The purpose of workers’ compensation laws is twofold: Provide workers access to medical care and lost wage reimbursement for work-related injuries and illnesses, and shield employers from lawsuits filed on behalf of sick and injured workers. Oregon and all other states except Texas mandate that employers participate in their workers’ compensation programs by extending coverage to their workers.
Sick or injured workers gain access to benefits by filing a claim with their employer or directly with the workers’ compensation insurance company providing coverage. How long a person can continue to receive workers’ compensation benefits depends on the type of benefits and state law.
The following information about the workers’ compensation system in Oregon and the types of benefits available to sick and injured workers will give you a better understanding of how long they are paid. An excellent source for answers to questions that you may have about benefits is a consultation with a Bend workers’ compensation attorney.
How does workers’ compensation work in Oregon?
Employers with at least one employee on their payrolls in either a full- or part-time capacity must carry workers’ compensation insurance or cover them through a self-insured plan. Workers who become injured or sick through work-related accidents or conditions begin the claim process by reporting it to their employers.
The employer submits the report of the claim to the workers’ compensation insurance company for processing. Workers receive medical care through a healthcare provider of their choice unless they are covered through a managed-care organization (MCO), which means they must choose a medical provider within the MCO.
The insurance company handling the claim for benefits has 60 days to make a decision to accept or deny the claim. If the claim is accepted, the worker receives a letter from the insurer that lists the specific medical condition or conditions approved for benefits. Benefits payable with an approved claim include:
- Payment of expenses related to medical treatment for injuries and illnesses covered by the claim.
- Temporary disability or time-loss benefits, which are two-thirds of the person’s weekly gross earnings when they were injured or became ill.
- A doctor may authorize a person to return to work with restrictions on hours or duties, which entitles the person to temporary partial disability benefits to supplement the reduction in their wages.
- Permanent disability benefits, which are paid when a person is medically stationary, meaning they achieved maximum benefit from medical treatment, yet they remain totally or partially disabled.
A person is medically stationary when their treating physician determines that continuation of medical treatment will not significantly improve their injury or illness. A doctor may classify a person as medically stationary if they continue to have a disability, but it is not caused by their work-related injury or illness. An insurer will close a claim once a worker becomes medically stationary.
How long can you stay on workers’ compensation?
Some states impose limits on how long an injured worker may receive time-loss benefits. The law in Oregon does not limit how long you may continue to receive temporary disability or time-loss benefits, as long as your medical provider determines that you are disabled and cannot return to work. If you receive approval to return to modified or light-duty work, you remain eligible to receive benefits based on the difference in pay between what you earned before your injury or illness and the modified-duty pay.
If your claim is closed because a doctor determines that you are medically stationary, you may be eligible for benefits for medical expenses related to relief of pain and discomfort. A worsening or aggravation of your medical condition within five years from the closing of the claim may be grounds for reopening it to request a resumption of temporary disability benefits for time lost while out of work and benefits to pay expenses related to medical care and treatment.
Worsening or aggravation of an injury or illness that happens more than five years after the closure of your workers’ compensation claim may be reopened, provided that you have the medical basis for doing so in the form of a report from a physician. If approved by the workers’ compensation insurer, the medical benefits will be the same as you would have received had the claim been reopened within five years; however, time-loss benefits will be paid at a reduced rate.
Contact a Bend workers’ compensation lawyer
If you have questions about how much you are entitled to receive in workers’ compensation benefits and for how long, a consultation with a Bend workers’ compensation lawyer can be a trusted source for answers and advice. A review of your claim may provide options to challenge adverse decisions made by the workers’ compensation insurer.