If you are injured on the job, you should be entitled to Oregon workers’ compensation benefits. Workers may receive medical treatment, compensation for wage loss, and other assistance. To collect benefits, you must report your injury to your employer and meet other legal requirements.
The Workers’ Compensation Division oversees all Oregon workers’ comp claims. By law, most employers must have workers’ compensation coverage. Employers obtain coverage either by purchasing a workers’ comp policy from an insurance company or receiving certification from the state to self-insure. The State Accident Insurance Fund (SAIF), a not-for-profit, state-chartered insurance company, insures about half of Oregon’s employers.
Like all other states, Oregon has a no-fault workers’ compensation system. You do not need to show that your employer acted carelessly in order to receive benefits. As long as your injury happened on the job or was caused by your work activities, you are eligible for benefits.
Eligible workers may receive a variety of benefits, including:
Workers’ comp is your exclusive remedy against your employer and its insurance company. You typically cannot sue your employer and demand other compensation (for example, for "pain and suffering"). However, you may have a “third party” lawsuit if someone else’s carelessness caused your injuries (other than a coworker). To learn more, see our article on suing outside of workers’ comp.
To be eligible for workers’ comp, you must report the injury to your employer within 90 days of a work-related accident. Occupational illnesses must be reported within one year of discovering the illness’ connection to your work. If you miss these deadlines, you may lose your right to collect benefits. For smooth processing of your claim, it's best to report your work injury as soon as possible.
In Oregon, your notice must be written. Typically, injured workers complete a Report of Job Injury or Illness (Form 801), which is provided by the employer. (The form is also available online at the Division's website) However, any signed, written notice is acceptable, as long as it explains how, when, and where your injury occurred.
Once you notify your employer of your injury, it should tell you how to get necessary medical treatment. Under Oregon law, you can either select your own treating doctor or one from the insurance company’s managed care organization. At your first appointment, your doctor must complete a Workers’ and Physician’s Report for Workers’ Compensation Claims (Form 827) and send it to the insurance company.
At your doctor's appointments, it is important to give accurate information about the cause of your injuries and the severity of your symptoms. Insurance companies rely heavily on initial medical records when they evaluate claims. Either downplaying or exaggerating your symptoms may result in a denial of benefits.
Your employer must send your completed Form 801 to its insurance company within five days of receipt. Once it has your claim, the insurance company will determine your eligibility for benefits. Its investigation may involve:
In Oregon, the insurance company typically must pay temporary disability benefits and your reasonable and necessary medical expenses during its investigation. And, it must either approve or deny your claim within 60 days. If approved, you will receive a Notice of Acceptance that lists all your accepted injuries and medical conditions. If your claim is denied, you will receive a written notice of denial and an explanation of your appeal rights.
If your claim is denied, you have the right to appeal by filing a request for hearing with the Division. You should consider hiring a workers’ compensation lawyer at this point. The insurance company will have a lawyer, and you may be at a disadvantage if you proceed without an attorney. You can also receive information and assistance from the Ombudsman for Injured Workers.