Work injuries in Oregon are automatically covered by a mandatory insurance program called “Workers Compensation”, commonly referred to as "workers comp." If a worker is injured at work and the injury occurs while working (course and scope), the worker is entitled to compensation. The complicated part of workers’ compensation is making sure the insurance companies pay you your benefits. Getting compensation often requires developing expert medical opinion evidence to prove your case, and dealing with insurance company claims adjusters and insurance company lawyers to make sure they pay you your full benefits.
Oregon Workers Comp Attorney Colin Hackett is dedicated to getting the evidence you need to prove your case, to making sure you get all the benefits you are entitled to, and to keeping you informed and comfortable with the litigation process.
Colin Rockey Hackett law will invest the time and resources necessary to properly investigate the claim, develop the medical record, and make sure your doctor’s opinions supporting your claim are on record. We will do our best to give you the best opportunity to prevail in your workers’ compensation case.
If you have been injured at work, the first question is “is my claim compensable?” In Oregon, there are two basic kinds of claims: injuries and occupational diseases. An injury is a sudden, one time event that causes disability or the need medical treatment. Most claims happen like this. Examples include falling off a ladder or lifting something heavy and straining your back. More serious examples may include traumatic head injuries, herniated discs and broken bones.
An occupational disease occurs over time. Common occupational disease claims involve worn knee cartilage, worn shoulder rotator cuffs, spinal degenerative disc disease from years of lifting, hearing loss from long-term exposure to loud noise in factories, and respiratory problems from exposure to chemicals. Some medical conditions can be caused by either injuries or occupational diseases. The difference is the mechanism of injury.
The important legal distinction between injuries and occupational diseases is the standard of medical cause. In simple injury cases, the standard is “material contributing cause:” if the event contributes at all to the cause of the medical condition, the injury is compensable. In occupational disease cases, the standard is “major contributing cause,” which is much higher causal standard. Major contributing cause means the work exposure must be 51% or more of the cause of your medical condition. Insurance companies will often argue your injury is actually an occupational disease to subject you to this higher standard of medical cause. They will also use excuses like off-work activities, age, or pre-existing conditions to argue that you are not entitled to compensation. Often insurance companies prevail by using these techniques because the workers do not develop sufficient expert medical opinion evidence to rebut the insurance companies’ medical expert’s opinions. For this reason, occupational disease claims often require very technical legal expertise to prevail. As with many other areas of workers’ compensation law, quality legal representation is critical in these types of cases.
There are five worker’s compensation benefits: Temporary Disability (time loss), Permanent Disability, Medical Treatment, Vocational Benefits, and Death Benefits.
Medical Treatment is the most important and common of all workers’ compensation benefits. If you are injured at work, your workers’ compensation insurer is required to pay for all your medical treatment. You can choose your doctor, and if you do not like the doctor you are seeing, you can change. However, some claims are designated Managed Care Organization (MCO) claims. If your claim is designated an MCO, you can still choose your doctor, but it must be an approved provider. Sometimes MCOs do not have enough doctors in specialty practice areas or certain regions of the state. If this happens you should consult an attorney to make sure you are getting the treatment you need.
Temporary Disability (Time Loss). Time loss is when the insurance company is required to pay you for when you miss work due to your injury (disability). Normally, if a person cannot work at all they are paid Temporary Total Disability (TTD). Temporary total disability is 66% of your wages at injury by law. Often times, an employer will offer you modified work or part time work that to accommodate your disability. Modified employment, or working for less than your wages at injury, will cause your time loss benefit to change from temporary total disability to Temporary Partial Disability (TPD). Temporary partial disability only compensates you for the difference between your at injury wages and your modified wage. TTD calculations are sometimes technical and often mistakes are made. It is usually a good idea to have a lawyer double-check your TTD or TPD wage calculation to make sure you are receiving the correct temporary disability benefit.
Permanent Disability. Permanent disability is a benefit designed to compensate you for any permanent disability you suffer as a result of your accepted claim. Usually, if a worker is permanently disabled the disability is only partial. Permanent partial disability (PPD) is usually awarded for lost range of motion, strength, disfigurement or surgeries. Pain is not a compensable permanent disability under Oregon law. If a worker is injured so severely that they can no longer work at all, they may be entitled to permanent total disability (PTD). Although this is uncommon, if you believe you may have suffered PTD you should consult with a lawyer to make sure your insurance company pays you your full benefit.
Permanent disability benefits are awarded based on a very technical “rating” system. Rated permanent impairment means there are specific values for every kind of permanent disability. Permanent impairment is governed by a very comprehensive set of laws, and only with the combined expertise of doctors and lawyers is it possible to determine what your permanent disability benefit should be. Therefore, you should consult a lawyer if you think you have suffered permanent disability as a result of a work injury.
A worker will be awarded permanent disability through a process called closure. This process results in a legal notice called a “Notice of Closure.” This will occur only after your attending physician declares you “medically stationary.” You are medically stationary when your condition ceases to improve and is not likely to improve further with treatment. Once you are medically stationary, your claim should qualify for closure and that is the time to find out what permanent disability benefits you are entitled to receive. As always, you should consult a lawyer if you receive a notice of closure.
If you disagree with a notice of closure, there is a procedure to contest it. The procedure is called “reconsideration,” and you must file a “Request for Reconsideration” to appeal a notice of closure. Sometimes, if you disagree with the rated disability in the notice of closure, you may need to request a medical arbiter panel to examine you and rate your permanent impairment.
Vocational Benefits. If you cannot return to your job at injury because you have been permanently disabled due to a work injury, you may qualify for vocational benefits. If you qualify for the highest level of benefits, you may be entitled to benefits such as work place accomodations, a counseler to help you find a new job, and training. However, this program can have strict requirements and if the worker does not comply, they will lose the value of the benefit. You may have the option of settling your case for part of the value of these benefits. It is important to discuss this with a lawyer. Call us today if you have questions about your vocational benefits.
Death Benefits. If a worker is killed on the job, his estate is entitled to workers’ compensation benefit. Fortunately, these cases are rare, but when they do occur insurance companies are sometimes resistant to paying the full benefit. If you believe a loved one may have died as a result of work activities, you should contact an experienced workers comp attorney immediately.
Read about the Process of Getting Oregon Workers Comp Benefits...
Aggravation. An aggravation is an actual worsening of a previously accepted condition. Aggravation claims occur when an old work injury (either a closed disabling claim or a non-disabling claim that has been inactive for more than a year) gets worse. Your doctor must file a Form 827 aggravation and provide chart notes to "perfect" your aggravation claim. If you are successful re-opening your claim as an aggravation, you are entitled to all the same benefits you originally got for your work injury, including time loss and permanent disability (assuming your disability has worsened.) However, you do not need to get your claim re-opened to get medical treatment for a previously accepted claim because an accepted claim entitles you to medical treatment for life for the accepted condition.
Consequential Condition. A consequential condition is a medical condition caused by a previously accepted condition. An example is an accepted knee injury that caused a person to fall and break her wrist. The accepted condition - the knee injury - caused the broken wrist, thus making the broken wrist a "consequential condition." In order to prove a consequential condition is compensable you must prove the accepted work injury was the major contributing cause of the consequential condition.
New or Omitted Medical Condition. These are medical conditions that were a part of your original claim but never accepted. Often insurance companies accept the least serious of injuries, for example a low back muscle strain, without accepting the more serious underlying problem, i.e. a herniated lumbar disc. A new or omitted claim must be made in writing in the form of an unambiguous request that the insurance company accept a specific medical condition. You must write a letter to your insurer stating "please accept _______ condition as part of my (date of injury) workers' compensation claim." Then the insurer must either accept or deny your claim as though it were any other claim. If you receive a denial, you should call and lawyer to consult about your case.
Stress Claim. Stress claims are for mental health conditions that are caused by work incidents. These cases are generally very difficult to prove because the law creates a much higher burden of proof for claimants. However, a serious stress claim should be pursued aggressively with the help of a lawyer because the consequences of work-place mental health issues can be very serious. One of the most common stress claims is post-traumatic stress disorder. In order to prove a stress claim you and your lawyer must show that you have a diagnosed mental health condition (this requires a mental health professional), that the work is the major contributing cause of your condition, and that the work incident or exposure was "not of the type workers' are normally subjected to in the work place." All this must be proven by clear and convincing evidence (a higher standard of proof). Some examples of events that commonly trigger legitimate stress claims are physical assaults, robberies, sexual assault or possibly sexual harassment.
In summary, workers compensation is a very technical field of law. It requires careful, technical legal representation to prevail in most cases. If you have a work injury you should consult with a lawyer as soon as possible. Since most consultations are free, you have nothing to lose by calling. So call an Oregon workers comp lawyer today to make sure your rights are protected.