In Oregon, nearly all workers are protected at their workplace by the state’s comprehensive workers’ compensation laws. In the event that a worker becomes ill at work because of the conditions there or is injured while at work then compensation may be available to cover medical expenses and lost wages. Not all workers’ comp. claims are agreed to. Claims may be denied for a variety of reasons but this doesn’t mean that compensation cannot be obtained. An appeal against the claim denial with the help of a workers’ comp. attorney can result in compensation being granted. Workers’ Compensation Law in Oregon The Oregon Workers’ Compensation Board is the state regulatory body that deals with workers’ compensation laws and disputes. The state has strict workers’ compensation requirements that ensure that nearly all employees with the exception of domestic workers, casual workers, firefighters, police, shipping, railway and airline workers. If a worker becomes ill at work or is injured it is important to inform the employer as soon as possible. Workers’ compensation in Oregon covers all injuries and illnesses that are workplace related even mental health illnesses. Compensation covers all reasonable medical costs as well as payment for lost earnings. The latter depends on how temporary or permanent the illness or injury is and whether the employee is able to return to work at all. Employers who employ 21 or more employees are required by law to reinstate employees who have had to take time off work for treatment and recovery. Workers’ compensation is also available for those people whose spouses have been killed in a workplace accident. Burial expenses and two thirds of average earnings are available. Why a WC Claim Could be Denied in Oregon Not all claims are approved. The insurer can deny a claim which may mean you have to appeal the decision if you still think that you should be eligible for compensation. Some claims are denied for purely administrative reasons. A claim may have been made too late or the employee even failed to give full information about the incident to his or her employer. Occasionally, the employer gives incorrect information to the insurer leading to a denial. Typical mistakes include the date that the employee claimed that an accident happened. Denials can also include more serious allegations about the injury or illness such as these: The employee was not injured at work or did not become sick at work; The injury or illness was caused by intoxication; The employee failed to use safety equipment provided or failed to follow safety guidelines; The documentation provided was insufficient in detail to show the extent of the injury or illness. How to File an Appeal for a Workers’ Compensation Denial in Oregon If you get a denied claim decision from the insurer, you can appeal as long as you do so within 60 days of the decision being made. There are three levels of appeal available. The first step tends to resolve most disputes. The Workers’ Compensation Board will appoint an administrative law judge who will listen to evidence presented from both sides of the dispute. The judge will make a decision but you may still be able to appeal it further if you are dissatisfied with this decision. The next step is to file an appeal with the Court of Appeal. This has to be done within 30 days of the judge’s decision being made at the administrative hearing. The Court will not accept any new evidence presented at this stage but will review the decision made by the administrative law judge and decide whether the decision made was fair or not. The final step if still dissatisfied with the progress of your appeal is to appeal to the state’s Supreme Court. There is no guarantee that the Court will actually listen to your case. Hiring an Attorney for a WC Denial in Oregon While you are entitled to appeal a workers’ compensation denial, it is not an easy procedure. The insurer will be contesting the appeal and will be well prepared with an attorney to help them with their point of view. It makes sense to discuss the claim and denial with an experienced workers’ compensation attorney who will advise you about the appeals process and represent you if this is necessary at any of the appeal hearings.
