Oregon Workers’ Compensation is anything but straightforward. Many clients will contact us after receiving a letter that they were overpaid benefits. This often causes some anxiety and worry, but the fact is that the payments were not really overpaid, but instead paid in advance.
In the rules governing the payment of temporary total disability or temporary partial disability benefits, there are two requirements insurance companies must follow. These benefits are for wage replacement, and I often refer to these benefits as "time loss."
First, the insurance company is only required to pay any temporary total disability or temporary partial disability benefits if there is written authorization for either modified work or complete disability from work from the attending physician. As long as there is written authorization from the attending physician, these payments must continue. These payments must continue until the worker is declared medically stationary. The Oregon Workers’ Compensation people call this “substantive” entitlement to time loss.
However, there is also a procedural limitation on payment of time loss benefits. Another rule provides that the insurance company cannot stop paying temporary total disability or temporary partial disability up until the issuance of a Notice of Closure. This is the "procedural" apsect of time loss benefits.
In many cases, an attending physician will agree that an injured worker is medically stationary as of a certain date. However, the insurance carrier may need additional time to gather sufficient information to issue a Notice of Closure, or they just may not be doing their job. As a result, any payments after the date the injured worker became medically stationary up until the date of the Notice of Closure is referred to as an “overpayment.”
When the Notice of Closure is issued, the insurance company may notify the injured worker that it made an “overpayment” of benefits, and will take a credit for the overpayment by reducing the amounts due in the Notice of Closure. This is not really an “overpayment,” but instead an advance on the payment of permanent partial disability benefits.
In some cases, the injured worker may not be due any permanent partial disability, or the amount of permanent partial disability benefits due may not be sufficient to completely cover the “overpayment.” The most important thing to realize is that you are not personally responsible for any overpayments made by the insurance company. Instead, the insurance company will have a credit on any future permanent partial disability payments.
If you have questions about your Oregon Workers’ Compensation claim, call us at 503-325-8600. We deal with these issues every day.