Workers' Compensation: A Menu of Benefits
When somebody comes into my office to ask questions about a Workers’ Compensation claim, I get out my legal pad and I draw tall rectangle. Inside that rectangle, I make five boxes. Each box represents a benefit or a potential benefit that you may be entitled to with your workers’ compensation claim. The best way to understand this is to accept the fact that a workers’ compensation claim is nothing more than a stack of benefits available to you if you are injured on the job. Each benefit has its own requirement, and not every injured worker is entitled to every benefit. Here is a list of the benefits, and why you may still need help with your claim, even if the claim is accepted.
You are entitled to medical treatment for the condition that was accepted as a result of your claim. For example, you may have torn a ligament in your knee, but if the insurance company only accepted a knee strain, then you are only entitled to treatment for the strain, and not the ligament tear. There are many other rules about who can provide medical treatment, and how. If you have a dispute with the insurance company over medical services, you can seek review with the Workers Compensation Division. You can sometimes obtain medical benefits even after your claim is closed.
The official name is temporary total disability, or temporary partial disability. If your doctor gives you a note to be off work completely, or if there is no work available for you with a limited duty release, then you are entitled to temporary disability benefits. You may be able to work part time, and in that case, you may receive temporary partial disability benefits. If you disagree with the insurance company’s decision about temporary total disability, you can request review with the Workers Compensation Board.
Permanent Partial Disability
If your claim is disabling, and you have a permanent impairment that affects your ability to return to work, you may be entitled to a permanent partial disability benefit. This is a cash benefit intended to compensate you for lost earning capacity. There are two kinds of permanent partial disability: “work disability” and “whole person impairment.” If you are denied permanent partial disability, or disagree with the amount of permanent partial disability provided, you can appeal the decision to the Appellate Review Unit, which is part of the Workers Compensation Division.
Even if your claim is accepted, disputes can arise, and if you have questions, contact us. We help injured workers in Oregon every day.
If your claim is closed, a five-year time period begins to run from the date of your closure. If, within this five year period of time, your accepted condition “actually worsens”, your doctor can file a claim for aggravation. This is a request to re-open your claim to provide medical care. If the aggravation claim is denied, you can request review with the Oregon Worker’s Compensation Board.
If you are not able to return to your job after treating for your injury, and there are no other jobs available with your employer, then you may be eligible for vocational benefits. This depends upon your existing skills, and your wage at the time of injury. If you are found not eligible for the services, you can request review with the Oregon Worker’s Compensation Division.
One Last Thing: "Own Motion"
There is one more benefit worth mentioning, which is called an “Own Motion” claim. This is a claim that you can make for medical care and temporary total disability, even after your aggravation claim time limit has expired. You have to be a member of the work force, and the care required must involve something significant like a surgery or an overnight hospital stay. You also have to show the medical care is for your accepted condition, or something that resulted from your accepted condition. If this involved a new medical condition, you may be able to recover permanent partial disability. This claim process is much like an initial claim.
Disputes May Arise
Even if a claim is accepted, you may still have disputes with the insurance company. Oregon Workers' Compensation insurers will deny medical treatment, underpay permanent disability, or not even accept all of the medical problems resulting from your on the job injury. An injured worker can appeal any of these denials, and have an attorney help them. The attorney is paid only if successful in appealing a dispute.