Workers’ compensation offers a safety net when you suffer a work-related illness or injury. Workers’ Compensation insurance provides full medical coverage and lost wages benefits when you miss work while recovering.
Filing a claim for workers’ compensation benefits is a multiple-step process that begins by notifying your employer of your injury or illness. There are strict deadlines for starting the process, so you should report all work-related injuries and illnesses as soon as possible, even if you are not sure whether you will need to file a formal claim. You can also file a claim with your treating doctor.
This article offers an overview of the process for filing a workers’ compensation claim. Each state has its own laws and procedures governing claims for benefits, so you need to understand the Oregon-specific rules and requirements to avoid losing out on the benefits that you are entitled to. By consulting with a Bend (?) workers’ compensation attorney, you will receive the advice and guidance that you need to improve your chance of success with an Oregon workers’ compensation claim.
Who is covered by workers’ compensation insurance?
As a general rule, all employers must provide workers’ compensation coverage for their employees who suffer work-related injuries or illnesses. In Oregon, while all employees are covered by workers’ compensation insurance, independent contractors are not. In some cases, however, you may be an “employee” under Oregon law and entitled to workers’ compensation insurance even if you are told that you are an independent contractor. If the business owner controls and directs how you perform the work assigned to you, then you may be an “employee” even though you thought that you were an independent contractor. Consult with a Bend(?) workers’ compensation attorney to learn if you have questions about whether you are eligible for workers’ compensation benefits.
How to file a claim for workers’ compensation benefits?
The process of filing a claim for benefits for a work-related injury or disease begins by notifying your employer of the accident or incident. In Oregon, once you provide notice of work-related injury or illness, your employer should provide you with a Form 801 to complete. This form initiates your claim. Note that use of the form is not mandatory as long as you provide notice to your employer in writing within 90 days of the incident that caused your injury or that you learned that you had a work-related illness.
You can also initiate a claim by filling out a Form 827 at your doctor’s office. You should notify every doctor that you treat with that you injury or illness is work-related and compete a Form 827 at their office. The doctor’s office is required to submit the form to your workers’ compensation insurer to notify them of your claim and let them know about your medical treatment.
Employers must comply with Oregon workers’ compensation rules and cannot retaliate against injured workers.
When a worker notifies an employer of a claim, Oregon law requires that the employer submit the claim to its workers’ compensation insurance carrier within five days. The law prohibits employers from engaging in any of the following behaviors after you report a claim:
- Force a worker not to file for workers’ compensation benefits;
- Force a worker to say that the illness or injury was not work-related;
- Claim that a worker is an independent contractor when they are an employee;
- Refuse to submit a worker’s claim to the insurance company; and
- Fire or discriminate against a worker solely based on filing a claim.
Some employers may offer to pay the cost of your medical care and lost wages instead of filing a workers’ compensation claim in order to “save money” or “avoid complications.” However, this puts you at great risk should the employer find your medical bills are too much to afford or simply decide to stop paying. Additionally, without a workers’ compensation claim, you will have no coverage should you require additional medical treatment years later, when it is too late to file for workers’ compensation benefits.
If you employer fails to comply with Oregon workers’ compensation rules, you should consult with a workers’ compensation attorney to ensure that your claim is properly filed.
What happens after my claim is filed?
The workers’ compensation insurance company must notify you whether your claim has been accepted or denied within 60 days from the date that you filed your claim. During the initial 60 days, the insurance company may pay your medical bills and send you lost wages. However, this does not mean that they have accepted your claim. Your claim is not accepted until you receive a Notice of Acceptance letter from the insurer. If you claim is accepted, the insurance company will list the medical conditions for which you may receive benefits. You should consult with a workers’ compensation attorney if your Notice of Acceptance letter does not include all of the medical conditions that you suffered.
If you receive a letter denying your claim, you should consult with a workers’ compensation attorney to discuss your options and how to appeal the denial.
Get legal advice from a Bend Oregon workers’ comp attorney – it’s free!
Under Oregon law, your legal consultation and representation is free. Workers’ compensation attorneys work on a contingency fee basis, meaning that they only receive a fee if they successfully help you resolve a dispute regarding your claim. Workers’ compensation attorneys will not bill you for their time. When you consult with a workers’ compensation attorney, you will learn about your rights and benefits and the options available to you when filing a claim for benefits or when appealing an unfavorable decision. Workers’ compensation laws and procedures can be complicated and most people are unfamiliar with their rights and have little or no experience in navigating through the claims process. In most cases, you will benefit when you have an attorney on your side who has knowledge and experience and a history of success in helping injured workers obtain full workers’ compensation benefits.