What is workers’
compensation insurance? Workers hurt on the job are protected by workers’
compensation insurance. Oregon law requires employers to insure their
employees by purchasing workers' compensation insurance. There are over
200 insurance companies providing workers’ compensation insurance
in Oregon.
With rare exceptions, Oregon has a “no fault” system, which
means both workers and employers are protected from the time and expense
of determining who caused an on-the-job accident. It is the worker’s
responsibility, however, to prove that an injury or disease is job related
rather than substantially related to a preexisting condition.
Workers’ compensation insurance pays for medical services and provides
temporary total disability (lost wages) payments if an injured worker
must be off work due to their on-the-job injury.
What
kinds of injuries or illnesses qualify for workers’ compensation
benefits? Generally, any injury that occurs while working (or
illness due to work) that requires you to see a doctor or results in disability
or death may qualify for workers’ compensation benefits. An injury
could be traumatic (caused by an accident), cumulative (caused by repetitive
motion), or an occupational disease (such as loss of hearing). A doctor
must be able to verify that there is objective medical evidence showing
that an injury or disease exists and that work exposure was the major
cause.
How
you get benefits when hurt on the job? The insurer will begin evaluating your claim as soon
as it is received. The insurer will notify you and the employer in writing
when the claim has been accepted or denied. A claim number will be assigned
to the claim. A claims adjuster may contact you by telephone or in writing
to ask questions about your claim. You should have your claim number with
you when you complete any forms, see the doctor, or call the insurer.
Having the claim number available will also help you get your questions
answered quickly. You may receive time loss benefits based on your wages.
Time-loss
(wage replacement) benefit levels
You will get time-loss
payments from the insurer if your doctor authorizes time off work or modified
work (also called “light duty”) that results in lost wages.
Time-loss payments usually begin two weeks after you report the claim
to your employer, but only if the doctor provides written authorization
to the insurer soon after you are injured. Otherwise, your first check
will be mailed within two weeks from the date the insurer receives authorization
from your doctor.
During each appointment, ask your doctor to send appropriate time-loss
authorization to the insurer. If time-loss authorization expired before
your appointment, your doctor can approve time-loss payments only for
the previous two weeks. You may also help to ensure timely payment by
contacting the insurer as soon as you begin to miss work.
Time-loss benefits, sometimes called temporary total disability (TTD)
or temporary partial disability (TPD), are based on your weekly wage when
you were injured. If you had additional jobs at the time of injury, you
may be eligible to receive additional disability payments called Supplemental
Disability Benefits. You must notify the insurer about your other jobs
within 30 days of the insurer’s receipt of your initial claim and
provide proof of wages paid on the other jobs: check stubs or payroll
records. Permanent partial disability (PPD) benefits will depend on the
severity of your injury and payment will be for a body part or a system
(back, hip, respiratory system). Permanent total disability (PTD) benefits
are disability payments received monthly for the rest of your life if
you are permanently unable to work.
After your time-loss payments end, you may be entitled to unemployment
benefits (even if it would ordinarily be too late to qualify).
Supplemental
(wage replacement) benefit levels If you had additional jobs at the time of injury, you
may be eligible to receive additional disability payments. You must notify
the insurer about the other jobs within 30 days of the insurer’s
receipt of your initial claim and provide proof of wages paid on the other
jobs: Check stubs or payroll records. If you have a disabling injury,
you will also receive (TPD) if you must leave work for four hours or more
to receive medical treatment for your injury (unless your employer pays
your wages for this absence).
Temporary
Partial Disability (TPD) Temporary partial disability is due to a work-related
injury or illness that allows you to return to a modified light-duty or
part-time job that pays less than your job at injury. Until your partial
disability ends, you may receive partial time-loss payments to make up
the difference, or a portion of the difference, in wages. ORS 656.212
If your working hours are reduced or you are doing modified work that
pays less than your regular wage, the insurer will send you partial time-loss
payments (TPD) to replace part of your lost wages.
Permanent
Partial Disability (PPD) Permanent partial disability is the loss of use or function
of any portion of your body as defined by scheduled or unscheduled disabilities.
If your Notice of Closure shows you have permanent partial disability,
this means your injury caused a condition that has not returned to its
normal or pre-injury condition. You will receive payment from the insurer
for this disability, and the amount will depend on the severity of the
disability. Disability to certain body parts, such as a hand or foot,
is paid at a rate set by law. Payment for a body part or system (such
as the back, hip, or respiratory system) may be affected by factors such
as age, education, work history, and current ability to work.
If the insurer overpaid you for past benefits, the insurer may recover
the overpayment by reducing your permanent disability payments or by reducing
future benefits.
Temporary
Total Disability (TTD) Temporary total disability is due to a work-related
injury or illness that leaves you completely unable to work for a limited
period. You may receive time-loss payments to make up for lost wages.
ORS 656.210
If you cannot work at all, time-loss payments will equal two-thirds of
your gross wage, as long as that is not more than 133% of Oregon’s
average weekly wage.
Permanent
Total Disability (PTD) Permanent total disability is the loss of use or function
of any portion of your body, including preexisting disability, which permanently
incapacitates you from regularly performing work at a gainful and suitable
occupation. ORS 656.206(1)(a)
If your closure document shows you have permanent total disability, this
means you are permanently unable to work. You will receive monthly disability
payments for the rest of your life if you remain totally disabled. The
insurer will reexamine your claim at least every two years to see if you
remain unable to work.
Three-day
waiting period The first three days you lose work may not be paid by
the insurer unless you are hospitalized or unable to return to work at
all for at least 14 days. This is called a “three-day wait.”
It is required by state law and acts as a form of deductible. If your
doctor released you to any kind of work in the first 14 days after you
are injured, you will not be paid for the first three days missed. If
you are hospitalized overnight, or unable to be released to perform work
of any type (at the direction of your doctor) during the first 14 days
after you are injured, the first three days missed will be paid.
For
dates of injury prior to 1-1-05:
“Scheduled” versus “unscheduled” injury payments
Scheduled disability is the complete or partial loss
of use or function of your arm, hand, leg, foot, or other extremity of
your body, or the loss of your visual or hearing ability. These body parts
are listed on a schedule with an amount of money applied to each, so that
you and all Oregon injured workers receive the same amount of money for
the same disability, regardless of what job is performed at the time of
injury. ORS 656.214.
Unscheduled disability affects your ability to earn a wage. It
applies to impairment of body parts that are not listed as scheduled.
ORS 656.214(5)
Dates of injury on or after 1-1-05:
"Impairment" means the loss of use
or function of a body part or system stated as a percentage of the whole
person.
"Work disability" means impairment modified by age, education,
and adaptability to perform a given job.
Time-loss benefits Compensation paid to an injured worker while he or she is not working as a result of occupational injury or disease; includes temporary partial disability and temporary total disability.
If you have questions about the information contained in this document, please contact
Benefits & Certifications Unit, 503-947-7585.
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