Opening a workers' compensation claim
No. You can choose to pay out-of-pocket for work injuries, and forfeit any lost wages.
You should know that you have a very limited amount of time to file a workers’ compensation claim. If you wait too long, you may lose your right to insurance benefits.
To file a workers’ compensation claim in Oregon, you need to start with your employer. Ask for Oregon Form 801, Worker’s and Employer’s Report of Occupational Injury or Disease/Illness.
You will need to complete this form, and return it to your employer. They have to send it to their insurance company within 5 days.
Then, the insurance company has 60 days to accept or deny your claim.
You are probably covered by the Workers’ Compensation Act if:
- You are an employee (not a contractor).
- Your company carries workers’ comp insurance, and;
- You were injured on the job, or your injury is work-related.
Most, but not all, employers are required to carry workers’ comp insurance. Your employer should provide you with this information.
If your employer claims you are not eligible for receiving workers’ comp benefits, you should confirm this with the help of a qualified attorney.
It depends on the circumstances of your work-related injury or illness.
You may have as few as 30 days for an on-the-job injury. If you have an illness related to your work, you may have much longer.
In general, you should file a worker’s compensation claim as soon as possible.
A “Notice of Acceptance” is the letter you receive when your workers’ compensation claim has been accepted.
It means the insurance company will cover the doctor’s bills and lost wages detailed in the letter.
Workers’ compensation is a type of insurance. It provides medical care and lost wages for workers who are injured on the job.
In exchange for workers’ compensation benefits, employees agree not to file a lawsuit against their employers for the negligence.
Most Oregon employers are required to carry workers’ compensation insurance.
Workers’ compensation insurance was created to help people injured at work recover fair benefits quickly.
The alternative would be filing a lawsuit against your employer, which could take several years and cost a lot of time and money.
When your workers' comp claim is pending
It is important that you talk to your doctor about physical activities and limitations from your work injuries.
You should know that photographs and comments posted to any social media can be considered relevant to your injury claim.
While your claim is pending, you should not be undertaking any activity that you do not want to explain to a judge in court.
Your primary concern must be your own long-term health. Follow the care recommendations of your treating physician. Your doctor can help determine the physical limitations you should be following during your treatment.
Your workers’ compensation claim will not change. Your former employer’s workers’ compensation carrier is still responsible for handling your claim. You will not be penalized for changing jobs.
It should not affect you: your workers’ compensation claim will still be assigned to the employer’s insurer as of the date of the injury.
Workers' Comp and your Employer
You have the right:
- to file a workers’ compensation claim;
- to get medical care for your injuries; and
- to return to work if you are released from care by your doctor.
Your employer has to file a claim (Oregon Form 801) with their insurance company within five days.
After that, the insurance company will communicate with you about the claim.
A workers’ compensation lawyer can’t help you if there’s no workers’ compensation claim opened.
Contact the Oregon Ombudsman for Injured Workers, 503-378-3351.
Oregon Form 801, Worker’s and Employer’s Report of Occupational Injury or Disease/Illness is form you’ll fill out to start a claim for workers’ compensation insurance.
After you alert your employer to your injury, they should provide you with Oregon Form 801.
You complete the form and return it to your employer, and they send it to their insurance company.
Dealing with doctors and bills
If your doctor says that you can’t work because of your on-the-job injury, or that you can only work modified or light duty, you are entitled to recover your wages.
To do this, you need to ask for a written time loss authorization from your doctor.
Then, submit that authorization to the insurance company.
You will probably have to get written time loss authorizations for every pay periods you cannot work, or can only work with restrictions.
Without that written time loss authorization from your treating physician, the insurance company may not have to pay.
We recommend you keep copies of your time loss authorizations; many doctors don’t keep copies in your chart.
Tell the doctor that you were injured on the job.
You and your medical provider will need to complete Oregon Form 827, Worker’s and Health Care Provider’s Report for Workers’ Compensation Claims.
The doctor’s office will send the form to the insurance company, and give you a copy for your records.
First, make copies of all unpaid medical bills and collection notices, and send these to your workers’ compensation attorney.
Your attorney’s office can contact the medical provider or collection agency, and request that the collection action is stopped until the outcome of your workers’ compensation claim is determined.
Under Oregon law, medical providers cannot take collection action against you for medical bills incurred as part of a workers’ compensation claim that is pending litigation.
If you cannot perform your regular job duties because of a work injury, you need to see your doctor.
The doctor can provide the written time loss authorization, which is simply a document that says that you can’t work, or can only work with restrictions.
The insurance company will need a written time loss authorization to process and pay your lost wages.
An Independent Medical Examination, with a doctor chosen by the workers’ compensation insurance company.
The insurer might say you have to see their doctor for an IME before they will pay your medical bills.
We strongly recommend you talk to a workers’ compensation attorney before seeing an insurance company doctor for an IME.
When your workers' comp claim is denied
After the insurance company has denied your claim, you can file and appeal, and request a hearing with the Workers’ Compensation Board.
You only have a short time—generally 60 days—to appeal the claim denial.
Before the hearing, you will need to:
- Prepare your appeal;
- Assess your injuries and prognosis with your physician; and
- Provide the proper documentation for the judge.
We strongly recommend you consult with an attorney before appealing a denied workers’ compensation claim.
If Alvey Law Group successfully overturns the claim denial, the insurance company will pay the attorney’s fees.
If the insurance company denies your claim, you will receive no benefits—until and unless your attorney can get that denial overturned.
Even if your claim has been denied, you should continue to get the medical treatment you need.
If you have private health insurance, consider submitting any outstanding medical bills submitted to your health insurer. Most insurance companies will ask you to sign a Trust Agreement, which states that they will be repaid by the workers’ compensation carrier for any benefits if you are successful in overturning the denial.
Contact your lawyer’s office: they can make arrangements with your health insurer to get your benefits started.
If Alvey Law Group is not successful in obtaining benefits for you, there is no attorney fee.
This is general information on workers’ compensation; it is not legal advice. Please direct specific questions to your attorney.