This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you have an accident at work, notify your employer and about your job-related injury as soon as possible. Also, if your injury requires medical attention, seek the attention of a health care provider. Two forms you should make sure to complete are the Form 801: Report of Job Injury or Illness and the Form 827: Worker's and Health Care Provider's Report for Workers Compensation Claims. You can request the Form 801 from your employer and the Form 827 from your health care provider.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Your employer should provide you with the information pertaining to the workers' compensation insurance coverage program the employer partakes in.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
The best way to insure you receive benefits is to facilitate open communication with your employer, employer's insurance provider, and your medical care provider.
4. What benefits might I be eligible to receive?
If your injury requires medical treatment, you may be eligible to receive medical care benefits until you have reached recovery (as deemed by your doctor). You are capable of selecting the medical care provider of your choice. However, the medical care provider may be limited in the time that individual or service provider is capable of providing you treatment for or you may run the risk of having to pay out of pocket for your treatment if your claim is denied.
Depending on the extent of your injuries, if you are unable to return to work, you may be eligible to receive time-loss benefits. These are essentially wage replacement payment to compensate your for days of work missed as a result of your injury. However, you will not be eligible for such payments unless 1) your doctor has authorized it and 2) you have missed three or more days of work.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
After completing the Form 801, your employer should submit the Form to the employer's insurance provider within five (5) days. Next, the insurance provider is expected to provide a determination with regards to your claim about whether your employer will accept or deny liability. This should happen within sixty (60) days of you providing your employer the Form 801. If your claim is accepted, the insurance provider will send you a Notice of Acceptance which will list the conditions it pre-approves coverage for. If your claim is denied, your insurance provider will specify any appeal rights you may utilize in challenging the determination.
If you are unhappy with the determination of the insurance provider, either regarding the determination as a whole or an issue is in dispute, you may request an order of reconsideration within sixty (60) days. The insurer is then expected to provide an answer within 18 days of your request.
At this point, you or the insurance provider can request a hearing with the Workers' Compensation Board should any issues continue to persist. The Workers' Compensation Board will review your claim and the case history in order to issue an Order or Opinion. The insurer's denial is either reversed or affirmed. Either party- you or the insurer- can proceed with another round of appeals in which the Workers' Compensation Board will review the claim. This request must be made within thirty (30) days of when the Workers' Compensation Board's Opinion and Order was issued.
6. If I am not happy with the determination, how do I appeal?
If after exhausting all appeals with the insurance provider and the Workers' Compensation Board, you or the insurance provider remain unsatisfied with the determination(s) that have been made, a final round of appeals may be made to the state Court of Appeals (within thirty (30) days of the Workers' Compensation Board's review of the initial Order and Opinion) and then possibly to the state Supreme Court. These proceedings will be governed by the rules and procedures of the Oregon State Court.