Oregon Workers Compensation – The Process

After an injury on the job in Oregon, workers compensation should take care of your medical bills and lost wages so you can focus on getting better. But, people injured on the job are often overwhelmed by questions, and don’t really know what benefits they are entitled to. The process of worker’s compensation claims can be complicated and, although there are similarities, no two cases are identical. This article will help you understand and navigate that process.

Types of Injuries

Workers’ Compensation injuries can be categorized in a few ways. One is an acute injury that happens all of a sudden. For example, you lift a heavy weight and hurt your back. Or, the injury could be caused by what is known as an occupational disease. Heavy work over a long period of time that causes carpel tunnel syndrome or tendonitis is an example of an occupational disease. Still another type of workers compensation injury is where you have a pre existing condition that gets aggravated during the performance of your job. So, the fact that you already had an injury to a certain body part, like a bad back that gets worse as the result of an incident at work, doesn’t prevent you from potentially having a workers compensation claim for that increased injury.

In all circumstances, when you are aware that you have a workers comp injury, you are required to file a workers compensation claim and there are short time limits. You may have as little as 60 days from your notice or knowledge of the injury to file your workers comp claim. Generally speaking, you file the claim by filling out a form 801 and giving it to your employer. If your employer won’t give you the form to keep you from filing the claim, you can download one here (download link).  Once you file the claim, the insurance company has the authority to deny or accept the claim and they generally have 60 days to notify you of their decision. Your employer might object to it off the record, but the ultimate decision is the responsibility of the workers comp insurance carrier.

If the claim is accepted

A lot of people think that workers compensation will pay for everything, but it won’t. Workers comp is an insurance policy with limited benefits that is required by law. It doesn’t put the worker back to 100% of his pre injury status nor does it even attempt to.

One of the benefits that are paid on a on a workers comp claim are lifetime medical benefits that are caused by the injury that is the subject of the claim.

So, for example, if the claim is accepted for a low back disc herniation and you say “I have a hurt knee and you should pay for that too”, they’re not going to pay for the knee. Sometimes complications arise because there are disputes about whether or not an injury is related. Obviously if you have degenerative disc disease and you strained your back, there could be an issue as to whether or not there is a causal relationship if you want them to pay for a surgery on the degenerative disc disease.

In addition to lifetime medical benefits, an accepted worker’s compensation claim will cover 2/3 of lost wages for a period of time limited to when you are actively recovering from the injury until you are medically stationary. Medically stationary is defined as no further material improvement in your condition is expected as the result of medical treatment for the passage of time.

What if my injuries are permanent?

If there is a permanent injury, like impairment or loss of range motion, or if you have a permanent inability to perform a work related function, you are entitled to a permanent disability award. The value of the award is based on a complicated formula that depends on your age, education, work experience, type of injury, amount of impairment, and the degree of your inability to work, to come up with a final value. It’s akin to blue booking out a car for a price and the formula determines what your award will be. This is what people normally call their “settlement. It happens once you are medically stationary and the claim is closed.

Other Benefits

If you’re not employable within 80% of your wages at the time of the injury, you will need retraining to get re-employed. In this case, your worker’s compensation claim will give you vocational benefits. With these benefits, you get paid 2/3 of your wages for up to 18 months of time off and the cost of the school program is covered.

If the claim is denied

The worker’s compensation insurance carrier is required to send a response to your claim via certified mail within 60 days. If the claim is denied, you have the right to appeal that decision. If you haven’t already, now would be a good time to talk to a worker’s compensation attorney like the Law Offices of Brian Whitehead. A good attorney will advise you whether or not you should appeal and, if a lawyer accepts your case, they don’t get paid until you win. And if you don’t win, the attorney doesn’t get paid.

There are all kinds of issues on workers comp. – how much time loss you get, how much permanent disability do you get. It’s not always just whether your claim is denied, it’s about whether they give you the correct amount of benefits. Sometimes they won’t give you time loss when they’re required to give you time loss. Sometimes they give you an incorrect amount.

Sometimes they won’t give you permanent disability. Sometimes you make a claim for something like a herniated disc, but they accept a low back sprain strain. Then when they close the claim and they’ve only accepted a strain sprain, and there never was one in the first place, they don’t have to give you any disability. So ultimately you have to make sure the insurance carrier accepts the condition that your doctor diagnoses.

These cases can be complicated and no two are the same. If you need help to make sure you get the benefits you’re entitled to, contact the Law Offices of Brian Whitehead. Our founding attorney, Brian R. Whitehead, has been handling workers’ compensation cases for more than 25 years. We provide the experienced legal representation you need.

fossilgraphicsOregon Workers Compensation – The Process