Workers Compensation Process Flowchart

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Workers Compensation Process Flowchart Powered By Docstoc
					                            Workers’ Compensation Flowchart
                                   (This is an overview. Some programs and processes are not covered.)

              On-the-job injury or                Worker or insurer, within 30 days of Order on                       Opinion and Order issued
           occupational disease claim             Reconsideration, may request WCB hearing.*


                                                   Order on Reconsideration issued within 18                 Denial reversed —          Denial affirmed —
   Worker notifies           Worker goes to       working days (up to 60 days longer if additional             Return to claim          Claimant, within 30
    employer and              physician and                   information needed).                           processing at “claim       days, may request
  completes worker          completes worker                                                                  accepted.” Insurer,       WCB review. (See
     section of                 section of                                                                   within 30 days, may        “Order on Review
     Form 801                   Form 827           Reconsideration — Insurer, within 7 days of              request WCB review.              issued.”)
                                                    claim closure, or worker, within 60 days of                 (See “Order on
                                                   claim closure, may request review by WCD.                   Review issued.”)



  Employer reports          Physician reports        PPD — Insurer, within 30 days of NOC,
   claim to insurer          claim to insurer         must begin payment of award, if any.*
                                                                                                                  Worker or insurer, within 30 days,
    within 5 days             within 3 days.                                                                        may request WCB review.*

                                                    PWP — If worker cannot return to regular
                                                     work and has PPD, WCD issues a card
                                                                                                                       Order on Review issued
                                                        that allows worker to offer hiring
                                                        incentives to Oregon employers.
    Non-disabling/disabling classification
                                                                                                            Worker or insurer, within 30 days, may appeal
                                                   NOC — Insurer, within 14 days, determines                to Court of Appeals (review for errors of law
                                                   extent of worker’s disability, including PPD,                     or substantial evidence).*
   Non-disabling          Disabling means time
 means no time loss        loss authorized or                if any, and closes claim.
    authorized.               likelihood of
                          permanent disability.                                                                    Court of Appeals decision issued
                                                    Insurer receives knowledge that worker is
                                                      medically stationary or claim otherwise
                                                               qualifies for closure.                               May appeal to Supreme Court
   Insurer begins TTD or TPD payments,                                                                             (discretionary review for errors of
      if authorized by attending physician,                                                                           law or substantial evidence).
 within 14 days of employer’s knowledge date
    (EKD) and continues at 14-day intervals           Vocational             CDA — Worker and
            unless the claim is denied.              assistance, if         insurer may agree to
                                                    needed, may be            settle at any time,
                                                  provided at any time         subject to WCB
         Insurer, within 60 days of EKD,               after claim                 approval.
     must accept or deny claim and report             acceptance.
  both disabling and all denied claims to WCD
           within 14 days of decision.




 Claim accepted —            Claim denied —
     TTD or TPD           Insurer issues denial
   payments, if any,        letter. TTD or TPD                                                                      Abbreviations
  continue at 14-day          payments stop.                                                              801: Worker’s Report of Injury
 intervals for as long     Claimant, within 60
     as attending         days (up to 180 days                                                            827: First Medical Report of WC Claims
   physician verifies        with cause), may                                                            CDA: Claim Disposition Agreement
 worker’s inability to      request a hearing.                                                                 (Compromise and Release)
  work or until claim        See “Opinion and                                                            NOC: Notice of Closure
        closes.               Order issued.”
                                                                                                         PPD: Permanent Partial Disability
                                                                                                         PWP: Preferred Worker Program
                                                                                                         TTD: Temporary Total Disability
                                                                                                         TPD: Temporary Partial Disability
                                                                                                         WCB: Workers’ Compensation Board
              OREGON
                                                                                                         WCD: Workers’ Compensation Division
                         Workers’ Compensation Division
D DEPARTMENT OF 350 Winter St. NE
 C CONSUMER
B
S        BUSINESS P.O. Box 14480
         SERVICES Salem, OR 97309-0405
                                                                                                     *   Some compensation is stayed (not paid) during
                                                                                                         appeal (see ORS 656.313)
440-2235 (5/04/COM)      www.wcd.oregon.gov

				
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