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By actively participating in the workers’ compensation claims process, you can ensure your employees receive the care they are entitled to following an injury, while controlling costs. Below are your rights and responsibilities when one of your employees files a workers’ compensation claim.
Employers must accept notice of a claim from a worker and report that injury to their insurance company within five days. If the worker needs no medical treatment or is given only first aid, there is no need to notify the insurer. A record of this injury should be maintained for a year. If, however, the employer later learns that the injury has worsened and requires medical attention from a licensed practitioner, the employer must report the injury within five days by using Form 801.
When filing Form 801 to report an injury to your insurer, you may attach a sheet to the 801, expressing any concerns that the claim might be suspicious or fraudulent. Be specific about your concerns, and provide documentation to back them up.
In your insurance contract, you give the right to process and settle claims to your insurance company. However, your insurance company is working for you. If you want to know what is happening on a claim, call your insurer or your agent. Let them know you want to cooperate in any way necessary to get the injured worker back to work. The sooner the worker is returned to work in any capacity, the better the odds of a successful rehabilitation.
Your claims processor may need you to provide up to 52 weeks of the worker’s wage and earning records. The claims processor may also ask questions related to the wage earning agreement between you and the worker and require information regarding any gaps in earnings of more than 14 consecutive calendar days.
If wage and earning records are requested, you should provide all wages for the time period requested, which may include, but is not limited to, the following:
• Regularly paid wages
• Holiday pay
• Vacation pay
• Sick leave
• Special pay (e.g., shift differentials)
• In-kind considerations (if the considerations will not continue during the period of disability)
Your claims processor may also require details about the number of hours worked at different rates of pay. The Oregon Employment Department outlines how wages should be itemized in a pay statement and these detailed pay statements may assist the insurer in calculating wages. For more information, see the Oregon Bureau of Labor and Industries (BOLI) webpage or contact BOLI directly.
It is important that you provide this wage information promptly, if requested, and respond to any related inquiries to assist with the timely and accurate payment of benefits.
You can contact the worker and keep in touch throughout the claims process. Let the worker know you are concerned with his or her well-being. Keep communication lines open, and you and your employee will not likely become adversaries.
You can contact the injured worker’s physician at any time and ask for the conditions under which the worker can return to work. You have a right to keep abreast of the worker’s condition or to facilitate an early return to a modified or regular job, with the physician’s approval. The worker must participate in his or her physical rehabilitation to the fullest extent possible.
Getting the worker back to work at modified duty can save you money and benefit the worker. Under modified duty, if the worker receives full pay, your insurance carrier pays the worker nothing, and time-loss costs stop. This will decrease the effect the claim will have on future insurance costs. Also, the sooner the worker returns to work, the better the chance of a more complete recovery. There are some restrictions on what an employer may offer as modified work. Refer questions to your insurer.
You have the right to request a hearing on any action taken involving a worker’s right to compensation or the amount of the compensation. Send the request in writing to the Workers’ Compensation Board.
If you have reason to believe that an injured worker’s condition may have been caused by prior employment, you can request a Paying Agent Order under ORS 656.307 to bring a previous employer into the proceeding. However, the worker must have filed a claim for the same condition with the prior employer for an order to be considered.
You have the option of reimbursing the insurer up to the amount published annually in Bulletin 345. These reimbursed costs cannot be used for experience-rating calculations. The insurer must notify you of this option before the start of the policy year. If you want to participate in this program, you must respond in writing. You may opt to participate later, but the insurer must agree to your participation date.
Workers’ Compensation Division
Business Identification Number
Employer coverage indexing
Small Business Ombudsman for Workers’ Compensation
Active and Inactive Self-Insured Employers
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