A workers' compensation claim in Oregon is an an insurance benefit system. Generally, after you have completed treatment, if your claim is "disabling," it will be closed. Within five years after the date of closure, you have the option, through your doctor, of filing an "aggravation" claim, which is a claim that your condition has "actually worsened." What happens if you need treatment after the five year aggravation period expires?
You may be able to file an "Own Motion" or "new or omitted medical condition" claim. There are different types of claims, and each has its own set of requirements. Let's summarize the different kinds of Own Motion claims.
A worsening claim is a claim the the already accepted conditon has worsened. In order to re-open your claim, you must:
- Make a written request for time loss or a claim reopening after the aggravation period has expired;
- Show that the treatment is for the condition the insurance company accepted;
- Be disabled from work, at least partially,
- Show that the condition requires “hospitalization or inpatient or outpatient surgery, or other curative treatment prescribed in lieu of hospitalization that is necessary to enable the injured worker to return to work.” ORS 656.278(1)(a).
- You have to be a member of the workforce. This means you are working, you are willing to work and are looking for work, or, you are willing to work, but looking for work would be futile.
New or Omitted Medical Condition Claims
This is a claim for a condition that was not originally accepted by the insurance company, or employer. For example, you may have suffered a knee injury years ago, and now you find yourself with serious arthritis, maybe even needing a joint replacement. The arthritis was never accepted. This kind of new or omitted condition must be filed after the aggravation claim period has expired, and you must show that the new or omitted medical condition claim is "compensable." This kind of claim is not considered an "Own Motion" claim until it has been determined to be compensable.
You can still file a new medical condition claim prior to your aggravation claim period expires, but it is a claim made under a different statute.
Pre 1966 Claims
This is a claim for medical benefits for a compensable injury that occurred prior to January 1, 1966, unless the injury occurred from August 5, 1959 through December 31, 1965 and resulted in an award of permanent total disability. Depending on the date of the injury, these claims may be be processed with the Oregon Workers' Compensation Board, or the Department of Consumer and Business Services.
This is just an introduction to possible options. The benefits available under all these claims include medical services, and possibly more benefits depending on which type of claim you have. If you have a question about any kind of "post aggravation" claim for your Oregon Workers' Compensation Claim, give us a call at 503-325-8600. We have helped many injured workers' get the benefits they deserve.