by Scott Herson-Hord, on Jul 20, 2022 4:50:12 PM
Oregon Workers’ Compensation Law first originated in 1914 by the Oregon Legislative Assembly. The law now pays for workers’ medical treatment and lost wages after a successful claim. The cause for treatment or lost wages must be a work-related injury and / or illness.
Oregon employers with at least one employee, full or part-time, must carry workers’
compensation insurance or be self-insured. Workers’ compensation insurance not only protects workers but also protects employers by shielding them from liability lawsuits that might result from work-related injuries or illnesses.
Oregon Workers’ Compensation Overview
According to Oregon Workers’ Compensation law, every employer with one or more part or full-time employees must have worker's compensation insurance.
However, there are a few exceptions where you don't need workers' compensation insurance:
- If your payroll is less than $500 per 30-day period
- If your employees work at your home and handle tasks such as cleaning, gardening, maintenance, and home healthcare
- If you own or run a business as a member of an LLC, a partner in a partnership, sole proprietor, or a corporate officer
All worker's compensation claims fall under the Worker's Compensation Division (WCD), while Oregon's compensation law contains most of the law about worker's compensation insurance. This guide will elaborate on everything you need to know about Oregon worker's compensation.
Oregon Workers’ Compensation Reporting Process
Any employees who suffer a work-related injury or illness may elect to file a claim to receive workers’ compensation benefits.
Employees must fill out the Report of Job Injury or Illness (form 801) from their employers or the Worker’s and Physician’s Report for Workers’ Compensation (form 827) from their doctors.
Once the proper form is submitted, the claim process begins. Once employers or a doctor receives a form, they must forward it to the insurer. Claims may take up to 74 days for acceptance or denial.
When claims are accepted, insurers must send a notice of acceptance. The letter must outline the medical conditions that will be covered under the claim.
When claims are denied, employees will receive a letter from the insurer explaining why the claim was denied and shall provide appeal information.
The WCD recommends that employers notify insurance companies within five days of knowledge of the claim, and even if an employee does not wish to file one, employers should still offer form 801 and maintain a copy.
Employers cannot prohibit employees from filing a claim. Employers may also offer or recommend specific doctors or care, but may not direct care in any way or require employees to use any specific doctor.
Oregon Workers’ Compensation Benefits
Injured Oregon employees can receive payments for time lost from work once health care providers notify insurers of the injured workers’ inability to work.
Employees won’t receive payment for the first three calendar days they are unable to work.
- If the employee is completely disabled for at least 14 consecutive calendar days
- The employee is admitted to a hospital as an inpatient within 14 days of the first onset of total disability.
Employees will receive a compensation check every two weeks during the recovery period as long as health care providers verify the employees’ inability to work. These checks will continue until the employee returns to work or is considered medically stationary. Time-loss benefits are two-thirds of a worker’s gross weekly wage at the time of injury, up to a maximum set by Oregon Workers’ Compensation law.
Covered Medical Treatments Under Oregon Workers’ Compensation
When claims are accepted, insurers or self-insured employers will pay medical bills due to medical conditions the insurers accept in writing.
These can include reimbursement for:
- Prescription medications
- Other expenses up to a maximum established rate
Injured employees must make a written request for reimbursement and attach copies of receipts as proof.
Medical bills are not paid if:
- The claim has yet to be accepted
- If a claim is denied
Oregon Workers’ Compensation - Special Considerations
In addition to the exemptions discussed above, other special considerations regarding Oregon Workers’ Compensation Law include the following.
Oregon Leased Workers
If your company leases its employees, you can provide workers’ compensation contractors to your employees for a fee. In return for that fee, employers must cater for the following:
- Worker's payroll
- Employment taxes and assessment
- Worker's compensation insurance
- Medical benefits
- Retirement options
However, it is possible to reach an agreement with the contractor to provide coverage for any leased employees.
Oregon Temporary Employees
Temporary service providers are not registered by the Department of Consumer and Business Service (DCBS). Employers who hire temporary workers are only required to cater to those employees in special situations.
- Seasonal workloads
- Employee absence and leaves
- Special projects
- Professional skill shortage
Employers must use a written document stating how long each temporary employee will be retained. Otherwise, temporary employees must be treated as leased employees.
Employers are required to provide workers’ compensation for temporary employees.
Oregon Workers’ Compensation Audits
Having worker's compensation coverage means the difference in serious penalties and back-charged premiums from the state government. It also protects against financial problems such as employee medical expenses, legal fees, and employee lost wages.
The WCD assesses several different types of penalties for companies that are not compliant with Oregon Workers’ Compensation law.
The WCD issues standard audits to non-compliant insurers that are out of compliance with any regulations relating to the accuracy, timeliness of benefits, claim processing and reporting.
You can receive this penalty if you violate the rule of OAR 436, which relates to delayed compensation to the worker, such as:
- Late reimbursement
- Not paying medical bills
- Time loss
- Disputed claim settlements and claim disposition agreements
You may be issued this penalty if you fail to comply with the director's order under ORS 656.745.
These are issued to self-insured employers who fail to comply with the OAR 436-056. You can get this penalty for several reasons.
These include failure to:
- Submit annual financial statements, reports of loss, and excess insurance policies on time
- Provide proof of adequate staff to process claims
- Obtain approval of a service agreement before processing claims
- Adequately set claim reserves
- Notify the division of claim moves on time
It's advisable to keep records of accidents and report work-related accidents to the workers' compensation board and the insurer within the WCD set time limit for reporting accidents.
Doing so helps avoid facing any of the above penalties. In addition, reporting the accident in time allows the insurer to release compensation and initiate treatment for the worker.
Oregon Workers’ Compensation Posting Requirements
All Oregon employers that are covered under workers’ compensation law are required to display a notice of compliance poster in an easily viewable and accessible location.
An Oregon labor law poster subscription service is a great way to ensure posting requirement compliance.
Final Thoughts On Oregon Workers’ Compensation Law
While the WDC has put together an FAQ on Oregon Workers’ Compensation, the helpful information isn’t always enough.
Whether you are an Oregon-based employer applying for workers' compensation coverage for the first time or want to change your current insurer, you will need a good Oregon insurance partner network.
Guest Author: Scott Herson-Hord
Scott Herson-Hord is the CEO of Great Northern Staff Administrators (GNSA), an Oregon payroll services company that specializes in serving small to mid-size businesses with administrative solutions to streamline back-office processes from benefits to human resources. Starting his career in finance and working more than 10 years as a controller for various companies, Scott leveraged this experience over the next 22 years with GNSA to become one of the pacific northwest’s foremost experts in human capital management (HCM).