WORKERS' COMPENSATION CLAIM PROCESS
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On-the-job injury or occupational disease claim. Employer must notify employer of work-related injury with 90 days of date of injury (or within 1 year of date of injury if employer had knowledge of injury within 90 days of injury)
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Worker notifies employer and completes Form 801
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Worker goes to a health care provider and completes worker section of Form 827
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Employer reports claim to insurer within 5 days
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Health care provider reports claim to insurer within 3 days
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If claim is disabling, time-loss payments, if authorized by the health care provider, begin and continue every 14 days unless the claim is denied
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Insurer must accept or deny the claim within 60 days
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if the claim is accepted -- time loss payments, if any, continue every 14 days for as long as the attending physician or authorize nurse practitioner authorizes the worker to be off work or the claim closes. Medical and other services are provided to help the worker recover and return to work
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If the claim is denied -- insurer issues a denial letter.
Time-loss payments stop
interim medical benefits may be paid if the worker has health insurance.
Worker has 60 days (up to 180 days with cause) to appeal the denial.
In some cases, worker may request medical exam by a doctor selected by the WCD.
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Worker and insurer may make a claim disposition agreement (at any time after claim acceptance), subject to approval by the WCB
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The claim will be closed when the worker is medically stationary.
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The claim is closed and a decision is made about the amount of worker's disability, including PPD, if any. A notice of Closure is issued by the insurer.
If the worker cannot return to regular work and has a PD, WCD issues a Preferred Worker Card, which allows worker to offer hiring incentives to Oregon employers.
Insurer (within 30 days of the NOC) must begin payment of PPD, if any. However, if the claim closure is appealed, payment may be stayed until the litigation is complete.
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Vocational assistance is provided if the worker is eligible (at any time after claim acceptance).
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Insurer, within 7 days, or worker within 60 days of claim closure, may request reconsideration by the WCD Appellate Unit.
After the claim is closed, worker remains eligible for certain medical and vocational services. If the accepted condition worsens, the claim may be reopened for additional disability and other benefits.
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WORKERS' COMPENSATION CLAIM PROCESS
