Claims Kit

Penalties for Late Reporting 656.262(3)(b)

Failure to report subjects the employer to a charge for reimbursing the insurer for any penalty the insurer is required to pay because of such failure.

Physician Selection ORS 656.245

The employee has the choice of physician. Unless the insurer has enrolled in a managed care organization (MCO), the employee may be treated by any doctor who qualifies as an attending physician under Oregon law.

If the employer is covered by an MCO contract, the insurer may enroll the employee with the MCO at any time after the injury, and the employee may be required to pick an MCO doctor. The insurer must give the employee a list of providers with the enrollment notice. After enrollment, if the employee has a regular doctor who is a family practitioner, general practitioner, or internal medicine specialist, he or she may continue to treat if treatment is provided according to the MCO contract.

The employee may change doctors two times. Additional changes require approval from the insurer or the Workers' Compensation Division. If the employee does change doctors, they must fill out Form 827 at the doctor's office.

Posting Requirements ORS 656.056

All employers in Oregon who are required to provide workers' compensation coverage must display a Notice of Compliance poster in a central gathering area. (ex. breakroom)

Each poster includes workers' compensation information to help workers and employers provide current insurance information to health care providers at the time of injury to speed up the claim process.

Employers will automatically receive a Notice of Compliance poster when they first get compensation coverage or change coverage providers.

Once you have the posting notice, it remains valid and without need to update the posting as long as the policy remains active. You are allowed to make and post copies of valid posters. If the policyholder, employer name, or the insurer changes, you will automatically receive a new poster. A change in the policy number, which is a common practice at annual renewal, does not require a new posting notice as long as the other elements remain the same.

Ordering information:
If you wish to replace your Notice of Compliance poster with a newer form, you can order an English poster or Spanish supplement online at: http://www.cbs.state.or.us/external/wcd/docs/nocorder.html

Reporting of Claim by Employer   ORS 656.262(3)(a), OAR 436-060-0010

The employer must report a workers' compensation claim to their insurer within 5 days of being notified of an injury.

Employers must provide Form 801 to injured workers (or anyone acting on the worker’s behalf) immediately upon request, or upon receiving notice or knowledge of an accident that may involve a compensable injury.

The employer must provide Form 3283 to the worker at the time a worker files a claim for workers’ compensation benefits. An insurer may revise the form to include its name and phone number in the heading, at the end, or in the paragraph “What if I have questions about my claim?”. Form 3283 may be printed on the back of Form 801.

Communicating worker eligibility for supplemental disability benefits - Industry Notice