Workers’ Compensation FAQ

How do I file a claim?

  • If you believe you were injured at work or suffer from an illness or medical condition because of your job, give notice to your employer as soon as possible.
  • Ask your employer to give you Form 801 (“Report of Job Injury or Illness”) and complete the top “worker” portion of the form.  Then, give it back to your employer.
    • If you have more than one job, be sure to indicate that on the 801 Form. You may be eligible for additional time-loss benefits.
  • Your employer will complete the bottom portion of the Form 801 and will send the form to its workers’ compensation insurance company. Your employer should also give you a copy for your records.

What happens after I file a claim?

  • Get the name and phone number of the workers’ compensation insurance from your employer.
  • Go get medical treatment from a health care provider of your choice and tell the provider that you were injured on the job. Remember: Your employer cannot choose your health care provider for you.
  • At your first visit with your health care provider, they should ask you to complete a Form 827 (“Worker’s and Health Care Provider’s Report for Workers’ Compensation Claims”). The provider will send that form to the insurance company and should give you a copy for your records.

If I can’t work, will I receive payments for lost wages?

  • Yes, but your health care provider must authorize your absence from work. No payment is due for time missed from work that has not been authorized by your health care provider.
  • You should provide a copy of your provider’s note/authorization to your employer and insurer as soon as possible.
    • If you have more than one job, you may also be eligible for additional time loss if your doctor authorizes time off or modified work from your secondary job(s).
  • You will not be paid for the first 3 calendar days (waiting period) for your time off work – unless: you are off work for 14 days in a row or hospitalized overnight within the first 14 days.
  • Time-loss benefits will stop if one of the following happens:
    • Your health care provider fails to provide time-loss authorization
    • Your time-loss authorization expires
    • Your health care provider gives you a release to return to regular work
    • You return to regular work at full wages
    • Your claim is denied
    • A Notice of Closure closes your claim
  • Time-loss benefits will also be reduced or stopped if one of the following happens:
    • You return to work part-time
    • Your health care provider approves a written offer of modified work and you refuse to take the job
    • Your health care provider approves work with your employer and your employer fires you for cause

How are time-loss payments calculated?

  • Payment for time lost from work is called “temporary disability”and is based on your average weekly wage at the time of injury.
  • The insurer will calculate your average weekly wage by averaging the wages you earned, with your employer at injury, over (and up to) your lats 52 weeks before your injury.
  • Time-loss payments will equal two-thirds (66.6%) of your average weekly wage.
    • Oregon has a minimum and maximum amount payable, that is adjusted every year.
  • If your doctor returns you to modified or light-duty work and you return to work, but earn less money than before, you may be eligible to receive partial time-loss payments or “temporary partial disability”.

If my claim is accepted, what medical bills will the insurer pay?

  • If your claim is accepted, the insurer should pay for all of the following:
    • Medical treatment related to your on-the-job injury
    • Prescription drugs
    • Transportation, meals, and lodging necessary to attend medical appointments (with some limitations)
  • Your health care providers should not bill you for medical services. Your providers should directly bill the workers’ compensation insurer.
    • If you pay out-of-pocket for medical services, the workers’ compensation insurer will not reimburse you. Instead, the workers’ compensation insurer will pay the provider and you will need to obtain reimbursement from the provider.
  • The pharmacy should also directly bill the insurer for prescriptions.
    • If you have to pay out-of-pocket for prescriptions, you may be reimbursed by the workers’ compensation insurer.

What happens if my claim is denied and my health care provider sends bills to me?

  • If your claim is denied, your health care provider is allowed to send you a copy of the bills.
  • At this point, you may want to get your personal health insurance involved. This may help treatment continue.
  • If you appeal your denial, the provider may make no further attempt to collect payment from you until either of the following happens:
    • All your appeals are completed
    • You settle the claim
  • If you do not appeal your denial, then your health care provider can bill you.
  • If you have health insurance, the health care provider is required to bill your health insurer.

What is an independent medical examination (IME)?

  • An IME is an exam scheduled by the insurer processing your claim.
  • The insurer will choose the IME provider(s) and will pay for the exam.
  • The insurer may require you to attend up to three IMEs. Some exams may be scheduled with more than one health care provider at more than one location, but count only as one of the three IMEs. This is called a panel exam.
  • The IME providers:
    • Will not provide treatment
    • Will prepare a report to document their findings and opinions, and to answer questions asked by the insurer related to your claim
    • Will send a copy of their report to the insurer

Appeal rights and claim settlements

  • You can appeal any decision made about your claim. An appeal is a request for a formal review of a decision made about the claim.
  • If you receive a notice that your claim or benefits are denied or are being ended, the document you receive will have instructions on how to appeal if you disagree with the decision.
  • There are time limits for most appeals. You will lose your appeal rights if you do not appeal within the limits as printed in the letter or notice you received.

An attorney can help you understand your rights and obligations.  If you have any questions or concerns about workers’ compensation claims, you can call the workers’ compensation attorneys at Bennett Hartman at 503-227-4600 or via email at info@bennetthartman.com.

We provide free consultations and workers’ compensation attorneys are paid on a “contingent fee” basis. This means that you do not have to pay an attorney unless the attorney wins your case or settles your case for you.