Workers Compensation Frequently Asked Questions
Workers’ Compensation FAQs
If you have never filed a workers’ compensation claim before, the process may seem overwhelming and confusing. Below are some answers to commonly asked questions we receive in our office regarding workers’ comp. For specific answers to your individual questions, contact the Law Office of Jodie Anne Phillips Polich, P.C. now.
Assuming your doctor or health care provider finds you are medically unable to return to work right away, you could be entitled to workers’ compensation benefits for lost wages. Normally you will receive your first weekly benefit check within 14 days after your employer’s workers’ compensation insurer receives authorization from your doctor. Note that these benefits will not replace 100 percent of your pre-accident wages. Rather, you are entitled to receive up to two-thirds of your prior average weekly wage.
If your work-related injury is more serious and you are never able to return to your prior job, you may apply for vocational assistance benefits, which can help you find new work. You may also be eligible for permanent disability benefits.
There are many cases where your doctors are only able to stabilize your medical condition following a workplace accident. But they cannot fully cure your ailment or restore you to your pre-accident level of health. When this happens your healthcare provider will find you are “medically stationary.”
You can continue to receive medical benefits under workers’ compensation after you are declared medically stationary. Such benefits may include diagnostic care, prosthetic devices, and prescription drugs necessary to maintain your condition.
There may come a point where you are “medically stationary” but not necessarily better. Once you are deemed stationary, your employer’s insurance company will still move to close your workers’ compensation claim. Note this does not necessarily mean you will stop receiving all workers’ compensation benefits. Depending on your medical condition, you may be entitled to permanent disability benefits as part of the closing process.
The Notice of Closure is the formal document that your employer’s insurance company will send you regarding the final status of your workers’ compensation claim. You will receive a Notice of Closure once your health care provider has declared you medically stationary. In addition, you will receive the notice if your work-related injury has healed or you fail to keep up with any required medical appointments.
The Notice of Closure will detail any prior medical and temporary disability benefits you received, as well as what permanent benefits you are entitled to going forward. If you disagree with the terms of the closing notice, you have 60 days to file an appeal with the Oregon Workers’ Compensation Division.
Even if you are temporarily unable to return to work while on workers’ compensation, you are still considered an employee and a member of the active workforce. But if you quit your job – or are terminated – for reasons unrelated to your injury or disability, then your now-former employer may no longer be responsible for paying temporary disability benefits.
Not necessarily. It is common practice in Oregon for a workers’ compensation insurer to pay “interim medical benefits” while it reviews your claim. This enables you to seek immediate medical attention for your injury. But the insurer still has 14 days under the law to deny your claim and revoke any interim medical benefits. If that happens, you (or your private health insurance company) may be held responsible for any medical costs already incurred.
If your workers’ compensation claim is ultimately accepted, the insurer will reimburse you for certain out-of-pocket costs incurred in connection with your medical treatment. Common expenses include prescription drugs, as well as transportation, lodging, and meals related to medical appointments. You are responsible for keeping receipts of all out-of-pocket costs and filing a written request for reimbursement within two years.
The answer to this is generally “no.” Workers’ compensation is a no-fault system, so it does not matter whose negligence caused the accident. The employer accepts responsibility for covering all work-related injuries. Of course, if your employer denies your workers’ compensation claim, you have the right to pursue an administrative appeal of that decision to the Workers’ Compensation Division.
It is also important to note that workers’ compensation shields only the employer from civil liability. If a third party’s negligence caused your accident or injury, you are still free to sue them. For example, if you are in a car accident while driving a company-owned car to meet with a client, you could file a personal injury lawsuit against the other driver.
First, you need to check with the insurer as to the status of your claim. If your claim has been denied, your doctor is required to bill your private health insurer first before billing you directly. While you may ultimately be liable for those bills, your doctor is not allowed to take any collection action until you have either settled your workers’ compensation claim or exhausted all of your appeals against the denial of your claim.
For the many Oregon workers’ compensation claims a lawyer is unnecessary. The insurer will simply accept your claim without complaint. But if you do run into any resistance, an attorney is necessary to guide you through the process and advocate on your behalf. At a minimum an attorney can explain your rights and answer any questions or concerns you may have. And if the insurer does deny your claim, an attorney can help negotiate a settlement or, if necessary, handle an appeal to the Workers’ Compensation Board.
If you need independent, professional advice on handling an Oregon workers’ compensation claim, contact the Law Office of Jodie Anne Phillips Polich, P.C. today. Our office concentrates on complex workers’ compensation claims, and our goal is to make sure all of our clients understand the process. While no attorney can guarantee a favorable outcome, we can advise you and pursue compensation for your medical expenses and lost wages.