Although it is better to have your claim accepted than denied, there still may be some issues lurking beneath an accepted claim. Here are a couple of things to consider, even if your claim has been accepted.
Check The Notice of Acceptance
The Notice of Acceptance is probably the most important document in your claims file. This document, usually in the form of a letter, notifies the injured worker of the exact medical condition that the insurance company will recognize as the work related injury. Some people may have suffered a torn rotator cuff of the shoulder, or a herniated disc in the low back, but the notice of acceptance may only include a shoulder strain or a lumbar strain. The treatment for a strain injury is much different than the treatment required for a torn rotator cuff or a herniated disc. Also, if you are permanently impaired as result of your on-the-job injury, the insurance company may only calculate permanent partial disability for the accepted strain injury, and not a herniated disc or torn rotator cuff.
You should examine the notice of acceptance closely, and consider speaking with your physician to make sure that the injuries resulting from your on-the-job accident are fully covered in the notice of acceptance.
Here is also an important tip: Under the Workers' Compensation statute, an insurance company may pay for medical care to treat a condition that it is not actually accepting as part of the claim. Merely paying for the medical care does not legally obligate the insurance company to accept that particular condition. We have seen insurance companies pay a physician to perform a complicated extensive surgery, only later to convince that same physician to sign a document that none of the conditions treated in the surgery were result of an on-the-job injury. As a result, our client was left with little or no permanent partial disability benefits, and was not qualified for vocational training. So, even if your medical bills are being paid for that herniated disc or that one rotator cuff, this conditions may not be part of the accepted claim.
If you determine that the insurance company has not accepted all of your medical problems, you can make a written request that the insurance company include all of the conditions resulting from your injury. In some cases, a new medical condition may be discovered after the notice of acceptance was issued. In that case, you can ask the insurance company in writing to include the new medical condition as part of the claim as well.
Check the Claim Classification
Included in the initial Notice of Acceptance is a claim classification. An accepted Oregon Workers' Compensation claim will be classified as either "disabling" or "non-disabling." If the claim is disabling, then it means that the insurance company agrees that you have missed time from work as result of your injury, or that you will likely have some permanent impairment as result of your injury.
The insurance company is required to issue a Notice of Closure with a disabling claim. This notice provide you a lot of valuable information, and also indicates whether not you are entitled to a Permanent Partial Disability benefit. If you have missed time from work, or you feel that your injury will have some permanent limitation in your ability to work, check the classification. You have only one year from the date of the notice of acceptance to ask the insurance company to change the classification. Should it refuse, then you have a right to seek review with the State of Oregon.
If you are not sure whether your claim was properly classified, or if the insurance company has taken full responsibility for all the injuries you suffered, call us at 503-325-8600. We can evaluate your claims file, and let you know where you stand.
