Oregon Workers' Compensation
Claim Guide

Our experienced workers' compensation lawyer in Portland can help you with your work comp benefits.

01

Oregon Work Injuries

Have you been injured on the job? Back, shoulder and knee injuries are common in Oregon’s workplaces. Frequently diagnosed conditions include sprains, strains, fractures, disc herniations, bulges or protrusions, lacerations, rotator cuff tears and meniscus tears. Occupational diseases, such as carpal tunnel syndrome, trigger finger, epicondylitis and hearing loss are also regularly experienced by Oregon workers. Regardless of whether you are experiencing a workplace injury or occupational disease, every claim begins with a first report of injury. Curious about the claims process? Click here for a claim flowchart from the Oregon Workers' Compensation Division.

02

Reporting Your Injury

Oregon law requires all workers notify their employer within 90 days of an injury. Occupational diseases must be reported within a year. If you do not report your injury or occupational disease within the required period, you could lose your right to file a claim. Click here to learn more about filing a workers' compensation claim in Oregon.
 
Your employer is required to provide you with an 801 form. Employers cannot refuse to allow you to file a claim. If your employer refuses to file a claim or provide you with a form 801, you should contact an Oregon workers' comp attorney immediately.
 
Do you need a form 801? Click here for an official form 801 from the Oregon Workers’ Compensation Division.

03

Claim Investigation

The insurance company will have 60 days to investigate your claim. Almost all claims in the state of Oregon are processed by one of eleven companies. These companies include SAIF Corporation, Liberty Mutual Insurance, Sedgwick Claims Management Services, Gallagher Bassett, Argonaut Insurance, Broadspire, CNA, CorVel, SDAO, Hartford and Travelers Insurance.  If the insurance company fails to either accept or deny your claim within 60 days, you could be entitled to a penalty against them.

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04

Accepted & Denied Claims

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If the insurance company denies your claim, you will have 60 days to file an appeal. The Oregon Workers’ Compensation Act is a complicated area of the law that often seems strange and confusing. Even attorneys who do not regularly practice in this area of the law find it difficult to understand. Insurance companies retain teams of defense attorneys who are experts in this field of practice. Your chances of winning a denied claim without legal assistance are low. Goin Law Group highly recommends contacting a Portland workers' compensation attorney immediately if your claim was denied. You can click here for additional information regarding claim denials.
 
If your claim is accepted, the insurance company will pay for authorized time off work and medical treatment related to your accepted condition(s). You may also be entitled to vocational assistance and permanent impairment. Click here to learn more about Oregon workers' compensation benefits.

05

Medical Treatment

Regardless of whether your claim is accepted or denied, you will need an attending physician to manage your treatment for the work injury and prescribe time loss. The Oregon Workers’ Compensation Act limits who can act as an attending physician. There is no limit for a medical doctor; however, chiropractors, physician’s assistants, nurse practitioners and similar medical professionals have limits for how long they can act as your attending physician. Some insurance companies also require treatment within a “managed care organization,” which means you are required to treat with a doctor from a pre-approved list of physicians. Oregon’s most common managed care organizations, or “MCOs,” are the Majoris MCO, Caremark MCO, Providence MCO and Kaiser MCO.
 

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Every claim is accepted for specific conditions. Insurance companies frequently attempt to accept the least serious conditions they can find in your medical record. By doing this, the insurance company hopes they can close your claim without paying for more expensive treatment, such as surgery. For example, insurance companies will frequently accept shoulder strains instead of rotator cuff tears, knee strains instead of meniscus tears and back strains instead of disc bulges, protrusions or herniations. It is important to consult with an Oregon workers' compensation attorney to make sure that your claim was accepted for the right conditions.
 
Most work injuries are treated with physical therapy, chiropractic adjustments, acupuncture and massage therapy. If your symptoms continue, your doctor may recommend injections and diagnostic testing, such as x-rays or radiographs, CT Scans, MRIs or MR Arthrograms. Surgery is not usually recommended until diagnostic testing has been performed. Many injured workers experience delays in medical treatment as a result of the insurance company refusing to authorize physical therapy, diagnostic testing or surgery. If your treatment has been delayed or denied, you should consult with a Portland workers' comp attorney immediately. You can also click here to learn more about treatment disputes.

06

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Time Loss

Many injured workers miss time form work as a result of their injury. In general, the insurance company is required to compensate you for wage loss that occurred as a result of the work injury. Time loss payments are referred to as “temporary disability.” Temporary total disability is paid when your attending physician takes you completely off work. “Temporary partial disability” is paid when you return to modified duty at a lower hourly wage or work fewer hours.
 

Insurance companies frequently pay time loss benefits at an incorrect rate, fail to issue payment for all periods owed or pay benefits in an untimely manner. You could be entitled to a penalty from the insurance company if they paid your benefits incorrectly. Goin Law Group recommends speaking with an Oregon workers' compensation attorney if the insurance company is refusing to pay for your time off work, has issued payments that were late or you think the amounts paid were incorrect. Click here to learn more about time loss benefits. 

07

Claim Closure

Eventually, your accepted conditions will reach “maximum medical improvement,” which means you are “medically stationary.” At that point, the insurance company will begin the process of closing your claim.  Your attending physician will determine whether you should have permanent work restrictions or permanent impairment. Your attending physician’s findings will then be used to rate your permanent impairment award.

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Many insurance companies will call or send letters to the attending physician in an attempt to either close your claim without permanent impairment or reduce the amount of your permanent impairment award. If the insurance company is attempting to close your claim too soon, or you disagree with your permanent impairment award, you should consult with an Oregon workers' compensation attorney. Click here to learn more about workers' compensation permanent impairment. You can also click here to learn more about appealing a closure.

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08

Vocational Retraining

You may be entitled to vocational retraining if permanent work restrictions were prescribed by your attending physician.  If you are unable to return to the job at injury, your case will be reviewed by a vocational counselor, who will determine whether you qualify for vocational benefits. Vocational assistance can range from help with writing a resume to enrollment in a degree or certificate program at a local college or university.

What services you are eligible to receive will depend upon the job market and your work restrictions. If your vocational benefits have been denied, your vocational program was changed without your approval or the insurance company is refusing to perform a vocational assessment you should consult with a Portland workers' compensation attorney. Click here to learn more about vocational benefits.

09

Aggravation Claims

For disabling claims, you have five years following the closure of your claim to file an aggravation. An aggravation occurs when an accepted condition has “pathologically worsened,” resulting in a new need for treatment, surgery or time off work. An aggravation claim is usually filed by your attending physician with a form 827 and must be signed by you. An 827 form can also be obtained from the Workers’ Compensation Division by clicking here. The insurance company will have 60 days to accept or deny your aggravation claim, which restarts the claim process.  

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