Are you suffering from a work-related injury or illness? Depending on the circumstances of your injury, you may be entitled to financial benefits. If you’re one of the thousands of employees that need to take time off work to seek medical treatment, or you’ve developed a temporary or permanent disability as a result of your injury, then filing a workers’ comp claim is the most effective way of getting the support you need.
Unfortunately, the process of filing a claim can be confusing and frustrating; that’s where we come in. It’s easy to feel alone when you’ve suffered a work-related injury or illness, but you don’t have to. The attorneys at Ransom, Gilbertson, Martin, and Ratliff, LLP are highly knowledgeable about workers’ compensation law in Oregon and how best to argue your case. When it comes to receiving the compensation you deserve, having dedicated, expert representation is essential.
This article is designed to give you a detailed, step-by-step guide to filing a workers comp claim so that you can be prepared and informed about the process.
What is a Workers’ Compensation Claim?
Workers’ compensation is a type of insurance that protects employees’ financial interests in the event that they suffer a work-related injury or illness. If you’ve suffered from a physical injury, medically significant psychological or emotional distress, or have developed a debilitating disability or condition while on the job, then you are entitled to workers’ compensation. Workers’ comp benefits include:
- Medical expenses
- Lost wages
- Vocational rehabilitation
- Permanent disability
- Death benefits for spouses and dependent children
Private employers are required by law to purchase workers’ comp insurance and cannot legally deny you your right to file a claim. Nearly all Oregon workers are eligible for workers’ compensation, excluding independent contractors and federal government workers.
Step 1: Report Your Injury or Illness to Your Employer as Soon as Possible
The first step is notifying your employer of your injury or illness. Once you do this, your employer should provide you with the 801 “Report of Job Injury or Illness” form.
Under Oregon law, injuries and illnesses covered under workers’ compensation include 1) traumatic injuries and workplace accidents such as head trauma, burns, or back injuries that require medical intervention or time off work and 2) overuse injuries and occupational disease like carpal tunnel, hearing loss, or arthritis. In the case of a workplace accident or traumatic injury, you must notify your employer within 90 days of the incident; however, this does not apply to overuse injuries or occupational disease. In these cases, the injury or illness should be reported as soon as possible after diagnosis or knowledge of the work-related issue.
Step 2: Fill Out the Proper Forms
Once you receive the 801 form from your employer, you must use it to describe your injury or illness and its circumstances. It’s also advised to collect supporting documentation with witness testimonies, medical test results, x-rays, and other related evidence. You can file this supporting documentation, along with the 801 form, to strengthen your case and increase the likelihood of your claim being accepted by the insurer.
Alternatively, you can also request an 827 “Worker’s and Physician’s Report for Workers’ Compensation” form from your doctor. Your physician will be able to help you fill out the form and can send it to your insurer within 72 hours.
If your employer does not provide you with the proper form, you can download a copy of it from the state’s website.
Step 3: Your Employer Will File the Claim
Once you fill out a copy of form 801, your employer has 5 days to file the claim to the insurer. If your employer fails to file the claim within the designated time frame, they are breaking the law. An employer cannot legally deny you the right to file a claim. However, you can also file the form directly to the insurer if necessary.
It is also recommended that you collect supporting evidence for your claim. Collect any relevant witness testimonies and include medical documentation such as:
- Test results
- Physicians notes
- Medical records
Your employer will include this supporting documentation when filing your claim.
Step 4: Enlist an Attending Physician
You must also select a qualified medical doctor to oversee the treatment of your injury or illness. In most cases, the insurance company will allow you to select your own physician. However, in some instances, the company will require a doctor under a managed care organization (MCO) panel.
Step 5: Your Claim Will Be Investigated
The vast majority of workers’ comp claims are legitimate and are upheld; however, insurance companies still have to investigate your claim before you can receive benefits. They will conduct their workers’ comp investigation by taking a statement from you and any relevant witnesses. They will also choose a physician to conduct an independent medical exam to confirm your claim. Keep in mind that companies will sometimes choose doctors that have a bias against your particular injury or illness to avoid giving you benefits. Our job is to fight for your interests and prevent companies from short-changing you or wrongfully denying your claim.
Step 6: Your Claim Will Be Approved or Denied
The insurance provider has 60 days after your employer’s knowledge of the incident to approve or deny your claim. You will receive a written notice of their decision.
What To Do If Your Claim Has Been Approved
If your claim is approved, you will be sent a 1644 “Notice of Approval” form that will detail the conditions and benefits covered. Most workers are entitled to receive their first payment within 21 days of approval. In some cases, you’ll receive approval for certain benefits and not others. If you’ve been denied a benefit that you need, we can help get you the support you’re entitled to.
What To Do If Your Claim Has Been Denied
If your claim has been denied, you will receive a letter explaining the decision. Even in the event that your claim is denied, you still have options. You can appeal the decision and request a hearing to prove your claim. You should reach out to an experienced lawyer to advise and represent you throughout the appeals process. A lawyer with extensive experience and knowledge of workers’ compensation laws and proceedings will significantly increase your chance of a successful appeal.
Begin the Workers’ Compensation Claims Process with RGMR
When you’ve suffered a workplace injury or illness, it’s not uncommon to feel alone or taken advantage of. Unfortunately, there are many cases of employers and insurance companies trying to deny workers the benefits they deserve. At Ransom, Gilbertson, Martin, and Ratliff, LLP, we understand how difficult and taxing this process can be. We have over 70 years of combined experience with workers’ comp cases. We’re here to offer you expert representation and fight for your interests.
We offer completely free consultations and won’t charge you anything unless we win your case! Contact us today to get the representation you deserve.