Your Notice of Acceptance Defines Your Claim, and Your Benefits
Workers' Compensation claims are a private insurance system, so the insurance company decides whether to accept your claim, and what to accept. You are told what is accepted in the Notice of Acceptance. So, if the insurance company accepts a knee strain, that is what is covering, even if you suffered a more serious knee injury, like a torn ligament. Even if the insurance company pays for a knee surgery to repair a ligament, paying these bills does not change its responsibility. Many people mistakenly think that paying the bills to treat a condition means that the insurance company is taking responsibility for that condition. That begins and ends with the Notice of Acceptance. What can you do about this?
In the Workers' Compensation statute, there is a section that allows you to make a written claim that a medical condition be included in the Notice of Acceptance. This is called an "omitted medical condition claim." Also, if you develop a new condition as a result of an already accepted condition, you can make a "new medical condition claim" in the same way. The claim is made in writing, and the insurance company has sixty days from the date it receives this request. If the request is denied, you can request a hearing. You must request the hearing within 60 days of the date of denial letter. The good news is that there is no time limit for making these claims. The statute says you can make the claim "at any time."
This is important because there are other benefits at stake. For one, medical coverage, not just for now, but for the future. Also, if your claim is "disabling" (see below), then you may be entitled to a permanent partial disability claim, which compensates you with cash for lost earning capacity. If not all your medical conditions are accepted, they may not be considered for permanent partial disability rating.
Important Update: Recent case law has changed how much the Notice of Acceptance governs your claim. The Notice of Acceptance defines what condition the insurance is processing, but when a benefit is denied becuase it is not "compensable," then the issue is not whether the benefit (disability, medical services) is related to the accepted condition (strain, sprain or fracture), but instead, whether the benefit is related to the "compensable injury." In other words, the real question in this whether the injury event caused the need for treatment. Joe (11-17-14)
Claim Classification: The One Year Trap
Your Notice of Acceptance also classifies your claim as either a "disabling claim," or a "non-disabling claim." The difference is significant. A "disabling claim" is a claim that causes you to miss work, or is expected to cause permanent partial disability. A "non-disabling claim" is a claim that does not cause you to miss work, and is not expected to cause permanent impairment.
Classification is important because if your claim is "non-disabling," then the insurance company is not required to issue a Notice of Closure, which tells you whether you are entitled to compensation for lost earning capacity (permanent partial disability), and if so, how much. Here is the trap. You only have one year from the date of the Notice of Acceptance to challenge the claim classification. If you do not challenge the classification within this time, and your claim is going to cause permanent impairment, you may lose your right to assert permanent partial disability benefits.
So, take a close look at that Notice of Acceptance to protect your future rights, and if you have questions, call us at 503-325-8600. We have offices in Beaverton and Astoria, can meet with you to discuss your claim.