only get paid if they get you something more than what you are going to get anyway. Even then, the fees are limited to percentages of the increase in benefits or amount of the settlement. In other cases, the insurer has to pay your lawyer's fees.
If the claim is accepted you will get a letter called a Notice of Claim Acceptance. On that letter will be listed some medical conditions. The insurance carrier can pay for treatment for conditions not on that letter without accepting them. Just because they pay for it doesn't mean they have accepted it. If you have other medical conditions resulting from your injury or occupational exposure that what are in their letter no worries. You can make a claim for new conditions at any time. Also check whether your claim is classified as disabling (meaning you missed time from work or permanent impairment is anticipated), or non-disabling. If your claim is non-disabling you have 1 year from the initial acceptance to ask the insurer to re-classify your claim to disabling.
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December 06, 2012
Claim Processing
