Types of compensation claims

There are many types of workers compensation claims, and it can be hard to determine which type of claim best describes your situation. The following is a comprehensive list of the types of workers compensation claims for which you may qualify.

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An aggravation is an actual worsening of a previously accepted condition. Aggravation claims occur when an old work injury gets worse, and requires treatment. A doctor must fill out a Form 827 claim for aggravation and provide chart notes to “perfect” your aggravation claim. A successful aggravation claim results in the same benefits as an original claim, including time loss and permanent disability (less prior awards). You do not need to file an aggravation to get medical treatment of a previously closed claim unless you require curative medical treatment or you have to miss work because of the worsened condition.

Consequential Condition

A consequential condition is a medical condition caused by a previously accepted condition. An example is an accepted knee injury that causes a person to fall and break her arm. The broken arm is a consequence of the accepted condition if the accepted knee injury is the major contributing cause of the broken arm.

New or Omitted Medical Condition

These are medical conditions that were part of your original claim but were never accepted. Often, insurance companies accept the least serious diagnosis, for example, a muscle strain instead of a torn ligament. Typically, people who have back or knee injuries must request that the insurance company accept the more serious diagnosis, i.e. disk herniation or torn ACL. Otherwise, later, the insurance company will refuse to pay benefits on the theory that the only accepted condition was a strain. A new or omitted medical condition may be made at any time and must be in the form of a written, explicit request to accept a specific diagnosis. The insurer must accept or deny the new condition claim as though it were any other claim. If you think you may need to request a new or omitted condition for your workers’ compensation claim, you should consult with an experienced Oregon workers’ compensation attorney.

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 such a high burden of proof for claimants. Workers with potential stress claims should not expect to have any easy time proving a stress claim, especially if a worker has preexisting mental health problems. Stress claims are not available for mental health conditions caused by incidents of the type “workers are normally subjected to in the work place,” i.e. disciplinary issues. However, one of the most common, successful varieties of stress claims is for post-traumatic stress disorder related to traumatic incidents at work. If you have been the victim of a robbery, for example, you may be entitled to benefits for mental health treatment related to the incident. Other common stress claims involve assault or sexual harassment.

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