FAQ

Oregon Workers’ Compensation (WC) laws provide for 4 main benefits: Medical services Temporary disability Permanent disability Vocational rehabilitation There is an additional category of benefits involving of survivorship benefits to those who qualify as “dependents” of workers who suffered a fatal injury while at work. As a claimant, you are potentially entitled to receive each of these benefits, so long as the essential prerequisites are met. Determining whether or not you meet these requirements can sometimes be difficult to discern, which is where we come in.

Anyone injured at work should seek medical treatment immediately. After that, you need to give sufficient notice to your employer, letting them know you suffered a work-related injury. Employees must provide this notice within 90 days of the date of injury. Please note that if you wait too long, you could be barred from pursuing the claim. Such notice can be given by telling a supervisor, preferably in writing, that you suffered a work-related injury. You can also provide notice by filing official paperwork. However, providing notice is not the same as initiating a claim. If you should choose to file a workers’ compensation claim, you may do so either by completing a Form 801 with your employer, or a Form 827 with your doctor (both forms can be found here). Once you complete the applicable paperwork, the insurer will have 60 days to investigate and either accept or deny your claim. During an investigation, they will usually take recorded statements from the claimant and any witnesses, and collect information from an independent medical examination (IME). Please note that you have the right to have an attorney present during your recorded statement, and you may bring an observer with you to your IME. This 60-day period is called “deferred status.” Next, you will need to establish yourself as a patient of an “attending physician,” who will work with you during your recovery. Your attending physician (AP) is the medical provider primarily in charge of directing the care and treatment of your work-related injury. If you are unable to perform your full work duties, your AP may issue off-work or light-duty work restrictions. It is your responsibility to get these restrictions to your employer in a timely manner. These restrictions will protect your ongoing right to employment and ongoing right to receive temporary disability. Please keep in mind that such restrictions must be issued contemporaneously with your inability to work. Your doctor can only retroactively authorize restrictions up to 14 days from the date of the office visit.

If the workers’ compensation insurer denies your claim, you have 60 days from the date of the issuance of the denial to request a hearing before the Workers’ Compensation Board (WCB). Do not let your denial become final by waiting more than 60 days to request a hearing. Remember, you have the right to have a lawyer represent your claim. Having legal representation to litigate the denial can prove invaluable in obtaining fair compensation. Keep in mind, the insurer will undoubtedly have legal counsel on their side as well. Contact Elmer & Brunot, PC if you receive a denial and our team can help you get the hearing requested promptly.

$0 Lawyers who choose to represent claimants in Oregon’s WC system only get paid if they are instrumental in obtaining compensation for the injured worker. If your lawyer is not successful, you owe the lawyer nothing. Any payments for workers’ compensation legal help come in two variations: assessed fees and out-of-compensation fees. Assessed fees: If you receive a denial of compensation (claim denial, temporary disability or medical dispute), and your attorney is successful in getting the denial set aside, the insurer will be ordered to pay your attorney directly for his or her services. Out-of-Compensation fees: If your lawyer helps you settle your claim, your lawyer will receive a portion of your settlement. This variation looks like the standard contingency fee award in other legal settlements. Currently, this contingency fee is defined by Workers’ Compensation Board rule to be 25% of the first $50,000 of any settlement, and only 10% of all proceeds above $50,000. If your lawyer helps you obtain more benefits upon reconsideration, your lawyer will receive 10% of only the increase in those benefits.

If the insurer issues a Notice of Closure (NOC), you have 60 days from the date of its issuance to request reconsideration of the NOC by the Workers’ Compensation Division (WCD). Reconsideration is, in essence, an audit of the NOC. The WCD may rescind, modify, or affirm the insurer’s NOC. The WCD will review your file to make sure your accepted conditions were, in fact, medically stationary, you were paid temporary disability for all periods of entitlement, and your permanent disability award, if any, was accurately calculated. The WCD’s findings will be contained in a document that will be issued upon the audit, called an order on reconsideration. If you have received a NOC, please contact our office and we will be glad to help you submit reconsideration paperwork to the WCD.

Claimant: Any party pursuing benefits under the WC system. This may include injured workers or the surviving family members of workers who were fatally injured on the job. Attending Physician: An attending physician is the medical provider primarily in charge of directing the care and treatment of the injured party’s work-related injury. There are certain restrictions regarding who you may see, and you can only have a maximum of 3 different attending physicians over the life of your claim. An attending physician has 3 essential duties: Authorizing light-duty/off-work restrictions; Referring the patient to diagnostics, surgery, physical therapy, and other specialists; Determining physical impairment and permanent work-restrictions once the patient reaches maximum medical improvement and has become medically stationary. Insurer: The insurer is the workers’ compensation insurance company an employer uses for workers’ compensation coverage. Some Oregon employers may be self-insured. Click here to do a coverage search of your employer. Injury: Under Oregon workers’ compensation law, an injury is a condition that arose suddenly from a discrete, identifiable event, or series of events, while in the course and scope of a person’s employment. Occupational Disease: Under Oregon WC law, an occupational disease is a physical or mental condition attributable to repetitive work exposure. Your lifetime work activity must be the major contributing cause of the occupational disease for which you now seek compensation. If you find out you suffer from an occupational disease, you must file a claim for that condition within one year of learning that you suffer from a work-related ailment. Pre-Existing Conditions: A pre-existing condition can be any type of condition a person was diagnosed with or received treatment for in the past. For example, a worker may have an existing arthritic condition that existed before her employment, which might contribute to her current inability to work. Preexisting conditions can affect your eligibility to receive workers’ compensation benefits. Compensability: The short-hand term used to describe an injury or occupational disease that belongs in Oregon’s WC system. A compensable injury is any injury that arises out of, and occurs during, employment. It either requires medical care, results in an inability to work, or leads to death. A compensable occupational disease is a disease or infection that occurs during the course of employment and is caused by substances or activities to which an employee is not ordinarily subjected or exposed to. The employee must have been exposed doing something other than regular, actual employment, though the disease must require medical services, results an inability to work, or cause the worker’s death. Deferred Status: The 60-day period after which the insurer receives official notice of an employee’s claim. During the 60-day period, the insurer investigates the compensability of the employee’s claim. Interim Compensation: Temporary disability and medical service benefits received during the deferred status of a claim. Notice of Acceptance (NOA): The formal document issued by the insurer acknowledging that a claimant suffered a compensable injury, occupational disease, or death. The NOA will enumerate the conditions or disease determined to be compensable. Notice of Denial: The formal document issued by the insurer stating the determination that the claimant did not suffer a compensable injury, occupational disease, or death. A claimant must request a hearing within 60 days of the date the denial issued or else that denial will become final. Temporary Disability: Commonly referred to as time loss, temporary disability benefits are paid when a WC claim results in an inability to work—i.e., disability. Temporary disability is categorized as either total temporary disability or temporary partial disability, depending on your restrictions and your employer’s ability to accommodate those restrictions. Total temporary disability is two-thirds of the employee’s average weekly wage at injury. Temporary partial disability is two-thirds of the difference between the employee’s average weekly wage at injury and your post-injury earnings. The attending physician can authorize work restrictions, thus entitling you to temporary benefits. Medical Services: Employees have the right to receive medical services as they relate to the accepted conditions or disease, so long as those medical services are reasonable and necessary. Medical services include diagnostics, curative treatment, and palliative care. Medical services may also include prosthetics and durable medical equipment. Medically Stationary: Eventually a worker’s recovery from the accepted conditions or occupational disease will plateau and they will reach maximum medical improvement. Once it is determined that no further material improvement would reasonably be expected from medical treatment or the passage of time, you are considered medically stationary. Ratable Impairment: Ratable impairment is the impairment recognized and measured by Oregon’s relevant administrative rules. The process of rating impairment intends to measure the difference caused by the accepted claim pre-injury to post-injury. Common ratable impairments include the loss of range of motion, sensation, or strength attributable to the accepted claim. Ratable impairment does not include pain and suffering. Permanent Disability: Permanent disability is categorized as either partial permanent disability or total permanent disability. It is determined by taking the injured person’s ratable impairment, and applying other factors such as date of injury, details about the job where injury occurred, and whether the worker will be able to return to work. The return to work may include a return to full-duty or might require a permanent work restriction once the worker has reached medically stationary status. This is a non-discretionary tax-free award the insurer pays an injured worker if there is ratable impairment or permanent work restrictions due to the compensable claim. Notice of Closure (NOC): The formal document the insurer issues once it has been determined that the worker is medically stationary and there is sufficient information in the medical records to determine the extent of the worker’s ratable impairment. The NOC will outline the date the worker became medically stationary, periods of time for which the worker was entitled to temporary disability, and the amount of the worker’s permanent disability award, if any. You have 60 days to request reconsideration of a NOC. Reconsideration: Reconsideration is the process by which a claimant can challenge the NOC to the Workers’ Compensation Division. If you request reconsideration, the WCD will sometimes send you one of their doctors called a “medical arbiter” to premeasure your ratable impairment, if one exists. The WCD will either affirm, modify, or rescind the NOC after it “audits” the NOC in a document called an Order on Reconsideration. Vocational Rehabilitation: Vocational rehabilitation is a job-training benefit that may be available to a claimant if certain requirements are met. The claimant must have been issued a permanent work restriction upon becoming medically stationary and the employer at injury must be unable to offer permanent light-duty work accommodating any such permanent work restrictions. Also, the claimant must not be able to return to the work force making at least 80% of his or her wages at injury because of a permanent work restriction. If those prerequisites are met, the insurer will pay for tuition and out-of-pocket expenses relating to the vocational rehabilitation. The insurer will also pay total temporary disability during any periods of time during where claimant is attending courses. Aggravation Rights: If a claimant’s accepted condition pathologically worsens, he or she may have a compensable aggravation claim. The major contributing cause of the pathological worsening must be attributable to an injury or event occurring in the course and scope of employment. A claimant can file an aggravation claim by completing a Form 827 with his or her attending physician. Own-Motion Status: If a claimant suffers a pathological worsening, need for treatment, or inability to work after the 5-year aggravation rights period expires, a claimant may still be due benefits and have his or her claim reopened upon the Board’s own motion. Claims Disposition Agreement (CDA): The settlement of an accepted claim wherein a claimant sells back all rights to the accepted claim except reasonable and necessary medical services. This settlement takes place in exchange for an agreed-upon sum of tax-free settlement proceeds. Disputed Claims Settlement (DCS): The settlement of a denied claim wherein a claimant agrees to allow the denial of his or her claim to become final in exchange for an agreed-upon sum of tax-free settlement proceeds.

"Personal injury" is a general term that refers to an injury that came about as a result of someone else's negligence. A personal injury claim refers to a potential lawsuit you may have if you were injured due to the negligent or intentional act of another person or entity. Personal injury claims may arise in a variety of ways. Most commonly, people may have a viable personal injury claim if they were injured in a motor vehicle accident. Other common personal injury claims involve being injured by slipping and falling due to a hazard on a premise, or injuries due to negligently designed or manufactured consumer products.

Short answer: probably not. If you are injured due to the negligence of your employer or your co-worker, you cannot sue your employer for your personal injuries. Rather, your sole and exclusive remedy for any such injuries is the workers’ compensation system. However, there are some notable exceptions to this “Exclusive Remedy” Doctrine, such as:Intentional injuries: if your injuries were due in substantial part due to the willful and unprovoked aggression by a co-worker or employer, then you may sue that person for an intentional tort. Red-tagged equipment: if OSHA if has posted a red warning notice on a machine, device, apparatus, or equipment, and your employer requires you to use it before they make it safe, then you may be able to bring a personal injury action against your employer. Non-complying employers: if you were injured while working for an employer that was not carrying required workers’ compensation insurance, you can not only bring a personal injury claim, you can also file a workers’ compensation claim. Third-Party Claims: if you were injured at work by some negligent third-party who is unassociated with your employment, a viable third-party personal injury claim can be filed.

A third-party claim is a personal injury claim in the event you get hurt while on the job due to the negligence of someone other than a coworker or employer—i.e., you got injured due to the negligence of some third party unaffiliated with your employment. Most commonly, it is possible to file a third-party claim if you were injured in a motor vehicle accident while you were on the clock for your employer. Other common third-party claims involve being injured due to negligently designed or manufactured equipment used in your job or injuries due to the negligence of another person who is engaged in a common enterprise with your employment, such as a subcontractor.

Getting into a car accident can be very scary and it leaves most people rattled. But there are some important steps to take after an accident to help ensure you have all the information you need later. If you find yourself in this unfortunate situation keep this checklist handy: What to do after a car accident Call 911 if there are injuries. Stay safely out of the way of further harm. Stay in your car if that is the safest place, or if moving may further injure you. You can move your car to a safe location if your car is obstructing traffic or otherwise creating an unsafe situation. Just don’t leave the scene of the accident. Swap insurance information with any other drivers involved in the accident. Get the names and contact information of any witnesses to the accident. Call your insurance company and follow any instructions given to you by your insurance representative. Take photos of the accident scene, including any vehicle damage, and any personal injuries you suffered. Seek medical treatment immediately and document your providers, your recovery, out-of-pocket costs, and any lost-wages due to inability to work.

"PIP" stands for Personal Injury Protection. Every auto insurance policy issued in Oregon must carry PIP coverage. PIP is part of your auto insurance policy that provides payment for medical treatment and a percentage of your lost wages due to injuries suffered as a result of using, occupying, or maintaining your vehicle. Your medical providers should bill your PIP policy for any treatment caused by a car accident in the following days, weeks, or months. Keep in mind that PIP coverage only lasts for one year from the date of the accident is subject to maximum limits dictated by your particular insurance coverage. If you received PIP benefits due to the negligence of another motorist, you may have to pay PIP back should you elect to bring a lawsuit against the at-fault motorist and receive a settlement or judgment.

Liability coverage is part of your auto insurance policy that provides payment to a person or entity that was injured due to your fault. If you are the injured party, you are going after the at-fault driver’s liability coverage; if you are the at-fault party, the injured party is going after your liability coverage. Liability coverage is subject to maximum limits dictated by your particular insurance coverage. If the damages caused by an at-fault driver exceed the maximum liability coverage limits, the injured party has a choice to either pursue the “excess amount” directly from the at-fault party in their personal capacity or pursue more coverage provided under your underinsured motorist coverage.

UIM coverage, or Underinsured Motorist coverage, is a part of your insurance policy that provides payment to you as the injured party should the total damages stemming from your motor vehicle accident exceed the at-fault driver’s liability coverage. Your UIM policy stacks on top of the liability policy and provides another source of recovery aside from pursuing excess amounts directly from the at-fault party’s personal finances.