Oregon's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers and sole proprietors.
Exemptions from coverage may apply to certain employees, including domestic servants working in private homes and casual workers.
Medical Benefits are provided to employees entitled to workers' compensation benefits, with medical coverage for medically necessary treatment that is neither excessive nor inappropriate.
The initial choice of treating physician is made by the employer, or by the employee if care is provided through a managed care plan. The employee may change physicians up to two times, with any additional changes requiring approval by the workers' compensation commission. An employer may obtain up to three independent medical exams (IMEs), and may request that the workers' compensation commission approve additional IMEs. If the workers' compensation insurer denies a claim based upon the result of an IME, and the injured worker's treating physician disagrees with the IME doctor's findings, the worker may request an IME.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 3 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 14 days indemnity benefits become retroactive to the date of the injury. The waiting period may be waived if the employee is totally disabled as a result of the injury, with the disability continuing for fourteen or more consecutive days, or if the employee is admitted to a hospital for inpatient treatment within fourteen days of the onset of total disability.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's average pre-injury weekly wage, subject to a cap, and continue for the duration of the temporary disability.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Oregon PTD benefits are calculated based upon 2/3 of the injured worker's pre-injury weekly wage, subject to a cap, and may potentially continue for life. Additional benefits may be paid to the worker's spouse and children. Offsets may apply for Social Security disability benefits, and for PTD benefits that exceed the injured worker's wage at the time of the injury.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In Oregon PPD benefits are determined based on a whole person impairment rating. If the injured worker returns to his or her regular work, PPD benefits are calculated by multiplying the percentage rating of the worker's permanent impairment by the state's average weekly wage. If the worker does not return to his or her regular work, the worker may qualify for a work disability benefit calculated based upon the injured worker's age, education, and vocational factors and the worker's average weekly wage, subject to a cap.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Oregon, TPD benefits are paid based upon /3 of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement resulting in psychological adjustment issues, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are subject to a cap in amount and duration. Benefits may continue for minors until the age of 18, the age of 23 if the dependent is a student, or indefinitely in the event of disability. Spousal benefits end upon remarriage, at which time the spouse may receive a three year lump sum benefit.
Attorney fees are defined and capped by formula, based upon the services provided and the time the attorney devotes to the case. Attorney fees are subject to review by the worker's compensation division or workers' compensation board.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Oregon Workers' Compensation Division
350 Winter Street, NE
P.O. Box 14480
Salem, OR 97309-0405
(503) 947-7585 or 1-800-452-0288