How Oregon Workers' Compensation Works
Oregon Workers' Compensation is really nothing more than an insurance policy that provides a series of benefits to a worker injured on the job in Oregon. Employers are required to have this insurance available to their workers. When someone is injured, they file a claim with their employer, who then must send it to the workers' compensation carrier. The carrier, or insurance company, investigates the claim, and decides whether to accept or deny the claim. If the claim is accepted, then the insurer will issue a Notice of Acceptance. The Notice of Acceptance is important because in it, the insurance company is telling you exactly what it will cover on your claim.
The Accepted Condition
The Notice of Acceptance must tell you a few things, but the most important thing is tells you is the medical conditions that it is covering on your claim. This is called the "accepted condition." The accepted condition is the medical condition that the insurer agrees that you suffered as a result of your on the job injury. This is important because in setting out the medical conditions it is accepting, the insurer is defining its own responsibility on your claim. For example, if you tore a ligament in your knee, but the insurance company accepts a knee strain only, it is only responsible to cover the knee strain. That includes medical services, temporary disability, permanent disability, and vocational services. If you feel that the insurer failed to include a medical problem your Notice of Acceptance, you can make a request to include left out or medical conditions. You can also ask the insurer to include any newly discovered medical problems as you continue to treat for your injury.
Claim Classification
All Oregon Workers' Compensation claims are classified. A claim is either "non-disabling," or "disabling." A non-disabling claim is one that does not cause more than four calendar days of missed time for work, and there is no anticipation of any permanent impairment. A disabling claim is one that causes more than four days of missed work, or where the injury is probably going to cause some permanent work limitations. What's the big deal with classification?
If your claim is classified as disabling, that will force the workers' compensation carrier to eventually close your claim by issuing a Notice of Closure. This document notifies you of several rights you have with the claim, and will tell you if you are entitled to a permanent partial disability benefit. The workers' compensation carrier also has to notify you of what it is accepting by updating your Notice of Acceptance when it closes the claim.
You can ask that the claim be re-classified, but you must do it within one year of the date your claim was accepted.
There is more information included in the Notice of Acceptance, but the key here is to appreciate that it is the single most important document in your claims file.
Questions
If you have questions about your Notice of Acceptance, or any other issues with your Oregon Workers' Compensation claim, contact us. We help injured workers navigate their claims every day.
