Oregon Workers' Compensation is a privately administered insurance benefit program. However, if you file a claim, and that claim is denied, you have the right to appeal the denial, and have the State of Oregon review the decision. Here are some thoughts on appealing claim denials.
Most importantly, you must file your request for hearing within 60 days of the date on the denial letter. There is an exception if you can show "good cause," but that exception is so narrow, it almost does not exist. You can file your request for hearing by simply writing a letter to the address provided on the denial letter. An attorney can help you fill out the request for hearing form which allows you to be more specific on what issues you are appealing.
You should also know that an attorney is able to take your case, and a fee is not payable unless that attorney is "instrumental" and getting the denied claim overturned or set aside. If the attorney is not successful, there is no attorney fee. Also, if your attorney is successful in overturning a denial, he or she may be able to get any case expenses reimbursed by the employer up to certain amounts provided for in the statute.
In many cases, the key to overturning a claim denial is obtaining a favorable medical opinion. Many times, an injured worker will turn to their treating physician, or even retain a physician to review the case, and provide an opinion. Another option is to seek a worker requested medical examination, which is similar to an insurance company seeking an independent medical examination.
If you have a denied Oregon Workers' Compensation claim, call us at 503-325-8600. We have extensive experience representing injured workers before the Workers Compensation Board.
