The Accepted Oregon Workers' Compensation Claim
It’s a relief to know when your claim for an on the job injury in Oregon has been accepted. This is because if things go the way they should, you get the medical care you need, and get back to work. But even when you have an accepted claim, there are a few things you must know about your claim.
Check Your Notice of Acceptance
When an insurance company accepts a claim, it issues a Notice of Acceptance. This tells you that the claim is being accepted, but it will also tell you what specific medical condition is accepted. This is important because the insurance company is only obligated to cover the accepted medical condition. For example, if you suffer a torn knee ligament, and the insurance company accepts a knee strain instead, it only has to provide you benefits to treat the knee strain, not the torn ligament. We see a lot of cases where the insurance company accepts a minor injury only but will pay medical expenses for the more serious injury. The law allows the insurance company to pay medical bills for something it is not accepting without being responsible to provide benefits for the more serious injury. So, to take our example above, your insurer may pay for a knee surgery to repair a torn ligament, but legally, is only responsible for the knee strain. This can be misleading and affect other benefits like vocational training and permanent partial disability.
You can ask the insurance company to amend the notice of acceptance to include more serious conditions, which is much like filing a new claim. There are a lot of things to consider when making this claim.
Make Sure You Are Getting Paid for All Lost Income
If you are working more than one job when injured, you may recover “supplemental temporary disability.” This is a wage replacement benefit for the income you have lost when your injury keeps you from working your other job too. You must notify the insurance company within thirty days it receives notice of your claim. There are additional requirements for verifying your employment and earnings requirements.
See Your Doctor Regularly
Workers’ Compensation in Oregon is all about documentation. If you have been disabled from your work because of an on the job injury, you must regularly check in with your doctor, and make sure there is ongoing documentation of your disability from work. If you do not have documentation of your disability, the insurance company may not have to pay any time loss. Even if you get your physician to retroactively authorize you to be off work, there are often limits on retroactive benefits the insurance company must cover.
The workers’ compensation statutes and rules allow an insurance company and an employer to offer you a modified job position. This is a job that is modified to accommodate any limitations you may have. For example, your doctor may release you to a sedentary or “sit-down” job with lifting restrictions. The insurer and the employer must follow a process in to make a valid offer of modified work. First, the employer must have the job available. Sometimes, the employer may create a modified position for you. Then, your attending doctor must review a written description of the position and sign off on approving you to work that job. Once these steps are completed, your employer will make the written offer of employment.
Often, everyone is working in good faith to get you back to work. It’s always good to get back to work if you are not slowing your recovery. Some employers and insurance companies abuse this process by creating a job, but then making you do more than what you are released to do. Here are a few things to remember with modified work:
- Keep the work restriction with you when working. If a supervisor or manager asks you to do something beyond the job restrictions, politely inform the supervisor you should not be doing that task and offer to take on another task.
- If the manager forces you to do the work, you are in a tough position because you are not following doctor’s orders if you undertake the task. If you refuse, then your employer may think you are refusing to follow instructions. We recommend our clients contact us right away when this happens. If you have no attorney, call your adjuster when you can. Often, adjusters are not happy to hear about employer’s violating the restrictions on a modified work release because they know it could cause you more harm and complicate things on your clam. If you have no choice, consider leaving the work place and contacting your doctor right away to document the violation of the modified work restrictions.
Anticipating Claim Closure
If you lose time from work, or if you have a serious injury that will limit your work ability even when treatment is complete, your claim will go to closure. When a claim closes, the insurance company issues a Notice of Closure. When this happens, you are no longer entitled to restorative medical care, and any time loss (disability) benefits you are receiving stop. You will know that the insurance company is getting ready to close your claim if it schedules an independent medical examination. Sometimes the letter notifying you of the examination will tell you that the exam is being scheduled to assess your permanent impairment. If you are getting close to the end of physical therapy, or your doctor tells you there is only one more follow up appointment left, then you may be looking at claim closure. The thing to remember is that for the insurance company to close your claim, your doctor must agree that you are “medically stationary.” This means you are as good as you will get, and more time, or more medical care will not get you any better. You have leveled out, so to speak. You may have good and bad days, but over the long haul, you are stable.
Consider Asking for Vocational Rehabilitation
If you not sure that you can go back to your prior job duties, even after you complete medical care, you may ask the insurance company to evaluate you for vocational rehabilitation. This is a benefit that might include a training program aimed at getting you back to a job that pays as much as your previous job. Whether you qualify for this benefit depends on your employer, your skills, how much you were making, the extent of your disability, and the local labor market.
Most accepted claims go smoothly, but there could be issues along the way. If you encounter a problem with your claim, and have a question, contact us. We talk to injured workers every day, and often, you need not get a lawyer on board officially. But if you do, the lawyer only gets paid for results, and only when the State of Oregon says so.