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Employers are responsible for the health and safety of workers on the job. But workers' compensation insurance providers are often quick to deny claims. Vick & Conroyd is ready to help you pursue your rights under Oregon law. We will help you understand the law as it protects workers today and will work aggressively to make sure you receive what you are entitled to. Every year, workers in Oregon suffer thousands of injuries while on the job. Although you may never suffer an injury your entire working life, the effects of such an injury, when it does occur, can present a serious threat to not only your physical well-being, but your entire lifestyle. Additionally, you are faced with the task of navigating through the bureaucratic maze of the workers' compensation system. We have attempted to present the basic information you will need in order to deal with the workers' compensation system when you do suffer an on-the-job injury. What is Workers' Compensation? Workers' compensation is insurance coverage that your employer, with few exceptions, is required to provide for you for accidental injuries or occupational diseases connected to your employment. Employees also contribute several cents per day to programs that assist injured workers. When and How Do I File a Claim? If you are injured on-the-job, you should immediately inform your employer and fill out a workers' compensation claim form. Even if your injury or condition does not require medical attention at this time, you should report the incident or your condition to your employer and obtain something in writing confirming you have told them of this problem. There are time limits on the time period for filing a claim. You also have the right to file a workers' compensation claim for an occupational disease if your condition has gradually developed as the result of your employment activities. What If the Claim is Denied? The workers' compensation insurer for your employer currently has 90 days in which to accept or deny your claim. For injuries occurring on or after January 1, 2002, the insurer's time period in which to accept or deny your claim has been reduced to 60 days. If your claim is denied, the insurer is required to send a certified letter to you explaining the basis of the denial and providing you with your appeal rights. Appeals generally must be filed and received by the Workers' Compensation Board no later than 60 days from the date of mailing of the denial letter. Missing the 60-day deadline is generally fatal to your claim, and it is advisable to seek legal assistance if you have received a denial of your claim. What Benefits Are Available? Temporary Total Disability If your attending physician has taken you completely off work due to your injury or condition, the insurer is obligated to pay time loss benefits equal to 66 2/3% of your gross wages, up to a maximum established by statute. Temporary Partial Disability If your doctor releases you to perform light or modified work, your benefits are considered to be temporary partial disability payments. If your employer does not have work within the limitations set forth by your doctor, your time loss benefits will continue. If work is available, you are obligated to begin such work. Permanent Partial Disability If your injury or condition has kept you off work for more than three days or has resulted in a permanent injury, your claim should be considered disabling, and the insurer will be required to eventually close your claim once you have become medically stationary. If the doctors have identified permanent limitations, you should be eligible for some financial benefits for your permanent injury. Medical Benefits You are generally entitled to receive whatever medical care you need for your injury or condition, and the insurer is generally obligated to pay these medical bills. However, there are a number of limitations on your right to obtain medical care. Miscellaneous Benefits The insurer is obligated to reimburse you for prescription drugs, prosthetic devices and certain other benefits such as mileage for trips to and from your doctor. What Happens When the Claim is Closed? If you have not missed more than three consecutive days from work, your claim is probably considered "non-disabling" and you will not receive a closure of your claim. If you have missed time from work, or your doctor says your condition has produced a permanent injury, your should seek to have your claim reclassified as disabling and you should probably obtain the services of an attorney. All disabling claims are eventually closed by or a Notice of Closure. If you disagree with the amount of disability set forth, you have the right to appeal. There are time limits for doing so and it would be wise to seek legal advice. Future Benefits? Even though your workers" compensation claim has been closed, you do continue to have future benefits. Vocational Benefits If your injury or condition is permanent, resulting in an award of permanent partial disability, and if your employer is unable to take you back in any regular or modified position, paying you at least 80% of your gross wages at the time you were injured, you can qualify for vocational assistance. Aggravation Rights If your condition worsens after your claim has been closed, such that your ability to work has been affected, you may be eligible to have your claim reopened for an "aggravation". There is a specific form for filing an aggravation claim. Other Conditions or Claims If you develop a physical condition which your doctor believes is the result of the original accepted injury or condition, you will need to send a demand letter to the insurance company requesting they process a claim for a new condition. When Should You Seek Legal Advice? 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