Frequently Asked Questions Regarding Workers’ Compensation for Residents in Oregon
Can I sue my employer if I get hurt on the job?
If you are hurt while on the job, you cannot sue your employer for the injury. This is what a workers’ compensation claim is for. If your work injury was caused by someone or something other than your employer (such as a defective product or an employee from a different company), you may have a right of action against the ‘third party.’
How do I know whether I’m covered by workers’ compensation?
Oregon requires all employers to carry Worker’s Compensation insurance for their employees. If an employer fails to carry Worker’s Compensation insurance, the worker’s claim is assigned to a substitute insurance carrier to provide benefits. Further, if an employer fails to carry insurance, you can also sue the employer. Sometimes, employers say a worker is an independent contractor in order to escape liability, but many who are called independent contractors are still covered.
Can my employer tell me where to get medical treatment?
No, your employer cannot dictate where you receive your medical treatment. You have the choice to select your own treating doctor. If you seek treatment with a chiropractor or nurse practitioner, there are some limitations. If your claim is accepted, you may be enrolled in a managed care organization (MCO). At that point, you can continue with the same doctor if that doctor agrees to the MCO terms, or you can choose a doctor from the MCO provider list. Whenever you go to a doctor, the doctor should complete a Worker’s Compensation Physicians Report and put in writing if you are excused from your regular work.
Do I have to follow up with the doctor that I am directed to at an urgent care clinic or the emergency room?
If you originally seek treatment at an urgent care clinic or emergency room, you will likely be directed to a follow-up appointment with a specific doctor. You have no obligation to follow up with that doctor; you can choose another doctor for your follow up. Your attending physician is very important to your claim, so it’s important to find a doctor you trust.
What if I get injured on the job but I’m not sure I want to file a workers’ compensation claim?
If you are injured while working, and you do not plan on filing a workers’ compensation claim, you should document an injury sustained on the job in writing with your employer and notify a supervisor as soon as possible. While a minor injury may not present immediate issues, you will protect your right to file a workers’ compensation claim in the future.
Can I return to work while my claim is pending?
Your attending physician will recommend care and determine when you are able to return to work. If your attending physician recommends modified work with restrictions you should provide the restrictions to your employer, and ask them to provide a modified job offer in writing for your doctor to review. If your doctor has approved a modified work offer, you must return to it or risk losing Worker’s Compensation benefits.
What happens if my workers’ compensation claim is denied?
If your claim is denied, you should consult with a lawyer. There is a strict 60-day deadline for requesting a hearing on a denial. Many denials are issued incorrectly. For helping you with a denied claim, a lawyer is paid only by winning the claim by the insurance company who made the wrongful denial. If you do not win the hearing, there is no charge to you.
What if my doctor takes me off of work for my injury?
If your attending physician takes you off of work, he must put that in writing. Then, the insurance must pay temporary disability benefits. These benefits should be 66% of your average weekly pay, and they are not taxable. Temporary disability benefits are also paid if you’re attending physician has you on modified work and the employer has not made a written offer of modified work. In order to be sure to receive temporary disability benefits, you should ask your doctor to provide in writing your work restrictions each visit.
If I am offered a modified or light duty job by my employer, do I have to take it?
Your employer may offer you modified work and pay you a wage when your doctor releases you to modified or restricted work. If you do not begin the available modified employment, the insurance company does not have to continue paying time loss benefits.
Modified work must meet certain requirements. Your doctor must approve the modified job and your employer must provide you with notice of the work offer. There are some limited situations where the obligation to accept the modified job is nullified: if the job is further than 50 miles from your residence or where you were injured (unless you had multiple or mobile work locations at the time of the injury) or if the modified job is not with your employer at the time of injury or at a worksite of your employer at the time of injury.
I’m doing modified work for my employer but what do I do when they give me work beyond my restrictions?
This is a common problem, and the best way to handle this is to have a copy of your doctor’s work restrictions at your place of work. If your employer asks you to do work that is outside your restrictions, you can reference your work restriction paperwork. Make it clear you want to do modified work but you cannot physically do what is being asked of you. It’s important to discuss with your physician about any problems you are having. Your doctor can clarify your work restrictions or further restrict the work you are released to do. Note: it’s important that your doctor and employer do not think you don’t want to work. Your claim could have issues if your doctor thinks you’re trying to avoid work.
What if my modified job pays less than what I earned at my regular job? Am I still entitled to time loss?
If you are earning less than you were before your injury either due to working less hours or earning less per hour than before your injury, you’re entitled to additional time loss benefits for the difference between your average weekly wage and your post-injury earnings.
What is my temporary disability pay rate based upon?
Temporary disability is paid at a rate of 66% of your average weekly wage. This is based on the job you are working at the time of your injury. To determine the average, use up to 52 weeks prior to the work injury of the wages, including overtime and performance-based bonuses. If your job had changed in the 52 weeks prior to your injury you would use only the wages earned at the new position. Also, exclude any extended gaps, such as prior medical leave, from the calculation. If you think you’re being paid less than what you are entitled to contact a lawyer for assistance.
What if I can’t do the same kind of work activities I could do before my injury?
If you have a permanent impairment, you may be entitled to a permanent disability award. This happens when you have finished treatment for your injury, and is presented in a document titled Notice of Closure. It is important to understand that this document does not mean an end to your claim. After closure, claims can be opened and closed as many times as needed.
The permanent disability award is based upon impairment measurements made by your attending physician, and your ability to return to work activities. It is very important that if you are not returning to your full regular job, with all the things you used to do, that your doctor writes this the final release. This simple note of the release can means tens of thousands of dollars more compensation.
What if I can’t do the job I was doing at the time I was injured?
You may be entitled to a work disability award if your attending physician determines that you are unable to do some of the aspects of the job you were doing when you were injured. The insurer may ask you to review a description of the work you were doing when injured – you should ensure it is accurate, especially regarding the weight you had to lift prior to the injury. Inaccurate job descriptions can negatively impact your award.
What should I do if my medical bills aren’t being paid?
If you have an accepted workers’ compensation claim, workers’ compensation insurance should pay all your medical bills and should reimburse you for travel to all your medical appointments and pay for your prescriptions. If you receive notice that your bills are not being paid, you should contact the lawyer for assistance. Oregon law prohibits collection actions against injured workers based upon medical bills.
What does claim closure mean?
Disabling claims are open while you recover from your injury. They must be ‘closed’ when you are medically stationary. If your claim has been classified as disabling injury, the insurer will issue a “Notice of Closure.” A Notice of Closure is a legal document that closes your claim. It will list the periods time loss was authorized and tells you how much permanent disability you may have. An Updated Notice of Acceptance at Closure is a letter that tells you what medical conditions have been accepted and what conditions have been denied. Permanent disability will be determined by the accepted conditions.
If the updated notice is incorrect or incomplete, you must notify the insurer in writing. If you disagree with your claim closure, you have the right to appeal by asking the Workers’ Compensation Division for reconsideration. You must ask for the reconsideration within 60 days from the mailing date printed in box 1 of the front of your notice of closure.
Can I reopen my claim after it has been closed?
Yes, you can open your claim if your accepted conditions get worse. This is called an aggravation claim and must be filed by the attending physician. You can also open a closed claim if you develop an additional problem related to the accepted conditions or injury. This is called a new or omitted medical condition. Even though it is said that aggravation rights expire after five years, this is a mere technicality. There is no real time limit on reopening your claim.
Do I still get benefits after receiving a Notice of Closure?
The Notice of Closure is merely an end to an open period of the claim. The claim continues beyond the closure. In the Notice of Closure, you may receive an award of permanent disability. Typically you’ll receive monthly payments of this award. In addition, if you can not return to your regular work, you may be eligible for vocational assistance. If your get vocational retraining, your temporary disability will be paid to you while in training.
Should I settle my workers’ compensation claim?
Settlement means a negotiated agreement in which you give up your rights in exchange for money from the Workers’ Compensation insurance company. You do not need to settle your claim in order to get benefits. Still, sometimes a settlement is a good idea. There are two types of settlements in Oregon Workers’ Compensation. First, there is a disputed claim settlement. This is available when your claim or part of your claim has been denied. In a disputed claim settlement, you give up your claim, or the part of the claim that is been denied, in exchange for a payment.
The second type of settlement is a claims disposition agreement and this is for an accepted claim. It is a settlement of benefits, aside from medical benefits. In other words, the insurance company will pay money for you to give up your right to temporary disability, permanent partial disability, and/or vocational retraining. If you are considering a settlement of your Workers’ Compensation claim, you should contact a lawyer for assistance.
How is a settlement different than receiving benefits?
On accepted claims, you can enter into a claim disposition agreement (CDA). This is a legal agreement where, in return for an agreed-upon amount of money, you give up your right to the following:
- Present and future time-loss benefits
- Present and future permanent partial disability awards
- Permanent total disability awards
- Vocational benefits
- Aggravation rights to reopen your claim
Should you settle, you cannot release your right to:
- Medical benefits for accepted conditions
- Eligibility for the Preferred Worker Program
Should you disagree with the insurer about whether you have a valid workers’ compensation claim, or new condition claim, you and the insurer may agree to a cash settlement for the claim or new condition claim. If you agree to a cash settlement:
- Your claim, or new condition claim, will be denied
- You give up all rights to future benefits for the denied medical conditions of your claim
- When you settle, all future medical expenses will be your responsibility.