It is important to realize that changes may occur in this area of law. This information is not intended to be legal advice regarding your particular problem, and it is not intended to replace the work of an attorney.
Nearly every worker in Oregon is covered by workers’ compensation
insurance. (Exception: If you work for the federal government or are
engaged in maritime employment, you would not receive state workers’ compensation
benefits. Other benefits would be available to you instead.) Oregon
workers’ compensation insurance pays for medical expenses and
provides compensation when you lose time from work or suffer a permanent
disability from an accident or disease arising out of your employment.
It may also provide vocational assistance.
If you have experienced a work related injury or disability, you should
give your employer written notice of your claim stating when, where
and how your injury occurred. Your employer will send the notice to
its workers’ compensation insurance company. Usually, your employer
will have a special form that you can use. You should file your claim
as soon as possible because if you delay too long you may be denied
benefits. There are certain deadlines for filing your claim. Your employer
cannot refuse you the right to file a claim, and the law prohibits
your employer from firing or discriminating against you for filing
a claim.
You may choose your own Oregon doctor, or you may have to choose from
a list of doctors provided by the insurer. If you are not happy with
the doctor, you may seek another. One hundred percent of your medical
expenses related to your injury will be paid by your workers’ compensation
insurance. Your workers’ compensation carrier must either accept
or deny your claim within 60 days from the day your employer had notice
of your claim.
If you lose more than three days in a row from work or are hospitalized,
you are entitled to receive money to compensate for your lost wages
within 14 days of the day your employer had notice of your claim. The
amount of money you receive will depend on your average weekly wage.
It probably will be close to two-thirds of your gross salary tax-free,
up to a maximum amount set by the legislature. Your wage reimbursement
checks will continue to be paid to you every two weeks, until your
doctor releases you to return to work. If you return to regular work
without a doctor’s release, if your claim is denied or if you
receive an order from the workers ’ compensation department or
your insurer closing your claim, your checks for time loss also will
stop.
If your claim is denied, you may appeal this denial by asking for a
hearing. You must ask for a hearing within 60 days or you risk losing
all of your rights under the Workers’ Compensation Act.
If you ask a lawyer to help you contest the denial, you will not have
to pay for the lawyer’s professional services, although you will
be responsible for out-of-pocket costs. The lawyer cannot charge a
fee that is not approved by the Workers’ Compensation Board or
the court. If you win your case on the insurance company’s denial,
the insurance carrier will have to pay your lawyer. If you lose and
the denial is upheld, you will not owe the lawyer for professional
fees.
If your claim is accepted, it will remain open until you are medically
stationary. When you are medically stationary, your claim will then
be closed. If you have suffered any permanent disability, you will
be entitled to receive additional compensation called permanent partial
disability, or “PPD.” The amount of compensation depends
on the date of your injury and the body part injured. If you are not
happy with the amount of your PPD, you may appeal within 60 days from
the date your claim is closed by asking for reconsideration. If you
ask a lawyer to help you get increased compensation, the lawyer will
charge you 10 to 25 percent of any increase you actually receive. If
you do not receive any increased compensation, you will owe your lawyer
nothing except for out-of-pocket costs he or she has paid on your behalf.
After your claim is closed, you may receive medical care. However,
some medical services may not be covered. If your condition becomes
worse within five years after your claim is first closed, resulting
in increased disability, you may have your claim reopened for additional
compensation including time loss if you miss work. Any request to reopen
your claim should be in writing and sent to the insurance carrier with
a report from your doctor. After five years, your rights are much more
limited.
While your rights under the Workers’ Compensation Act are generally
your only remedy against your employer for a work-related injury, you
may have additional remedies against other persons who are responsible
for your injury.
Legal Editor: Jennifer R. Roumell, April 2008