The Not So Short Answer

There is a section in the workers' compensation statute that tells us the meaning of a pre-existing condition, but the Courts and the Workers' Compensation Board, through case decisions, is always looking at this issue, so what it actually means changes or evolves over time.

However, the statute's definition depends on the kind of claim involved.

The Pre-Existing Condition and the Injury Claim

For an "injury claim," a pre-existing condition includes any injury, disease, congenital issue, personality disorder or similar issue that contributes to the need for medical care or disability. However, there must be a diagnosis or at least some medical care for these conditions before the on-the-job injury. The big exception here is "arthritis." The term "arthritis" is more a legal term then medical term. Just like pre-existing conditions, there have been court battles over the exact meeting of arthritis in the workers' compensation context. 

The bottom line: If you treated for a condition before your on-the-job injury, and it contributes to your need for medical care or disability, then it's a pre-existing condition. Also, if you have the legal definition of "arthritis," then it's a pre-existing condition.

The Pre-Existing Condition and the Occupational Disease Claim

Another kind of claim you can file in Oregon is known as an "occupational disease" claim. Occupational diseases occur over time when you are exposed to some environmental factor at work that causes an issue. For example, hearing loss claims are often occupational diseases because the hearing loss occurs over a long period of time when exposed to excessive noise at work. Carpal tunnel syndrome is a repetitive stress injury that occurs with repetitive grasping and gripping at work over an extended period of time. A pre-existing condition exists in a occupational disease claim if it contributes to disability from work or need for medical care, and preceded the onset of the occupational disease itself.

The "Silent" Pre-Existing Condition: "Arthritis"

Many of our clients approach us with a claims denial that a pre-existing condition is the main cause of our client's need for medical care, or disability from work. However, our clients will tell us they have never treated for any kind of pre-existing condition, and understandably, cannot understand how the claim could be denied.

The main culprit with these kinds of denials is the definition of "arthritis."  The general legal definition of "arthritis" in the Oregon Workers' Compensation system is any "inflammation of a joint."  Insurance retained doctors will come up with creative definitions of arthritis to find that there is an "inflammation of a joint." The claim of "silent" arthritis is the most common tactic insurer's use to deny claims when our client never experienced pain before their on-the-job injury.

Medical Opinions Are Important

When we handle these kinds of claims, we review all of the medical records carefully, and often consult with treating doctors to find out whether there is a pre-existing condition, and if so, whether it actually combined with the injury event in the first place.

Questions?

If you are facing a claim denial, and want to know your rights, contact us. We can review your file, and let you know where you stand. If we take on your case, the Oregon Workers' Compensation statute allows us to recover a fee only if we prevail.

 

Yes, but there are some limits.

Generally, you can change your doctor two times without insurance company approval.  You may do this for several reasons.  Sometimes, an injured worker and their doctor do not see eye to eye, or you may need a certain kind of doctor, depending on your injury.  Certain changes of doctors do not count as a change of physician.

There are other rules if the insurance company enrolled you in a Managed Care Organization, also known as an MCO. 

If you have an open claim, and are not sure if you can change doctors, or if you even need to, give us a call at 503-325-8600.  We have offices in Astoria and Beaverton, and can meet to discuss your claim.

Yes, by filing a request for hearing.  The first, let's start at the beginning.

When your attending physician finds that you are medically stationary, it means that you do not require any additional medical care to restore  your functional abilities. At that point, your claim will be closed with a Notice of Closure. That document will describe many things, including whether or not you are entitled to permanent partial disability. If you are not satisfied with any of the decisions outlined in the Notice of Closure, you can file a Request for Reconsideration of your Notice of Closure.

When you request reconsideration of your claim regarding the extent of your permanent partial disability,  the office that reviews your request, called the Appellate Review Unit, may schedule medical examination with a physician, referred to as a "medical arbiter."  That physician will issue a report, and in most cases, the Appellate Review Unit will adopt the findings in that report. The Appellate Review Unit then will issue an Order on Reconsideration.

An injured worker can appeal the Order on Reconsideration by filing a request for hearing with the Workers' Compensation Board Hearings Division.

YOU MUST FILE THE REQUEST FOR HEARING WITHIN 30 DAYS OF THE ORDER ON RECONSIDERATION.

Any of the exhibits offered to  the Administrative Law Judge must be  part of the "reconsideration record." The reconsideration record is simply all the documents that were before the Appellate Review Unit when it reconsidered the Notice of Closure.  Often times, the "hearing"  is nothing more than submission of written arguments to the Administrative Law Judge.

If you have an accepted Workers' Compensation claim that has recently closed, or an Order on Reconsideration, and want to know whether to file an appeal, contact us. We have offices in Beaverton and Astoria, and can meet to discuss your case.

No.

The Oregon Workers' Compensation statute and rules specifically state that an insurance carrier can pay a medical bill to treat a medical condition, and not accept responsibility for that condition.  This can lead to a lot of confusion.  A real life example is helpful.

Years ago, we represented a man who suffered a low back injury at work.  He filed the claim, and the insurance company accepted responsibility for a low back strain.  However, his problems were more complex, and a neurosurgeon performed a multilevel surgery to relieve pressure on the nerves from bone spurs, disc bulges, and other low back conditions.  The insurance company paid the surgeon for his work, which was significant, but then, weeks after the surgery, was able to get the surgeon to agree that none of the treatment provided was for the accepted medical conditions, and that none of the treatment was the result of any on the job injury.

Many times, an insurance carrier will pay a medical bill, but that does mean it is accepting the condition that required the treatment provided.  To do that, you must file a new or omitted medical condition claim. 

If you are in the middle of an Oregon Workers' Compensation claim, and are unsure what is accepted and what is not, call us at 503-325-8600.  We can meet with you in our Astoria or Beaverton office, review your claims file to look for options, and let you know where you stand. 

Whether you are able to request additional medical services on your Oregon Workers’ Compensation claim depends upon the nature of the settlement itself.

The Oregon Workers’ Compensation statutes and rules allow two kinds of settlement. The first is called a “disputed claims settlement.” Read this article to learn about these settlements, but basically, this is a settlement of the denied and disputed claim. If you entered into this kind of agreement, then the denial remains in effect, and medical services are not available to you. However, in some cases, this agreement may not apply to other medical conditions resulting from your on-the-job injury. To be sure, you may want an attorney to review the agreement to see if you can make a claim for medical problems that resulted from the injury, but were not part of your claim.

The other kind of workers’ compensation settlement and Oregon is a “disputed claims settlement.” This article provides details.  In this kind of an agreement, you are “selling” your rights to all the benefits of your accepted on-the-job injury claim except for the right to request medical services. The statute does not allow you to “sell” this benefit as part of a claims disposition agreement.

Even though you may have a claims disposition agreement that preserves your right to seek medical benefits, the insurance company may still deny proposed medical treatment for several reasons. For example, the insurance company may find that the proposed treatment is not medically necessary. An insurance company may also decide that the proposed treatment is not related to the original on-the-job injury. If treatment is denied, you have the right to appeal that decision to the State of Oregon.

If you are not sure whether or not it makes sense to request additional medical care, or to appeal a denied request for treatment, call us at 503-325-8600. We can review your file, and let you know your options. Under the Oregon workers' compensation system, we are not paid an attorney fee unless we are able to achieve a result in your favor.

Answer

You may have a claim against the person or business that caused her injury in some cases.

Introduction

Oregon Workers’ Compensation is a statute that requires employers to provide coverage for workers who are injured on the job. If an injured worker proves that the need for medical care or disability from work arose from an on-the-job injury, certain benefits are available.

These benefits are limited to certain coverages.

Available Benefits

While the claim is open, the injured worker is eligible for medical services and temporary disability (wage replacement) benefits. The need for medical care and any disability must be related to the medical condition the insurer accepted as part of the claim.

When an injured worker is found to be “medically stationary,” this means they no longer require medical care to restore their ability to work. When an injured worker is found medically stationary, the insurance company gathers information to close the claim and issue a Notice of Closure. At this point, the insurance company decides whether the injured worker is entitled to a cash benefit called “permanent partial disability.” This benefit is designed to compensate an injured worker for any permanent loss of earning capacity. However, it is not based on the actual future lost earning capacity for the injured worker, but instead application of findings and medical reports to the rules that govern calculation of the benefit. If an injured worker is unable to return to the exact job they were working, and other kind of permanent partial disability benefit is available, and is called “work disability.”

At about the same time, the insurance company will evaluate the injured worker’s eligibility for vocational rehabilitation services. An injured worker is eligible for vocational benefits when they are no longer able to return to the work at injury and meet other requirements. If qualified, and injured worker may be eligible for job training with the goal of getting them back to a job paying nearly the same as the job at injury.

After the claim is closed, if the injured worker experiences an “actual worsening” of the accepted on-the-job injury, the treating doctor can ask the insurer to reopen the claim. This is known as an “aggravation” claim. Only the treating physician can make the claim, and the option of filing an aggravation claim is good for five years after the claim is closed.

Even after the claim is closed beyond five years, the injured worker may still qualify for medical benefits and temporary disability if the accepted on-the-job injury condition actually worsens, or if the injured worker suffers a new medical problem that is a direct consequence of the accepted medical problem. For example, people who suffer serious knee injuries that go to surgery sometimes develop posttraumatic osteoarthritis in the same injured knee joint, requiring further surgery or a total knee replacement. In addition to proving the relationship between the worsening condition or the new medical condition, the injured worker must require significant article care, like surgery. The injured worker also must be a member of the workforce at the time they seek these benefits.

Why These Benefits are Limited

In exchange for having to provide these benefits to their employees, Oregon employers are generally immune from any other claims from their employees. This is true even if the employer is negligent in causing the employee’s injury. For example, an employer may ask an employee to perform a dangerous task, knowing that the employee was inadequately trained. Even if the employee can prove that the employer knew or should have known that they were putting the employee in a dangerous situation, there is no lawsuit or claim against the employer for personal injury damages. Of course, there are exceptions, but this is the general rule.

On the other side of the same coin, if an employee is negligent in causing their own injury, they are still covered in most cases for workers’ compensation benefits. Again, there are exceptions, including injuries that are due a major part to an employee’s intoxication or being under the influence of drugs.

The fact that the injured worker cannot sue their employer (generally) and that even negligent employees are covered makes the workers’ system in Oregon a “no-fault” system. This means that a claim cannot be denied because somebody was at fault in causing the injury.

Compensation Not Available to Injured Workers

The injured worker cannot recover any of their actual losses as if they were pursuing a personal injury negligence claim in Oregon. If so, the injured worker would be able to recover actual past and future medical expenses, and past and future lost income. Oregon law defines these losses as “economic” losses because they are objective and can be demonstrated with the actual medical bill or wage stub.

Although the Oregon Workers’ Compensation system provides similar benefits, there are often more requirements involved in qualifying for these benefits. In some cases, an injured worker could easily prove that the on-the-job injury is a significant factor in causing the disability or need for treatment but will not qualify for medical or wage replacement benefits.

The other compensation an injured worker does not qualify for is what is known as “non-economic” losses. This is often referred to as “pain and suffering” compensation. However, compensation for pain and suffering is only one part of the claim for non-economic losses. A claim for non-economic losses is a claim for compensation for the loss of the injured worker’s health. This includes pain, suffering, limited activity, and any permanent impairment resulting from the injury. Under the Oregon Workers’ Compensation system, a claim for non-economic damages is not permitted.

Although the permanent partial disability benefit may look like compensation for non-economic losses, it is considered compensation for future lost earning capacity. However, the permanent partial disability “award” rarely reflects the actual lost earning capacity. In a personal injury claim, this would be a form of “economic” damage, and in many cases, would be significantly greater claim.

The result is that an injured worker often ends up being undercompensated for the actual loss suffered. If we were to compare the compensation available to someone suffering the same injury in an auto collision, they may recover full compensation for their losses. This often is not the case in a workers’ compensation claim.

However, there are exceptions.

The Third Party Claim

The exception is the third-party claim.  A third-party claim exists when somebody other than the employer or a co-worker negligently injures a worker. The most common example is an injured worker running and earned for the employer. While stopped at a traffic signal, somebody rear ends the worker, causing injury. This injury occurred on the job and is covered under the workers’ compensation system. However, because somebody other than the employer and a coworker carelessly caused injury, the injured worker has a claim against the other driver.  That other driver is the “third party.”

Statutes and rules govern how an injured worker may pursue the third-party claim.  This is because many of the damages the injured worker can claim are the same as those the workers’ compensation carrier provided. For example, the injured worker can make a claim for their medical expenses and their actual lost wages. The workers’ compensation insurer is providing benefits for these losses.  Because the workers’ compensation carrier has paid benefits for these losses, the workers’ compensation carrier is in the same boat as the injured worker. They too have suffered a loss, although it is strictly a business loss.

Because the injured worker is making a claim for losses that the workers’ compensation insurer already paid, the injured worker is free to make a claim against the careless driver and their insurance company. However, out of any money the injured worker recovers, and must reimburse the workers’ compensation carrier for the benefits it provided.

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Example:

Let’s say that an injured worker is rear ended by another driver while at work. The injured worker makes a claim against the careless driver and their insurer. Meanwhile, the workers’ compensation carrier has paid $3,000.00 in wage replacement and medical benefits. If the injured worker settles their claim against the at fault driver’s insurance company for $5,000.00, it must reimburse the workers’ compensation carrier for the $3,000.00 that the workers’ compensation carrier provided in benefits.

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The first step in pursuing a third-party claim is to complete the “notice of election” form. This is a form submitted to the workers’ compensation carrier notifying it that the injured worker intends to pursue the claim on their own.  The other option is to let the workers’ compensation carrier pursue the claim, but that does not happen in most cases, especially if the injuries are serious.

The workers’ compensation carrier also has some limited “veto” power on settlement negotiations. The third-party statute requires the injured worker to seek approval to accept a settlement offer before resolving the claim. If there is a disagreement about whether an offer should be accepted, or how much of a personal injury settlement should be reimbursed to the workers’ compensation insurer, the Oregon Workers’ Compensation Board reviews the matter.

Sometimes, there may be issues about whether the third party was at fault, and that could affect the amount the negligent third party’s insurer is willing to pay to resolve the case. In those cases, the workers’ compensation carrier may negotiate a reduced amount of reimbursement.

The Employer Liability Law

The Employer Liability Law, also called the “ELL” is a statute that has been on the books for about a century.  This law applies to employers who conduct projects or work that involves a risk of danger.

Under this statute, an injured worker can recover actual losses by showing that the responsible party was engaged in dangerous or risky work, that the injured worker was an employee for the responsible party, and that the injury resulted from the dangerous or risky work.  These kinds of claims occur when several contractors are working together on a common project or enterprise. There are special requirements involved in making this kind of claim. However, these claims have legal advantages because employers overseeing this work must be much more careful given the risk of harm involved.

Questions?

If you have questions about third party claims or Employer Liability Law claims, contact us. If we are not able to take on the case, we can at least provide resources so you know where you stand.

You can file a claim for workers’ compensation benefits in Oregon, even if you were at fault in causing your injury. This is because the Oregon Workers’ Compensation system is a “no-fault” system.  The statute allows benefits where an injury “arises out of” and occurs within the “course and scope of” employment.  That is pretty much all you have to prove, but sometimes, it is gets a bit involved.

Of course, there are exceptions. For example, if an employee is engaged in “horseplay," that causes an injury, then the claim may be denied. This is because “goofing around” at work is not doing work. It’s goofing around. Also, if a worker suffers an injury due in major part to drug or alcohol intoxication, then the claim can be denied. These are two examples where an insurance company can deny a claim for careless behavior.

On the other side of this is the employer’s responsibility. An employer may be negligent in causing an injury to an employee. But the no fault nature of this system protects the employer too.  Exceptions?  You bet. An injured worker can sue an employer that intentionally harms an employee.  In other cases, there may be a claim under the  Employer Liability Law, which may allow for additional recovery.

Some workers' compensation claims require that you show a much stronger connection between the work activity and the need for medical care than if you were making a personal injury claim in a state court.  If the employer denies this kind of claim, you may have a personal injury negligence claim against the employer.  This claim may allow you to recover more than the limited benefits of an workers' compensation claim.

You may have been injured by a person other than a co-worker or employer, which allows for a "third party claim."

If you have been injured on the job and have questions about whether your claim will be denied for any of these reasons, call us at 503-325-8600. We have extensive experience working with injured workers on these issues.

Temporary Disability Benefits

Temporary Disability benefits are wage replacement benefits.  We sometimes refer to these benefits as "time loss."  There are a lot rules about when and how much of a wage replacement benefit you are entitled to, and when they can be terminated.  The rules change frequently, but here are the basics:

• You are entitled to time loss benefits after you have been disabled from your job due to an on the job injury for at least three days
• You must have written authorization from your physician to qualify for time loss benefits
• If you withdraw from the work force, you are not entitled to time loss benefits
• Your doctor can retroactively authorize your disability, but there are time limits on how far back  you can go to claim retroactive benefits.

You are entitled to time loss benefits even while the insurance company is investigating your claim to decide whether to accept or deny the claim.  Again, you must have a doctor's note taking you off work.

After your claim is accepted, you are entitled to time loss as long as your doctor keeps you off work, and puts it in writing.  Sometimes, you may be able to perform a modified job that provides for part time work.  There is a process the employer and the insurance company must follow to make an offer of modified employment (think of a light duty job).  If your modified job is part time, you are still eligible for a partial disability benefit, or partial time loss to cover the remaining hours you are missing because of your injury.

If You Quit Your Job

If you voluntarily leave your employment, you may still be entitled to time loss benefits if your doctor has you on limited duty, and you report your new earnings to the insurance company.  If you are earning less than you would have been at your former job, you may still be able to recover partial disability benefits.  If you do not report the new earnings, the insurance company is allowed to assume that you are making as much at your new job as you were at the job where you were injured. 

If You Are Terminated

Generally, if you are terminated from your job, whether your time loss stops depends on when you were terminated, and why.  If you are not terminated due to violation of a workplace rule, and your employer has a policy of offering modified work, then you still may be entitled to partial time loss benefits if you are released for a part time modified work.  The insurance company will pay you for the time that you would have been able to work.  If you violate a work place rule, however, it appears from the rules that you are out of luck.

The timing of termination is also important.  If you go back to work on a light duty, or modified job, and then you are terminated, there is case law suggesting that you are no longer entitled to any time loss benefits.  This is because you are not working for a reason other than your disability.

More Than One Job? (Read this if you were working two jobs when you were injured!)

If you are working more than one job at the time of your injury, you can claim time loss benefits for the wages lost from both jobs.  However, you must notify the insurance company of your second job within thirty days of filing your initial claim.

Job Changes Affect Other Benefits

Changing jobs, resigning, or job termination also effects your eligibility for vocational benefits. If, after your medical care, you still cannot return to your job, and there are no other positions that pay a competitive wage within your limitations, you may be entitled to vocational benefits.  This benefit can include job training and help starting a new career.  But if you leave your job and go to work for another employer, you are no longer eligible for those benefits.

Questions?

If you have a question, contact us.  We have nearly 30 years of helping injured workers under our belt.

We have many clients that consult with us at various stages of their claim.  Sometimes, there is a settlement agreement buried in all the papers they bring in for us to review.  They really do not understand what the settlement is all about.

If your claim is accepted, you are entering into a Claims Disposition Agreement, and can read about that here.

If you have a denied claim, then you are entering into a Disputed Claims Settlement, and you can learn more about that here.

So, should you settle?  Before you sign any agreement, you should call an attorney who knows how these settlement agreements work.  Your attorney can give  you the pros and cons of accepting a settlement, and then you can make an informed decision.

We help people every day decide which road to take when facing a tough decision on a workers' compensation case.  If you have a case, and have questions about settling, call us at 503 325 8600.

Although it can be an uphill battle, you may still have some options if you did not file a request for hearing within the sixty day time period under the Oregon Workers's Compensation law.

When your claim was accepted for some kind of injury, you may have asked that the insurance company accept another medical condition.  Sometimes, the condition that is denied may be different than the medical condition you actually suffered as a result of the injury.  For example, if you asked that a strain injury be accepted, but an MRI or other medical test shows a torn ligament or some other more serious injury, you may be able to still make a claim for that particular medical problem.

If your doctors find an injury that was not diagnosed before, this new evidence may overcome a previous denial.

There are also situations where the type of claim filed and denied is different than what is actually going on.  For example, you may have filed an aggravation claim for a condition that was never accepted.  Depending on the language in your claim denial, you may be able to file a new medical condition claim, or a consequential condition claim.

There are also possibilities with hearing loss claims or other kinds of occupational disease claims.  You may have filed a hearing loss claim ten years ago, that was denied, but not appealed.  That does not prevent you from claiming that your exposure to noise at work caused additional hearing loss.  Of course, you still need to prove your claim.

If you have questions about the nature of your denial, and whether there are other options, call us at 503-325-8600.  We are happy to help.

Generally, an Oregon Workers' Compensation Judge can consider more kinds of evidence than a state court judge. This is because the formal rules of evidence do not apply in a workers’ compensation hearing like they do in a state court.

A workers’ compensation hearing is an administrative procedure, and the Administrative Law Judge has quite a bit of discretion in deciding what evidence is admitted, and what is not. For example, a Judge could receive and evaluate hearsay evidence. “Hearsay” is a recognizable term, and simply means “what somebody else said.”  Also, in a Workers' Compensation hearing, medical opinions, which are the heart of many cases, can be in writing, whether by report, or in a deposition.  It is rare to have a medical expert to show up live at a hearing, but it does happen.

More often, however, the bulk of the evidence in an administrative hearing at the Workers’ Compensation Board is in the form of medical records, medical reports, and witness testimony. In some cases, a physician may author a report giving an opinion, and refer to documents that are not in the file, or not in the exhibits. Nonetheless, a Judge may decide this opinion can be admitted into evidence. However, the Judge may find that this exhibit is not persuasive, depending upon its reliability.

If you are facing a denied Oregon Workers’ Compensation claim, and have questions about how to prove your case, call us at 503-325-8600. We have extensive experience going to hearing for injured workers.

When your insurance company accepts your Oregon Workers’ Compensation claim, it must determine whether the claim is “disabling” or “non-disabling.” When a claim is accepted as “disabling,” then the insurance company must issue a Notice of Closure. Your claim is ready for closure when your attending physician has determined that you are “medically stationary.” At that point, the insurance company must gather the appropriate information to issue a Notice of Closure. However, sometimes the insurance company does not do its job.

Your option is to make a written request to the insurance company to issue a Notice of Closure. The insurance company has ten days from the date it receives the written request to either issue a Notice of Closure, or notify you in writing that it is refusing to do so. If the insurance company refuses to close your claim, you can request a hearing, seeking an order that the claim be closed. In addition, you can request that the insurance company pay a penalty for its unreasonable refusal to close the claim.

Sometimes, the insurance company will not respond at all. This may or may not result in penalties.

Why is it important to get your claim closed? Simply stated, when your claim is closed, you are moving forward from the injury, and can concentrate on returning to work, whether it be with the vocational benefit, or a modified position with your current employer.

If you are approaching claim closure on your Oregon Workers’ Compensation claim, and you have questions, call us at 503-325-8600. We work with folks every day facing these issues.

When you are injured on the job in Oregon, and the Worker's Compensation insurance company accepts your claim, it must tell you whether you have a "disabling" or "non-disabling" claim.

If the claim is disabling, the insurance company will eventually have to issue a Notice of Closure. In order to do this, the insurance company must gather information to determine how your work injury will affect your future ability to perform work activity.

In some cases, insurance companies fail to do their job and gather the information needed to issue a Notice of Closure. However, an injured worker may request that the insurance company issue a Notice of Closure within 10 days of the receipt of the written request. If the insurance company fails to respond to that request, either by issuing a Notice of Refusal to Issue a Notice of Closure, are not responding at all, the injured worker can request a hearing, and ask the Workers' Compensation Board Hearings Division to order the claim closed. In addition, the injured worker may be eligible for penalties if he or she can show that the insurance company was "unreasonable" in refusing to close the claim.

Proving that the insurance company was unreasonable is not limited to their mere failure to close the claim, but also in not taking the proper steps to gather the required information close the claim.

If you are workers' compensation carrier is ignoring you, and you have questions, call us at 503-325-8600. We review claims files all the time, and advise clients on their options at closure.

The Oregon Workers’ Compensation law provides a right of appeal of a Notice of Closure, which is known as a Request for Reconsideration.  There are several issues you may want to appeal from your Notice of Closure. However, you are not the only one that can appeal the Notice of Closure.

Oregon law allows an insurance company to appeal its own closure.  Why would an insurance company close a claim, and then later decide to appeal its own decision?  This is an excellent question.

Well, insurance companies often audit or review their decisions, and they may see an opportunity to correct a mistake.  Sometimes, an attorney gets involved, and again, sees a potential issue, or an opportunity to reduce a permanent partial disability award.  In all fairness as well, insurance companies are limited to the attending physician’s findings or concurrence with other doctors’ findings at closure, and may simply want a second opinion.

If you have a claim that has been closed, and your insurance company is seeking an appeal, or if you just have questions, give us a call at 503-325-8600. We can let you know where you stand.

The Oregon Workers’ Compensation Act regulates all aspects of workers’ compensation, including the fee agreement. As result, every fee agreement offered by every attorney representing injured workers in the State of Oregon is the same.  These fee agreements are simply a compilation of the rules on how attorneys can get paid for representing injured workers.

There are two common aspects to the Oregon Workers’ Compensation fee agreement. First, an attorney representing an injured worker in Oregon is not paid unless he or she does something to obtain benefits for the injured worker. This may be obtaining an increase in an existing benefit, like temporary total disability, or permanent partial disability, or it could mean successfully fighting a denied claim at hearing. In either case, the attorney must be “instrumental” and getting the injured worker and increased benefit, or overcoming a denied claim. If the attorney is not successful, there is no attorney fee.

The other common aspect of the fee agreement is that no matter what issue the attorney helps the injured worker with, the State of Oregon must approve the fee. For example, if the attorney goes to hearing with a client and successfully fights denied claim, then the Administrative Law Judge will decide the attorney fee. The insurance company or employer pays the fee, or appeals the Order. If the attorney obtains an increase in an injured worker’s permanent partial disability rating, then the Appellate Review Unit at the Oregon Workers’ Compensation Division will set the fee according to rule. This fee is a percentage of the increased recovery, depending the level of appeal.

Costs are addressed in the fee agreement. The term “costs” refers to those things that the attorney may need to spend money on to prepare the case. A common example of a cost on a Oregon Workers’ Compensation case involves obtaining expert opinions from attending physicians.  However, an insurance company or employer may be responsible for reimbursing the Claimant’s attorney for costs incurred in fighting a denied claim.

If you have a denied Oregon Workers’ Compensation claim, and have concerns about whether you need an attorney, call us at 503-325-8600. We offer twenty years of experience going to hearings with injured workers in Oregon.

If your Oregon Workers' Compensation claim has been denied, you have a right to appeal the decision. However, there similar options available to get you through the wait for a hearing, and a Judge's decision.

1. Requesting Hearing

If you receive a written denial, it must provide you an explanation of your appeal rights. You have sixty days from the date on the denial letter to request a hearing with the Workers' Compensation Board.  The request must be in writing.  This is the first step, and the most important.

2.  Documenting Disability

Battling a denied Oregon Workers' Compensation claim can take several months, even more than a couple years. During the time you were fighting the denial, you should document any ongoing inability to perform your job duties due to the on-the-job injury. This will better your chances of recovering temporary total disability benefits should you finally prevail on the claim. In some cases, the Workers' Compensation Board will acknowledge an "open ended" authorization to be off work from your physician. However, it is a better idea to get periodic notes from the doctor authorizing you to be off work. If you are only released for light duty work, document that as well.

3. Unemployment Insurance

Part of your wage withholdings include payment for unemployment insurance. If you are still able to perform some kinds of work, but your employer does not have any work available within your limitations, your employer may lay you off or discharge you from employment. Contact your local Employment Department office to see if you qualify for unemployment insurance benefits.

4. Vocational Rehabilitation

We have had catastrophic we injured clients contact the Oregon Vocational Rehabilitation Department to inquire about vocational retraining benefits. In certain cases, this Oregon agency may provide benefits to help you find work that you can do within your physical limitations. If you do complete a vocational program, you may render yourself and eligible for the Workers' Compensation sponsored vocational benefit, but you are that much closer to getting back on the job.

Another option is to get in touch with your local Community College to see if you qualify for any grants or other financial aid in an effort to train for work within your limitations.

5. Social Security Disability

If you feel that you are not able to return to any type of work as result of your on-the-job injury, you should consider applying for disability with the Social Security Administration. This benefit requires a showing of disability from occupations, depending upon your age, and that your disability has lasted or is expected to last for one year.

6. Expedited Hearing Requests

If you have no other income in your household after your claim has been denied, you may be able to request an expedited hearing due to a financial hardship. There are similar rules allowing for an expedited hearing where you have a critical need for medical care.

If you have questions about a denied Oregon Workers' Compensation claim, call us at 503-325-8600. We work with injured workers every day.

Many Oregon Workers' Compensation claims are accepted and processed without much problem. However, even with an accepted and open claim, there are a few things to consider in deciding whether you should talk to an attorney.

First, take a look at the Notice of Acceptance. This is a letter from the insurance company explaining what medical conditions have been accepted. You will want to make sure that the insurance company is accepting all of the medical conditions that resulted from your on-the-job injury. Otherwise, you may not be receiving all the benefits you deserve. The statute allows you to make a written request to the insurance company asking it to include additional medical conditions as part of the Notice of Acceptance. If the request is denied, you can seek review with the Oregon Workers' Compensation Board.

Another part of the Notice of Acceptance involves the "classification" of your claim. In Oregon, claims are classified as either "disabling" or "non-disabling." If you have missed work as result of your injury, or if your doctor expects that you will have a permanent impairment even after you have completed your medical care, then your claim should be classified as "disabling." You have one year from the date of the notice of acceptance to ask your insurance company to reclassify the claim. If the insurance company refuses to do so, you can seek review with the State of Oregon Workers' Compensation Division.

If you do have a disabling claim, you will receive a Notice of Closure. The Notice of Closure explains, among other things, whether you are entitled to a permanent partial disability benefit, and if so, how the benefit was calculated. You may want to have an attorney review the claims file to ensure that the permanent partial disability benefit was correctly calculated. If you disagree with the amount of permanent partial disability, you can seek review by filing a Request for Reconsideration with the Oregon Workers' Compensation division.

If you are in the middle of an Oregon Workers' Compensation claim, and have questions, call us at 503-325-8600, or order our free book.  You can order the electronic version, or call  and we will rush out a hard copy.

An "aggravation claim" unfortunately is not a claim for compensation for the aggravation the goes along with being injured on the job in Oregon. Instead, it is a request to re-open a claim that has been closed for less than five years.

Only and "attending physician" can file an aggravation claim. The "attending physician" is the physician primarily responsible for your care when your claim was originally opened. A recent case confirms that another doctor, not your attending physician, cannot file an aggravation claim.

Another recent case from the Oregon Workers' Compensation Board confirms that the "aggravation" must be of the "accepted condition." The "accepted condition" is the medical condition that the insurance company took responsibility for when it issued a Notice of Acceptance. If your claim involves a Notice of Closure, you also should have received an "Updated Notice of Acceptance."

So, to prove an aggravation claim, you must show an "actual worsening" of the accepted condition. This can be an actual pathological worsening of the injury (some change in the anatomy), or a can be inferred by increased symptoms. Either way, the aggravation must be proven with "objective" medical evidence. This simply means that a doctor is able to observe the actual worsening through clinical tests, x-rays, or laboratory results.

These claims are difficult to prove, and can be tricky. If you are in the midst of an aggravation claim, and have questions, call us at 503-325-8600.  We have answers.

An injured worker with an accepted workers' compensation claim is entitled to reimbursement for travel expenses associated with necessary medical treatment. Generally, the reimbursement rate for travel, effective December 23, 2013 is $.56 per mile. This is down one half cent from the beginning of 2013.

You can also recover expenses for meals if you meet the requirements under the rules. The current reimbursement rates are $11.50 for a breakfast, the same amount for a lunch, and $23.00 for dinner.

If you are required to stay overnight for an examination or treatment, you are entitled to reimbursement for lodging. Generally, the reimbursement rate is $83.00, but in certain parts of the state, that amount is adjusted due to seasonal rates.

If you are not medically able to drive to your appointment, get it in writing from your doctor, and your driver can be reimbursed as well.

Since we are talking about travel, you should also know that if your medical care is going to pull you off work for four hours or more, obtain verification of your missed time from work, and you can submit a request for time loss benefits for the missed time from work.

To avoid any problems, we recommend that you contact the carrier in advance to confirm authorization for lodging, and also keep those receipts for reimbursement of meals. We also recommend that you keep a record of these expenses as you incur them, even though you have several months to submit the request for reimbursement.

We focus our practice on denied workers' compensation claims, but if you have a question about the medical services benefit, or any other issue on your case, call us at 503-325-8600. If we cannot take your case, we can at least .9 the right direction.

 

When an Oregon Workers' Compensation carrier issues a Notice of Closure, one of the benefits it may provide is "work disability." This benefit is actually part of the "permanent partial disability benefit" that a worker may be entitled to, depending on whether he or she made a full recovery from their on the job injury.

The term "work disability" refers to any injured worker who is not able to return to the actual job performed at the date of injury. In order to qualify for this benefit, the attending physician, who is the physician primarily responsible for your medical care must State that you are unable to go back to the job you held at the date of injury.

You may still have the same job title, and work many functions of your position. However, if the duties of the job are changed because of any physical limitations you are left with after an on-the-job injury, then you may very well be entitled to this benefit. Even if you are working certain hours, and is work hours were limited as result of any permanent restrictions flowing directly from your on-the-job injury, this altered work schedule may also entitle you to the work disability benefit.

Generally speaking, this benefit is based upon "social and vocational" factors, including your skill level, your age, the physical requirements of your job before the injury, and your physical abilities after the injury. There is also an Index number known as the "state average weekly wage" that determines the amount of "work disability" benefits.

If you have an open Oregon Workers' Compensation claim, and have questions about this or any other issue, call us at 503-325-8600. We have extensive experience advocating for the injured worker in Oregon.