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What is workers’ compensation insurance?
Workers hurt on the job are protected by workers’ compensation insurance.
Oregon law requires employers to insure their employees by purchasing workers' compensation
insurance. There are over 200 insurance companies providing workers’ compensation insurance
in Oregon.
With rare exceptions, Oregon has a “no fault” system, which means both workers
and employers are protected from the time and expense of determining who caused an on-the-job
accident. It is the worker’s responsibility, however, to prove that an injury or disease
is job related rather than substantially related to a preexisting condition.
Workers’ compensation insurance pays for medical services and provides temporary disability
(lost wages) payments if an injured worker must be off work due to their on-the-job injury.
What kinds of
injuries or illnesses qualify for workers’ compensation benefits?
Generally, any injury that occurs while working (or illness due to work)
that requires you to see a doctor or results in disability or death may qualify for workers’
compensation benefits. An injury could be traumatic (caused by an accident), cumulative (caused
by repetitive motion), or an occupational disease (such as loss of hearing). A doctor must
be able to verify that there is objective medical evidence showing that an injury or disease
exists and that work exposure was the major cause.
How
does a worker get benefits when hurt on the job?
The insurer will begin evaluating your claim as soon as it is received.
The insurer will notify you and the employer in writing when the claim has been accepted
or denied. A claim number will be assigned to the claim. A claims adjuster may contact you
by telephone or in writing to ask questions about your claim. You should have your claim
number with you when you complete any forms, see the doctor, or call the insurer. Having
the claim number available will also help you get your questions answered quickly.
Time-loss (wage
replacement) benefit levels
You will get time-loss
payments from the insurer if your doctor authorizes time off work or modified work (also
called “light duty”) that results in lost wages. Your first check will usually
be issued two weeks after you report the claim to your employer, but only if the doctor provides
written authorization to the insurer soon after you are injured. Otherwise, your first check
will be issued within two weeks from the date the insurer receives authorization from your
doctor.
During each appointment, ask your doctor to send appropriate time-loss authorization to the
insurer. If time-loss authorization expired before your appointment, your doctor can approve
time-loss payments only for the previous two weeks. You may also help to ensure timely payment
by contacting the insurer as soon as you begin to miss work.
Time-loss benefits, sometimes called temporary total disability (TTD) or temporary partial
disability (TPD), are based on your weekly wage when you were injured.
After your time-loss payments end, you may be entitled to unemployment benefits (even if
it would ordinarily be too late to qualify).
Temporary
Partial Disability (TPD)
Under
ORS 656.210, temporary
partial disability is defined as partial disability that is only temporary, meaning the worker's
attending physician has released the worker to return to work with less than a regular work
release. The worker is partially disabled because he or she is capable of performing some
type of work, whether or not any work meeting his or her restriction is available.
Temporary Total
Disability (TTD)
Under
ORS 656.210, temporary
total disability is defined as
total disability that is only temporary, meaning the worker's attending physician has restricted
the worker from performing any type of employment duties. The worker is totally disabled
for a temporary period of time.
Supplemental
(wage replacement) benefit levels
If you had additional jobs at the time of injury, you may be eligible to
receive additional disability payments. You must notify the insurer about the other jobs
within 30 days of the insurer’s receipt of your initial claim. You must provide proof
of wages (e.g. check stubs or payroll records) paid on the other jobs within 60 days of the
insurer's request or you will be found ineligible for supplemental disability benefits.
Permanent
Partial Disability (PPD)
If your Notice of Closure shows you have permanent partial disability,
this means your injury caused a condition that has not returned to its normal or pre-injury
condition. You will receive payment from the insurer for this disability, and the amount
will depend on the severity of the disability. Disability to certain body parts, such as
a hand or foot, is paid at a rate set by law. Payment for a body part or system (such as
the back, hip, or respiratory system) may be affected by factors such as age, education,
work history, and current ability to work.
If the insurer overpaid you for past benefits, the insurer may recover the overpayment by
reducing your permanent disability payments or by reducing future benefits.
Permanent
Total Disability (PTD)
Permanent total disability is the loss of use or function of any portion
of your body, including preexisting disability, which permanently incapacitates you from
regularly performing work at a gainful and suitable occupation. ORS 656.206(1)(a)
If your closure document shows you have permanent total disability, this means you are permanently
unable to work. You will receive monthly disability payments for the rest of your life if
you remain totally disabled. The insurer will reexamine your claim at least every two years
to see if you remain unable to work.
Three-day waiting
period
The first three days you lose work may not be paid by the insurer unless
you are hospitalized or unable to return to work at all for at least 14 days. This is called
a “three-day wait.” It is required by state law and acts as a form of deductible.
If your doctor released you to any kind of work in the first 14 days after you are injured,
you will not be paid for the first three days missed. If you are hospitalized overnight,
or unable to be released to perform work of any type (at the direction of your doctor) during
the first 14 days after you are injured, the first three days missed will be paid.
For
dates of injury prior to 1-1-05:
“Scheduled” versus “unscheduled” injury payments
Scheduled disability is the complete or partial loss of use or function
of your arm, hand, leg, foot, or other extremity of your body, or the loss of your visual
or hearing ability. These body parts are listed on a schedule with an amount of money applied
to each, so that you and all Oregon injured workers receive the same amount of money for
the same disability, regardless of what job is performed at the time of injury. ORS 656.214.
Unscheduled disability affects your ability to earn a wage. It applies to impairment
of body parts that are not listed as scheduled. ORS 656.214(5)
Dates of injury on or after 1-1-05:
"Impairment" means the loss of use or function of a body
part or system stated as a percentage of the whole person.
"Work disability" means impairment modified by age, education, and adaptability
to perform a given job.
Time-loss benefits
Compensation paid to an injured worker while he or she is not working as a result
of occupational injury or disease; includes temporary partial disability and temporary
total disability. |
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