Workers' Compensation Benefits in Portland
What Do Workers’ Compensation Benefits Cover in Portland?
Workers’ compensation is a state-managed insurance program designed to provide “no-fault” benefits to individuals of all ages who are injured in the course of their employment. The Oregon Workers’ Compensation Division regulates and oversees the program. This includes handling disputed claims where the employer or its workers’ compensation insurer refuses to pay the benefits mandated by law.
It is important to understand that workers’ compensation includes many different types of benefits. The actual benefits received will depend on the severity of a workplace injury and the employee’s prospects for recovery and return to full-time work. In some cases, workers’ compensation benefits may even have to be paid to the worker’s spouse or dependent family members.
Below is a brief outline of just some of the workers’ compensation benefits available under Oregon law. Note that the laws and regulations governing workers’ compensation frequently change. If you need advice on the current state of the law, you should speak with a qualified Portland workers’ compensation attorney.
Following a workplace accident – or the onset of an occupational-related illness – an employee’s first priority should be seeking medical attention. If you need emergency care, you should proceed without delay to the hospital or your own doctor. But if you require ongoing medical care, you need to check with your employer or, in most cases, its workers’ compensation insurance provider.
The reason for this is that many insurers contract with third-party managed care organizations (MCOs) to provide medical coverage in workers’ compensation cases. Under Oregon law, the insurer can require you to select a doctor within the MCO. However, it may be possible for you to continue seeing your regular doctor if he or she obtains a temporary credential from the MCO and agrees to operate under its rules.
The good news is that once your workers’ compensation claim is approved, your employer or its insurer must fully cover any “reasonable and necessary” medical expenses arising from the workplace injury or illness. This includes medical bills and prescription drugs, as well as certain secondary costs, such as transportation to-and-from doctor’s appointments.
Time Off Work
Beyond medical benefits, Oregon workers’ compensation system also provides for “time-loss” compensation. These are payments designed to replace lost wages during the time you are medically unable to return to work at your pre-injury level. Time-loss benefits are classified as either “temporary total disability” (TTD) or “temporary partial disability” (TPD) benefits.
Let’s start with TTD benefits, which are paid when you are unable to work at all. These benefits do not actually replace 100 percent of your lost wages. Instead, state law limits TTD payments to two-thirds (66 and 2/3 percent) of your “average weekly wage” prior to your accident. In no case can TTD benefits exceed a state-determined maximum benefit, which was $1,280.80 per week for new claims filed in 2018. There is also a minimum “floor” on TTD payments, which is the lesser of $50 per week or 90 percent of your pre-accident average weekly wages.
TPD payments work similar to TTD benefits, except they are paid in situations where you are able to return to some level of work, usually under some level of medical restrictions. TPD benefits are two-thirds of the difference between what you earned pre- and post-accident. For example, let’s say you earned $600 per week before breaking your leg at work. Your doctor clears you to return to light duty, which cuts your weekly wages to just $400. Under this scenario, you would be eligible for TPD benefits of $133.33 per week, which represents two-thirds of the difference between $600 and $400.
Payment of either TTD or TPD benefits generally will continue only until your doctor certifies you have reached “maximum medical improvement,” that is to say, the point where your post-injury condition is unlikely to improve any further. At that point, you may be eligible for permanent disability benefits.
You should also be aware that the Oregon Workers’ Compensation Division recently issued a Notice of Temporary Changes to Workers’ Compensation Rules that affects the calculation of average weekly wages in cases where an employee earns “irregular” wages. Once again, a qualified Portland workers’ compensation benefits attorney can advise you on how these changes may affect your claim.
If you do sustain a permanent disability as the result of a workplace injury, you may be entitled to vocational assistance benefits. Vocational assistance includes retraining a person who is no longer able to perform the same type of work as they did prior to their accident. A qualified Portland workers’ compensation attorney can advise you of the specific eligibility criteria for vocational assistance and help explain the types of retraining that may benefit you.
Unfortunately, there are cases where a workplace injury or occupational illness is fatal to the employee. Oregon workers’ compensation law provides for the payment of death benefits in these situations. This includes a lump-sum payment for the deceased worker’s final disposition and funeral expenses ($19,620.20 for workers killed after July 1, 2017).
If the deceased worker had a spouse, he or she is entitled to monthly payments of $2,792.87 (as of 2017). Children of the deceased are also entitled to payments, which varies based on whether there is a surviving spouse who is responsible for the children. Although children’s death benefits are normally paid until they reach the age of 18, payments may be extended until the age of 23 if they are attending college.
Finally, there may be “other dependents” who are entitled to receive death benefits. A dependent in this context means anyone who relied on the deceased for at least 50 percent of their “average monthly support” for the 12 months prior to the worker’s death. The total death benefits for all surviving dependents may not exceed $418.91 as of 2017.
Contact an Portland Workers’ Compensation Benefits Lawyer Today
The complex web of workers’ compensation benefits may seem daunting if you have never dealt with the system before. Even after reading this article, you will no doubt have many questions as they apply to your specific situation. This is why it is important to speak with and hire an experienced Portland workers’ compensation attorney.
At the Law Office of Jodie Anne Phillips Polich, P.C., we can help educate you on the workers’ compensation process. Attorney Jodie Anne Phillips Polich is a former member of the Oregon Workers’ Compensation Board who has spent the past 15 years advising clients on the merits of their workers’ compensation claims and helping them pursue benefits.