Most Oregon businesses with employees are required to pay for workers’ compensation insurance (WC or workers’ comp insurance). The insurance provides compensation to employees who suffer work-related injuries. Here are some basic facts that you need to know about workers’ comp insurance in Oregon as a business owner and employer.
If your Oregon business has just one full-time or part-time employee, you’re generally required to carry workers’ compensation insurance. An exception applies if your payroll is less than $500 for any 30-day period — but if your payroll is ever $500 or more, you must get workers’ comp insurance for your workers. Another exception applies for certain people who only work in your home doing things like cleaning, gardening, home health care, or maintenance. One other important exception applies to certain people who own or run businesses, such as members of LLCs, corporate officers, partners in partnerships, and sole proprietors.
The Oregon Workers’ Compensation Division (WCD) is the primary state agency that handles workers’ comp claims. Most of the law for WC insurance is contained in Oregon’s Workers’ Compensation Law (Chapter 656 of the Oregon Revised Statutes). In addition to the Act, there are also administrative rules that cover workers’ compensation in Oregon.
In Oregon, workers’ compensation insurance is available through private insurance companies. If you’re having difficulty obtaining WC coverage for your business, contact the National Council on Compensation Insurance (NCCI) and ask for the Oregon desk. Be aware that many businesses are able to get coverage through Oregon’s state-chartered, non-profit State Accident Insurance Fund (SAIF). There is also an option to self-insure, but this may not be advisable for smaller businesses, in part because it requires that a lot of money be set aside to cover potential claims.
The employee should make you aware of a work-related injury or illness. The employee must complete the employee section of either a Form 801, Report of Job Injury or Illness, that you should offer to the employee, or a Form 827, Worker’s and Physician’s Report for Workers’ Compensation, that the employee receives from his or her doctor. You need to complete the employer’s section of the form and give a copy to your employee. You also need to inform your WC insurance carrier within five days of learning of the claim. Be aware that you are not allowed to direct an employee to a particular doctor.
Beyond these initial steps, there are subsequent steps to the WC claims process not covered here.
Your insurer must decide whether to accept or deny a claim within 60 days. Your insurer also must notify the WCD within 14 days of making the decision. Your insurer will use Form 1503, Insurer’s Report, to file a denial. If your insurer denies a claim, it must send a letter to the worker explaining why the claim was denied. At that point, the worker has the right to appeal the denial to the Hearings Division of the Workers’ Compensation Board (WCB) by filing a Request for Hearing.
If you disagree with the Hearings Division’s decision, you can request a review by the WCB, and, beyond that, you can also try to get a review from Oregon’s Court of Appeals.
If you don’t carry workers’ compensation insurance you may be subject to various penalties. The WCD will send you an order to obtain WC insurance and initially assess a penalty of two times the amount of the premium you should have paid for insurance with a minimum penalty of $1,000. If you still don’t get WC insurance, you will be assessed an additional penalty of $250 per day with no limit. The penalty cannot be avoided by bankruptcy. In addition, the WCD can obtain a court order that may lead to other penalties and sanctions, including jail time. Some of these penalty rules are contained in Section 656.735 of Oregon’s Workers’ Compensation Law.
There are other workers’ compensation requirements for Oregon employers, such as putting up posters about workers’ compensation coverage where employees can see them. The Nolo website has a section devoted to workers’ compensation. In addition, the Oregon Workers’ Compensation Division website contains many useful resources.