When you get hurt on the job, workers’ compensation should cover your medical care and wage loss so you can focus on healing. Unfortunately, this simple idea has become very complicated under Oregon’s current workers’ compensation system and many workers find they need an attorney’s help to convince the insurer to pay them their benefits.
WE CAN HELP YOU understand the workers’ compensation system, get you benefits and help you make decisions about your legal options.
The Workers’ Compensation System
Oregon adopted its first workers’ compensation system in 1913. Oregon workers who get hurt on the job are entitled to certain benefits. Most Oregon employers fall within the state law and are required to insure their workers against on-the-job injuries. Employers must pay workers’ compensation benefits to injured workers whether the injury was the employer’s fault the worker’s fault, or an unforeseeable accident.
The Four Types of Workers’ Compensation Benefits
Medical benefits: Include all medical services that are reasonable and necessary for your work injury or disease (hospital costs and doctors fees for emergency room, clinic, office visits, surgery, medication, physical therapy, etc.), and mileage to and from your visits.
Time loss benefits: Replaces 2/3 of your average weekly wage if you can’t work because of your injury, and supplements your wages if you are working a modified job for less money. Your average weekly wage is based on what you earned in the 52 weeks before the work injury and should include any regular overtime worked and performance-based bonuses earned. Time loss benefits are not taxable as income.
Permanent disability benefits: An award of money at the end of a claim based on your degree of permanent impairment and can include an additional work disability award if you are unable to return to full-duty work. This award is not taxable as income.
Vocational rehabilitation benefits: Available if you cannot return to your regular job and cannot find work that pays at least 80% of your pre-injury wages. You work with a vocational counselor to develop a plan that can include paying you time-loss benefits while you are retraining.
Your Legal Options
You cannot sue your employer for your injury and damages; your only remedy is your workers’ compensation claim. This is a “trade off” in the law: you do not have to show your employer was at fault, but, in exchange, the only remedy available to you is a workers’ compensation claim. HOWEVER, if your injury was caused by someone other than your employer (for example, a defective product or a person working for someone other than your employer) you may have a “third party” case against someone other than your employer.
You may be able to file for benefits outside the workers’ compensation system for disabling on-the-job injuries, including social security disability. For more information about a social security disability claim, refer to Social Security Disability link.
The Workers’ Compensation Process
You should ALWAYS inform your employer about any work injury IN WRITING. You do not have to fill out a particular form, although many employers have a form called an “801 Form.” Keep a copy of any report you give to your employer.
If your workers’ compensation claim is denied, you should consult a lawyer to see if it can be reversed. There is a strict 60-day time line for requesting a hearing on a denial, so act promptly. Your lawyer’s fee will be paid by the insurer if you win. If you lose there is no lawyer’s fee. It is critical that you have a doctor who supports that your injury is work-related.
You want to retain a lawyer who will agree to keep your case even after you prevail over a denial because disputes can arise over every type of worker’s compensation benefit. The insurer may deny medical care, miscalculate time-loss benefits, close your claim too soon, or refuse to close it at all. They can short-change your permanent disability award, assess an overpayment of benefits, refuse to give you vocational benefits, or try to take your vocational benefits away. All of these actions can be challenged, and sometimes penalties can be assessed on the insurer.
Depending on the type of dispute, your lawyer gets paid either a percentage of the increased compensation awarded, or the insurer is required to pay the lawyer fee.
Insurers often push claimants to settle their claims and sometimes settling the claim works best for the injured worker. Your lawyer is in the best position to help you determine whether and when settlement is in your best interest, determine the value of the claim, maximize the final settlement amount, and make sure your interests are protected.