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Workers’ compensation claims

Highlights

  • In 2018, insurers and self-insured employers accepted over 21,000 disabling claims. There were 1.1 ADCs per 100 workers.
  • There were 35 compensable fatality claims.
  • Just under 12 percent of disabling claims were initially denied by insurers. This was the lowest denial rate on record.

Workers’ Compensation Claims

The Oregon workers’ compensation system is a no-fault system, so the compensability of a claim is not dependent upon demonstrating that either the employer or worker was negligent. One purpose of a no-fault system is to promptly and fairly compensate injured workers for work-related claims.

When an injury or illness occurs and a claim is filed, the insurer’s compensability decision controls whether the claim is covered within the system. An accepted disabling claim entitles the worker to medical services and disability or death benefits. An accepted nondisabling claim entitles the worker only to medical services.

What claims are reported to us

Within 60 days of employer notice or knowledge date, the workers’ compensation insurer must classify disability and accept or deny the claim. The insurer must report accepted disabling claims and all denied claims to the Workers’ Compensation Division within 14 days of their decision about the claim. The insurer is not required to report nondisabling claims to the Workers’ Compensation Division, so all data on nondisabling claims is estimated.

The following table provides the numbers of employers and workers covered by the workers’ compensation system, the number of accepted disabling claims (ADCs), the disabling claims rate (the ADCs per 100 workers), the number of compensable fatality claims, and the fatality rate (fatality claims per 100,000 workers).

Workers' compensation claims

Year Subject employers Subject employees Accepted disabling claims Rate: accepted disabling claims per 100 employees Fatality claims Rate: fatality claims per 100,000 employees

Claim processing

If a claim is accepted by the insurer, temporary disability payments, if any, continue at 14-day intervals for as long as the attending physician verifies the worker’s inability to work or until claim closure. Within 14 days of receiving the qualifying closure information, the insurer determines the extent of the worker’s disability, and closes the claim with a notice of closure. Within 30 days of the notice of closure, the insurer must begin paying the award, either permanent partial or permanent total disability. If the accepted claim is attached to a death, the insurer must begin paying the death benefits within 30 days of claim acceptance.

If a claim is classified as nondisabling by the insurer, the worker may request a reclassification. The worker then has 60 days to appeal the insurer’s refusal to reclassify the claim.

If a claim is denied by the insurer, a denial letter is issued and temporary disability payments stop. Within 60 days of denial, the worker may request a hearing to dispute the denial of the claim.

The following table provides the percentage of disabling claims originally accepted by insurers. The table also provides the median days between injury and claim acceptance or denial, the percentage of disabling claims for which the decision was made within the statutory time period, and the percentage of disabling claims for which the initial temporary disability payment was made timely.

Workers' compensation claims administration

Year Disabling claim denial rate Disabling claims: median days to insurer acceptance Disabling claims: median days to insurer denial Disabling claims: Percent accepted or denied timely Disabling claims: Percent with first payment timely
Workers' compensation claims administration

Oregon workers’ compensation record-level claims

Oregon workers' compensation record level details for accepted disabling claims from 2013 through 2017. Personally identifiable information has been removed to maintain confidentiality.

View the record level claims dataset

View the data definitions for the record level claims dataset

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