Introduction
Oregon Workers’ Compensation is a private insurance benefit system. This means that private insurance companies who provide coverage to employers get to investigate and decide claims. Only if you disagree with the decision does the State of Oregon Workers’ Compensation Division or Workers’ Compensation Board get involved to review decisions and resolve disputes.
How Claims Are Investigated: The Deferred Status Period
When a claim is filed, Oregon Workers’ Compensation statute gives the insurer several tools to investigate claims. These include taking statements from you, your coworkers and your employer, obtaining medical records, including pre-injury records, sending you to an independent medical examination, and in some cases, conducting surveillance on your everyday activities.
The Starting Point: The Claims Index
Insurers will frequently conduct a claims index search at the outset of any claim. A “claims index” is a database that includes prior claim information. The insurer will look to see whether an injured worker has suffered similar injuries in the past. Depending on the nature of your injury, and what the doctor diagnosed, this kind of information can be critical in deciding a claim.
The Motives
In deciding whether a medical condition is work related, insurers should have access to medical records that deal with a similar injury or a prior injury to the same body part. However, there can be more to a claims index search.
One motive may be to test your credibility. At the beginning of a claim, you will likely receive a claim questionnaire. This claim questionnaire covers all kinds of topics, including your past work experience, your medical history, educational background and whether you filed claims in the past. The insurer will be interested to know if you are willing to disclose a prior similar injury. If you do not, it does not bode well for you because your credibility is always an issue with the workers’ compensation claim.
Another reason a carrier will want to know about past medical history is to see whether responsibility for your condition should be assigned to a previous employer or a prior workers’ compensation claim. These are referred to as “responsibility” claims.
Some kinds of medical conditions occur over a long period of time and may have accumulated while the injured worker worked for different employers, or even the same employer who had different insurance companies over the years.
A good example is a hearing loss claim. We have represented plywood mill workers who worked for several companies over the years, or stayed with the same company, but that company switched workers’ compensation carriers over the years. There are special rules designed to assign responsibility for the claim to a specific insurer or employer. Prior medical records will obviously come into play when making this decision.
Questions?
Honesty is obviously the best policy when providing information to the workers’ compensation carrier. If you have questions about filling out forms or how a prior claim may come into play, contact us. We work with injured workers every day.
