The Truth About Oregon Workers' Compensation Claims
The Bad News:
Oregon Workers' Compensation should provide injured workers benefits for medical care, lost income, and help moving on from an on the job injury. But unlike other states, Oregon's workers' compensation system is private. This means that the same insurance company responsible for paying claims gets to decide whether to cover the claim at all. And even when a claim is accepted, the insurance company still controls your claim from start to finish.
Some claim denials are based only on the opinion of the insurance company's doctors. Other claims are accepted, but only for some of your injuries.
The Good News:
The good news is that an injured worker can appeal a claim denial, dispute any denied benefit, or demand that the insurer take full responsibility for all your injuries.
Even though you can appeal your denial, you face a complex system that often makes little sense!
You can hire a workers' compensation lawyer in Oregon at no cost to you. The Oregon Workers' Compensation law says that your lawyer is paid only if successful getting benefits you deserve. The insurance company pays the attorney fees, or the fee comes out of increased benefits your lawyer recovers for you. The State of Oregon reviews and approves all fees to protect you.
Important Questions When Your Claim Is Denied
1. Should I appeal a claim denial?
You must file a request for hearing within sixty days from the date of the denial letter to appeal the denied claim.
2. How do I pay for a workers compensation lawyer?
The Oregon Workers' Compensation statute makes attorneys accessible to injured workers. Your attorney is paid only if successful on your case. The insurer pays the fees, or, fees are a percentage of the increased benefit award.
3. How do I prove my claim?
Proving your claim depends on the insurer's reason for denying your claim. Insurers often deny claims based on medical opinions.
4. What happens at a Workers' Compensation hearing?
The Oregon Workers' Compensation hearing is a lot like a court trial, but there are differences.
5. Can I resolve my claim with a settlement?
Just like everything else, there are rules about how you can resolve your claim. Settlements are allowed, but only certain kinds of settlement. More important, there is a lot to consider when deciding to resolve your claim, and if so, how.
Even If Your Claim Is Accepted, You Should Know:
Even with accepted claims, the insurance company may not be covering more serious and permanent injuries that include important benefits.
Your Notice of Acceptance may be the most important document in your claims file. The insurer is telling you what it will cover, and often, it is not complete. Find out what you can do to make sure insurer's are fulling covering your claim.
My insurance company enrolled me in a Managed Care Organization. What is this?
Managed Care Organizations, or "MCO's" place another layer of bureaucracy between you and your medical care.
My doctor asked for approval for medical care, but it was denied. What can I do?
All Oregon Workers' Compensation claims involve some form of medical care. Just like any other benefit, if a surgery or other medical treatment is denied, you have rights.
My claim was closed recently. What are my options?
Just like the term describes, when your claim is closed, benefits stop. Insurers often incorrectly close claims, and you may be losing benefits, or not getting what you deserve for permanent work restrictions.
Whether your claim is accepted or denied, you may have questions. Contact us. We work with injured workers every day, and can help you know where to stand.