Employer-Denied Workers’ Comp Claims in Oregon

Whether your Oregon employer can deny your workers’ compensation claim depends on how the company is insured.

Many businesses carry workers’ compensation insurance provided by third-party insurers, who then handle resulting claims. If your employer has gone that route, it is the insurance company that will either approve or deny your claim. However, if your employer is self-insured, it can issue the denial.

In either case, the insurance company’s or employer’s decision is not final. Oregon state law allows you to appeal the decision.

What Role Does the Employer Play in the Workers’ Compensation Process?

Oregon law places certain obligations on employers when it comes to workers’ compensation claims. Employers in Oregon must:

• Maintain workers’ compensation insurance as long as they employ at least one subject worker in the state.
• Provide an injured worker with Form 801, Report of Job Injury or Illness, upon request or learning of a potentially covered event.
• Report the potentially covered event to its insurer within five days of learning of the occurrence.

Many employers purchase their workers’ compensation insurance through an independent insurer. Insurance companies must investigate a claim and accept it if they determine that it is valid.

However, employers can alternatively self-insure instead of carrying workers’ compensation coverage. In that case, they have more direct control over the acceptance or denial of a workers’ compensation claim. That said, they are subject to the same laws as other insurers and must accept valid claims without bias.

Common Reasons Workers’ Compensation Claims Are Denied

In the most recent year with available data, insurers approved 60,100 workers’ comp claims in the state and denied 7,713, yielding an Oregon workers’ compensation claim denial rate of 11.4 percent. The denial rate for disabling claims was 9.9 percent.

Workers’ compensation claim denials can result from:

• Late reporting of the incident by the worker after the 90-day deadline has expired
• Determination that the accident happened outside the scope of the worker’s employment
• Insufficient medical evidence of the injury’s severity and its effect on the employee’s ability to work
• Belief that the worker was engaged in horseplay or was intoxicated at the time of the injury

What to Do After a Denial

You can take certain steps if you are dealing with a denied workers’ comp claim in Oregon. First, review the denial letter to understand the reasoning behind the insurer’s decision. Gather any additional information the insurer claims it needs to process your claim. Seek legal representation to help you appeal the decision within 60 days of its issuance.

How Our Oregon Workers’ Compensation Lawyer Can Help

Have you been hurt on the job? If so, Jodie Anne Phillips Polich, P.C. can help you whether you are dealing with an insurer- or employer-denied workers’ comp claim. We can:

• Collect evidence establishing your right to workers’ compensation
• File your claim within state deadlines
• Prepare you for hearings and represent you throughout the process

Do not make the mistake of handling a claim denial on your own. Contact us today to speak with an experienced workers’ compensation attorney in Oregon, and let us protect your rights under the law.