Have questions? We have answers.
I filed a claim that was denied. I don’t know why. What can I do?
A claim denial is supposed to list the reasons why benefits are refused. But often those reasons are vague and offer little explanation. To make matters worse, the usual deadline to appeal a denied claim is very, very short. Delay may mean a lost claim that legally should have been accepted.
Often the only way to know why a claim really was rejected is to obtain the claims file, which must be sent at no charge to your attorney upon request. If you are unrepresented, some materials may be withheld because you have not specifically asked for their release.
Generally, a worker has 60 days to appeal a denial of their claim. If there is “good cause” for not appealing within 60 days, a hearing may be requested up to 180 days after a denial is mailed. If there is proven mental incompetency, an appeal may be filed up to 5 years after a denial.
The first step to successfully challenge a denied claim is to obtain experienced legal counsel. That’s where we come in.
I was hurt at work several months ago. How long do I have to file a claim for workers’ compensation?
Injured workers must file their claims in writing within 90 days of their accident unless their employer knows they were hurt, in which case they have up to a year to make their claim. It is always helpful to fill out an accident report even if a claim is not filed right away. If you suffer an occupational disease, you have up to a year to file a claim.
Often, a doctor’s insurance form will be a “claim” even if the worker doesn’t personally turn it in. If there is any doubt about whether a claim was made, it is important to immediately seek legal assistance. Even if you do not know if a claim has been filed on your behalf, we can file a protective claim for you.
My accident claim was accepted. Does my employer have to pay for all my medical care?
Not necessarily. Depending on what medical conditions were accepted, your right to medical treatment may be covered or not. This is because multiple injuries or conditions may not be listed on your claim Notice of Acceptance. Workers must specifically ask, in writing, to have new or omitted conditions included in their claim. Then the insurer or employer has 60 days to respond. We frequently file these requests for additional medical conditions so all necessary medical care is covered.
You also may be enrolled in a “managed care organization” which limits the doctors and treatments you receive. If the MCO has refused to authorize treatment, an appeal must be filed with the organization first to protect your rights.
I was hurt on the job about a year ago and my claim was accepted. Now my doctor says I need surgery and will miss a month of employment. Will I be paid for my time off?
Yes, as long as your claim was classified “disabling” and remains open. But if you did not miss 3 days of work, your claim may be listed as “non-disabling.” If your claim was accepted less than a year ago, it is simple to request reclassification. But if more than a year has passed since you were notified of claim acceptance, your doctor will need to verify that you now are worse and that is why you will be off work after surgery. This is a common, and confusing, problem for injured workers who struggle to stay employed but eventually cannot continue to work without surgical care.
I am confused by all the paperwork I have been sent. Can you help and what will it cost me?
Absolutely, we often can answer your questions by phone and give you tips how to navigate the red tape. We do not charge by the hour – either to give information or review your claim file. We are paid a fee only if and when we obtain a benefit for you.
Oregon workers’ compensation is a very complex law, and claims examiners can take advantage of unrepresented injured workers. If you have been hurt at work, don’t add insult to injury by failing to protect your rights!