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Our
workers’ compensation system
By law, Oregon employers must carry workers’ compensation
insurance or be self-insured. Workers’ compensation
insurance protects workers by paying for medical treatment
and lost wages and protects employers by shielding them
from liability lawsuits that might result from work-related
injuries or illnesses.
Employers pay premiums to workers’ compensation insurance
companies, and those premiums finance most of the benefits
received by workers if they are injured or suffer an occupational
disease on the job. The legislature makes laws determining
the level of benefits and who qualifies for benefits. The
Department of Consumer and Business Services carries out
policy for the governor, regulating Oregon’s workers’
compensation system, making certain that employers provide
insurance, and ensuring that injured or ill workers receive
the benefits due them.
Oregon has had some kind of workers’ compensation program
since 1914. Today’s system is designed to do the following:
• Prevent or reduce worker injuries and illnesses
• Provide appropriate medical treatment and benefits
to help injured workers recover and return to work
as soon as possible
• Resolve disputes quickly and fairly
Preventing
workplace injuries and illnesses
When people think of workers’ compensation, they usually
think of the benefits workers receive after an injury —
that is one part of the system; another important part involves
preventing injuries and occupational disease. That’s
where Oregon
OSHA fits in. Oregon OSHA administers the Oregon
Safe Employment Act of 1973 (OSEA), under which employers
must provide safe and healthful workplaces for their employees
and ensure that workers have the training and equipment
to do their jobs safely. Workers, too, have responsibilities
in our workers’ compensation system: They must follow
their employers’ workplace safety and health procedures
and report hazards to supervisors. If employers don’t
correct hazards, workers have the right to file a complaint
with OR-OSHA.
OR-OSHA conducts unannounced inspections of workplaces to
make sure that employers comply with the law. OR-OSHA may
issue penalties against employers who violate OSEA, and
can even shut down or “red tag” dangerous worksites.
OR-OSHA may also inspect in the following situations:
• When it receives a complaint
• When there has been a fatal or catastrophic accident
• When an accident requires hospital admission with
medical
treatment other than first aid
• If another agency reports a potential problem
OR-OSHA also helps employers identify hazards and develop
safety and health programs. Consultative services are separate
from OR-OSHA’s enforcement activities, meaning that
employers can request no-cost help without fearing that
a consultation may lead to an inspection, citation, or penalty.
OR-OSHA provides a variety of other resources for employers,
including classes, workshops and statewide educational conferences.
Workers’ compensation insurance companies offering
coverage in Oregon provide similar consultative services
to the employers they cover.
If
a work injury or illness occurs
Workers who have work-related injuries or illnesses need
to file a claim to receive workers’ compensation benefits.
They fill out the First Report of Injury (form
801) from their employers and the First Medical Report
(form 827) from their doctors. Either
form begins the claims process. The forms are sent by the
employer or doctor to the insurer. Insurers must report
disabling claims to the Workers’ Compensation Division
(WCD) within 21 days of the employer’s notice or knowledge
of the claim, and accept or deny the claim within 60 days.
If a claim is denied, the injured worker gets a letter from
the insurer telling him or her why the claim is denied and
about the right to appeal the denial to the Hearings Division
of the Workers’ Compensation Board. If a claim is accepted,
the letter from the insurer will be a notice of acceptance
specifying the medical conditions that will be covered under
the claim. WCD oversees claims handling by auditing insurers’
files to see if the claims were processed accurately and
in a timely manner.
A worker temporarily or permanently disabled by an accepted
work-related injury may receive payment from the workers’
compensation insurer for medical treatment, lost wages,
and permanent disability. Some workers may qualify for vocational
services. Oregon’s workers’ compensation benefits
also include fatality benefits.
When an injured worker’s doctor determines that the
worker is medically stationary or that the work injury is
no longer the major cause of the disability, the worker
is notified that the claim will be closed and how much,
if any, permanent disability payment is due the worker.
Medically stationary means that the work-related injury
or illness is not expected to get better with further treatment
or the passage of time. If injured workers don’t seek
medical treatment, their claims may be closed, also. If
a worker’s medical condition gets worse, his or her
closed claim may be reopened.
WCD administers two programs that help injured workers return
to work: the Employer-at-Injury
Program, which offers incentives to employers to provide
light-duty work during a worker’s recovery, and the
Preferred Worker
Program, which offers employers incentives such as worksite
modification and wage subsidies.
Resolving
disputes
Throughout the claims process, injured workers are informed
about what to do and who to contact if they disagree with
a decision or some other aspect of how their claims are
being handled.
Either the insurer or an injured worker may request mediation
services from WCD or the Workers’
Compensation Board (WCB) if they dispute a claim issue;
either the insurer or an injured or ill worker has the right
to request a hearing or an administrative review. Some issues
must be appealed to WCD before going to the Workers’
Compensation Board. During the appeals process, the insurer
will have a lawyer; injured workers may also hire lawyers,
with fees paid out of or in addition to the compensation
awarded.
There are also ways to resolve disputes or disagreements
about OR-OSHA penalties. If an employer disagrees with a
safety or health citation, OR-OSHA will help in the effort
to settle the disagreement informally. If there is no resolution,
either party may appeal to WCB.
Who
does what
Oregon
OSHA helps keep people out of the workers’ compensation
system through safety and health programs. OR-OSHA adopts
minimum workplace health and safety standards that employers
in all industries must meet and specific safety standards
for selected industries such as agriculture and logging.
The Workers’
Compensation Division enforces and regulates Oregon’s
workers’ compensation laws and administers several
funds, including the Workers’ Benefit Fund, designed
to benefit employers and workers.
The Workers’
Compensation Board helps resolve workers’ compensation
claim and health and safety citation disputes. WCB conducts
hearings and reviews appeals under the Crime Victim Assistance
Program and approves claims disposition agreements.
The Ombudsman
for Injured Workers helps injured or ill workers with
all aspects of the workers’ compensation system.
The Small
Business Ombudsman helps businesses with workers’
compensation issues. Both WCO and SBO serve as advocates
for
the public, independent of the Workers’ Compensation
Division.
The Management/Labor
Advisory Committee is appointed by the governor and
includes five labor and five management representatives
who explore issues and make recommendations about workers’
compensation to policy makers.
The Insurance
Division licenses and regulates all insurance companies
operating in Oregon, including workers’ compensation
insurers. The division also reviews premium rates, conducts
hearings in rate-making and disciplinary cases, and hears
employer appeals on premium audits.
Self-insured employers; insurers, including the State Accident
Insurance Fund Corp. (SAIF); and managed
care organizations (MCOs) all play a role in the workers’
compensation system. MCOs are groups of healthcare providers
that contract with insurers to handle medical treatment
of injured or ill workers.
Outside of DCBS are other government entities that play
a role in Oregon’s workers’ compensation system.
Among these are the Bureau
of Labor and Industries (BOLI), which enforces wage
and hour laws and legal hiring practices and investigates
alleged abuses, and the Center
for Research on Occupational and Environmental Toxicology
(CROET) at Oregon Health Sciences University in Portland.
CROET provides the public, labor, business, health professionals
and government with information on hazardous factors in
the environment and on the job. CROET’s Web address
is www.ohsu.edu/croet/.
This brochure, produced by DCBS, provides an overview of
Oregon’s workers’ compensation system and is not
intended to substitute for legal advice. Please contact
your legal counsel, your insurance company, or one of the
programs or divisions listed in this brochure for specifics
and for more information, or visit our Web site, www.wcd.oregon.gov.
An
effective workers’ compensation system prevents or
alleviates pain and suffering and eases financial burdens
for workers and employers.
Who to call
OR-OSHA, 503-378-3272 or 1-800-922-2689
Standards
& Technical, for workplace safety and health questions,
and the Worksite Redesign Program
OR-OSHA Resource Center, for copies of standards
or other OR-OSHA publications
AV Library, for training and educational materials
and films
Records Management, for the citation histories of
employers in Oregon
Education, for information about conferences and
no-cost workshops
Enforcement, to report OSEA violations
Workers’
Compensation Division: 503-947-7810
Workers' Compensation Infoline: 800-452-0288
Benefit Consultation Unit, for workers’ compensation
benefits information
Reemployment Assistance Unit, for information about
the Preferred Worker and Employer-at-Injury Programs
Compliance Section, to report non-complying employers
or workers’ compensation fraud and for information
about managed care organizations (MCOs), and penalties
Employer Index, to verify workers’ compensation
coverage
Benefit Services Section, for information about vocational
assistance and dispute resolution
Workers’
Compensation Board: 503-378-3308
Ombudsman
for Injured Workers: 1-800-927-1271
or 503-378-3351
Small
Business Ombudsman: 503-378-4209
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