Oregon Workers’ Compensation’s is really nothing more than an insurance policy for injured workers that provides specific benefits. If a benefit is underpaid or denied completely, an injured worker has appeal rights. By the time an injured worker makes it into our office, some of those time limits have come and gone. Here are the crucial time limits you should know about.
When Your Claim is Accepted
Even when an insurance company takes responsibility, and accepts a claim, you should still be aware of how the claim has been “classified.” Claims are classified as either “disabling” or “non-disabling.” If you have missed time from work due to your injury, or if you are expected have some form of permanent partial disability, then your claim should be classified as “disabling.” This is important because insurance companies have to issue a Notice of Closure only for disabling claims, and with a claim closure, there may be significant benefits at stake.
The Bottom Line: You have one year from the date of the Notice of Acceptance to ask your insurance company to re-classify the claim. If the insurance company refuses to do so, you can then seek a hearing with the Workers’ Compensation Board within sixty days of the refusal to reclassify your claim.
When Your Claim is Denied
When your claim is denied, you have sixty days from the date of the denial to request a hearing. You can write a letter, fax, or email the Hearings Division of the Workers’ Compensation Board.
When Your Claim is Closed
An insurance company will close the claim by issuing a Notice of Closure. Among other things, this document describes the period of time you were entitled to temporary total or partial disability benefits (wage replacement), the date that you became medically stationary (no longer needing medical care to cure your injury), and whether you are entitled to permanent partial disability (compensation for lost earning capacity). You can appeal several issues from a Notice of Closure.
Bottom Line: You have sixty days from the date of the Notice of Closure to file a “request for reconsideration” with the Workers’ Compensation Division, Appellate Review Unit. Here is an example of the language you will see in your Notice of Closure notifying you of your appeal rights.
Mileage Lodging, and Other Medical Services
Common to every accepted workers’ compensation claim is the right to medical services. In addition to payment of medical expenses, you are entitled to be reimbursed for mileage traveled to and from medical appointments, and mandatory insurance medical exams. You can also be reimbursed for out-of-pocket medical expenses, which was commonly include prescription medications.
Bottom Line: You must make your request for reimbursement within two years of incurring the expense. Your insurance company will often provide forms that you can fill out to submit for expense reimbursement. If the insurance company does not pay your expense within 30 days of the request. If the request for reimbursement is denied, the injured worker can request review of the denial for reimbursement. If the insurance company denies reimbursement, it must advise you of your right to seek appeal with the Oregon Workers’ Compensation Division within ninety days of the denial letter.
If you have other questions about your rights with an Oregon Workers’ Compensation claim, call us at 503-325-8600. We have offices in Astoria and Beaverton, and have been helping injured workers for over 20 years
