The following information is from May 1998. Much of the statistical and legal information here may be inaccurate. This page was once located at: http://www.saif.com/quest_inj.htm
What is workers’ compensation insurance?
If you are hurt on-the-job, you are protected by workers’ compensation insurance. Oregon law requires your employer to purchase this insurance.
Your employer has selected SAIF Corporation to provide its workers’ compensation insurance. SAIF will pay you benefits if an injury or disease is work related. These benefits may include payment of your medical bills and wage replacement.
Oregon has a "no fault" system, which means both workers and employers are protected from the time and expense of determining who caused an on-the-job accident. It is your responsibility as an injured worker, however, to show that an injury or disease is job related.
What is SAIF Corporation?
SAIF is a self-supporting, not-for-profit publicly owned workers’ compensation insurance carrier. Your employer has selected SAIF to provide workers’ compensation insurance in the event of an injury on-the-job.
Don’t I pay for my workers’ compensation coverage? My payroll deductions include "workers’ compensation."
No. The actual cost of your workers’ compensation insurance coverage is paid totally by your employer to the insurance company your employer has selected. The amount your employer pays depends primarily upon your job. A hazardous job costs more to insure than a less hazardous job. For example, a roofing company may pay $34.22 for workers’ compensation insurance for every $100 earned by each of its roofers but just 44 cents for every $100 earned by its bookkeeper.
The payroll deduction you are referring to is the Department of Consumer and Business Services "cents-per-hour assessment." The money is collected by the Department of Revenue, and is passed on to the Department of Consumer and Business Services, the state agency that oversees the workers’ compensation system in Oregon, for use in special funds that it administers.
By law, 1.1 cents is deducted from your paycheck (and 1.1 cents is paid by your employer) for each hour you work and is used to fund various Department of Consumer and Business Services’ programs. Some of this money goes to fund the state’s Preferred Worker Program and other programs that encourage employers to hire or rehire injured workers with permanent disabilities and some goes into a fund which ensures that benefits paid to injured workers and workers’ beneficiaries keep pace with the cost of living.
In addition, your employer pays a separate assessment directly to the Department of Consumer and Business Services to cover the Department’s administrative costs.
Workers’ compensation insurance premiums cost Oregon employers hundreds of millions of dollars. It is a major expense for many employers and certainly may affect how many workers they hire, what other benefits they provide employees, and how much they must charge for the product manufactured or service provided and still compete with other businesses.
Why does my employer care about workers getting injured on-the-job if insurance covers those injuries?
| Your employer cares for several reasons. |
| No employer wants to see anyone get sick, hurt or injured on-the-job. |
| Employers don’t want to lose valuable, trained employees. The most valuable resource a business has is the people who work there. |
| Injuries cause rates to increase. You may have to pay more for car insurance if you are in an automobile accident. Similarly, your employer may have to pay more for insurance or may even have coverage canceled if there are too many injuries in the workplace. |
| There are many indirect costs associated with accidents. For example, there may be lost production time and damage to machinery, which are costs not covered by insurance. |
What do I do if I get hurt on-the-job?
Report your injury to your employer or supervisor immediately. He or she will assist you in getting appropriate medical treatment, if necessary.
You and your employer must file a workers’ compensation claim for benefits if you see a doctor for medical treatment or miss time from work. The claim is filed by completing a Report of Occupational Injury or Disease (Form 801) available from your employer. You must complete the top portion of the Form 801, then give the form to your employer who will complete it and send it to SAIF. If you are in the hospital or cannot complete the form due to your injury, your employer can send it in without your signature. Your employer should give you a copy.
Be sure and tell the doctor that your injury happened on-the-job and that SAIF insures your employer. The doctor is required to file a report, and will ask you to sign a portion of the form.
If your employer is enrolled in a managed care organization service area, he or she will provide you with a list of doctors who are authorized to treat injured workers under the contract. Your family doctor may also be authorized to treat you. Your employer will provide you with additional information, if necessary.
What kind of injuries or illnesses qualify for workers’ compensation benefits?
Generally, any injury that occurs while working (or illness due to work) that requires you to see a doctor or results in disability or death may qualify for workers’ compensation benefits. An injury could be traumatic (caused by an accident), cumulative (caused by repetitive motion) or an occupational disease (such as loss of hearing). A doctor must be able to verify that there is objective medical evidence showing that an injury or disease exists and your work exposure was the cause.
How do I get benefits when I get hurt on-the-job?
SAIF will begin evaluating your claim as soon as it is received. We will notify you and your employer in writing when your claim has been accepted or denied. A claim number and claims adjuster will be assigned to your claim. An adjuster may contact you by telephone or in writing to ask you questions about your claim. Keep your claim number with you when you complete any forms, see the doctor, or call SAIF. It will help in getting your questions answered quickly.
SAIF will evaluate your claim and accept or deny it as quickly as possible. Sometimes claim adjusters need additional medical information or must request investigations. This may cause a delay in the decision to accept or deny a claim. By law, insurance companies have up to 90 days from the time your employer knew of the injury or illness to make this decision.
While your claim is being evaluated, it is considered to be "deferred."
It is also important to keep your employer informed of your injury or illness. Your employer will need to know what your doctor reports after each of your medical visits. It is your responsibility to communicate information to your employer.
While your claim is deferred (and also when your claim is accepted), you will receive wage replacement benefits if your doctor states that you cannot work and you are unable to work for more than three days. This three-day wait is set by Oregon law. If your physician authorizes temporary total disability for 14 consecutive days or if you are hospitalized, wage replacement benefits are paid back to the first day you missed work.
SAIF must mail your check no later than 14 days after you tell your employer of your injury or 14 days from the date you were first unable to work. You will continue to receive checks for wage replacement about every 14 days. These benefits must be authorized by an attending physician..
Your wage replacement check will generally be equal to two-thirds of your weekly wage, up to the maximum which is equal to Oregon’s average weekly wage. This maximum is calculated annually using figures from the state Employment Department. The minimum for any injured worker is $50 per week or 90 percent of the worker’s weekly wage, whichever is less.
Your wage replacement benefit checks will continue until one of the following occurs:
| 1. | You return to your regular work; |
| 2. | Your doctor releases you to return to regular work; or |
| 3. | Your doctor approves a written offer of modified work by your employer, but you refuse to take it. |
| 4. | You return to modified work and receive the equivalent of your regular wage. |
| 5. | Your claim is closed. |
SAIF may send you forms during this time period to ensure that you are receiving the correct amount of wage replacement. Please complete these forms and return them promptly.
By law, if you are receiving medical care in Oregon, your doctor may not seek payment from you for the medical treatment related to your claim during the time your claim is being evaluated or if your claim is accepted. It is also important to know that during the time your claim is being evaluated (deferred), SAIF will not make payment for any medication the doctor may prescribe or for any other expenses such as transportation costs for visits to the doctor’s office. Keep receipts for these expenses as they will be paid by SAIF, in addition to your related medical bills, if your claim is accepted.
However, if your claim is denied and that denial becomes final, you will be responsible for payment of all your medical bills. You may bill your private health insurance company for medical treatment if your claim is denied by sending a copy of the denial to them.
According to Oregon workers’ compensation law, it is up to the injured worker to prove that an injury occurred on-the-job or that an illness was due to job-related factors. Workers who file a workers’ compensation claim for an injury that they know occurred off-the-job or attempt to collect wage replacement and benefits for one job while failing to report earnings at another may be committing fraud. SAIF will seek prosecution of those who attempt to commit fraud.
What are my responsibilities if my claim is accepted?
Your SAIF claims adjuster is available to assist you with your claim. Be sure to ask if you don’t understand something or receive any forms or letters that are confusing to you. Keep your claims adjuster up to date on the progress of your recovery. The adjuster is there to help you.
It is your responsibility to do all you can to return to work. Cooperate fully with those who are helping you to get back to work. Keep your medical appointments and follow your doctor’s instructions and treatment plan. Avoid any activities which will slow or stop your recovery.
It is important to follow all procedures outlined in your employee handbook regarding injured workers and to keep your employer informed of your condition. Your employer needs to know what your doctor reports after each of your medical visits. When your doctor releases you for work, you must contact your employer immediately. Be sure you obtain a written copy of your work release to give to your employer.
What happens to my job if I can’t work?
The intent of the workers’ compensation system is to help get you back to work. You have a responsibility to make every effort to return to work once you are able. Your employer may also ask you to return to a different job while you are healing. SAIF representatives will work with you, your employer, and your doctor to get you back to work as soon as possible. Studies show that most injured workers recover more quickly when they can return to the workplace.
In most situations, your employer is required to reinstate you to the job you had at the time you were injured. This reinstatement usually applies for up to three years from your date of injury. It does not apply if you are certified by an attending physician as unable to return to regular work, if you are eligible for and participate in vocational assistance, if you refuse to accept a modified job during your recovery period, or if you go to work for another employer after your doctor states you can return to work.
If you are unable to return to your old job and have a permanent disability, you may be eligible for the Preferred Worker Program that provides financial incentives to employers who hire injured workers with permanent disabilities. You will be notified by the Department of Consumer and Business Services if you are eligible or you can contact the Department directly at 1-800-445-3948 to inquire about this program.
Who do I call if I have questions about workers’ compensation?
Your employer can certainly help answer some questions you may have. If you have filed a claim, contact SAIF at 1-800-285-8525. You can also call the Department of Consumer and Business Services Injured Workers' Hotline at 1-800-452-0288 or the Workers' Compensation Ombudsman at 1-800-927-1271.
| Injured Workers’ Most Commonly Asked Questions |
| When will I receive a wage replacement check? | If SAIF has received notification of your injury, your initial check will be mailed no later than 14 days from the date you told your employer of your injury or you became unable to work because of your injury. Subsequent checks are mailed about every two weeks. |
| How much will my wage replacement check be? | In most cases, your check will be for two-thirds of your weekly wage up to a maximum which is equal to Oregon’s average weekly wage. There is usually a deduction for the three-day wait which is not paid in the first check. |
| Why is there a three-day wait? | The three-day wait is required by state law and acts as a form of "deductible." |
| How much is the maximum compensation? | The amount you are paid cannot be more than Oregon’s current average weekly wage. |
| How is the average weekly wage determined? | The average weekly wage is figured annually by the Oregon Employment Department. |
| When will my claim be accepted or denied? | Your claim will be accepted or denied as soon as possible. The law allows insurance carriers up to 90 days from the date your employer knew about your claim to make that decision. |
| What does "deferred" mean? | It means the claim has not been accepted or denied. No decision has been made yet. |
| Who pays for my medical expenses if my claim is deferred? | No one should pay for medical expenses while your claim is in a deferred status. If your claim is accepted, SAIF will pay for approved medical care related to your claim. If your claim is denied, you and/or your private health insurance carrier will be responsible for medical expenses. |
| How do I get reimbursed for prescriptions that I pay for myself? | Once your claim is accepted, you may send your prescription receipts to your claims adjuster for reimbursement. Most pharmacies can direct bill SAIF for most future prescriptions. |
| Why does SAIF send out all that paperwork inquiring about my medical and work history? | SAIF needs to ensure that the benefits you receive are appropriate and to determine your eligibility for vocational assistance or permanent partial disability. |
| Will I get retrained? | Retraining is one of the last options to get you back to work. In most cases, your re-employment will depend upon your existing skills and physical capabilities. If you believe your injury will prevent you from returning to any employment you have held in the past, you should contact us to review your eligibility for vocational benefits. |
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SAIF Corporation© Worker Information
Web Page Last Updated 05-29-98
URL: http://www.saif.com/quest_inj.htm