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Injured worker benefits

Workers injured on the job may be eligible for several kinds of benefits, including time-loss benefits, coverage of medical treatment, and more.

Overview  

SAIF works with employees and employers to ensure that the employee receives the appropriate care and payment.

Time loss

Workers whose injuries require them to miss work are eligible for wage compensation, called "time-loss benefits," if the attending physician authorizes them to be away from work. The formula for calculating time-loss payments is determined by the state and is described on the Benefit table page.

If your employee is owed time-loss benefits, you will be asked to provide wage information. The wage request form will help you report your employee’s gross wages for the 52 weeks preceding the date of the injury.

Medical coverage

If a claim is accepted, the medical providers will be reimbursed for necessary treatment related to the injury. (In Oregon, the amount of the payment is determined by the Oregon Workers' Compensation Fee Schedule.)

Managed care organizations (MCO)

MCOs contract with doctors and other health care providers to provide medical services to covered employees with work-related injuries or illnesses. MCOs emphasize quality medical care, disability management, and cost containment.

If a claim is accepted and enrolled into the MCO, the employee will be required to seek treatment from an MCO provider or a qualified general practitioner, family practitioner, or authorized nurse practitioner with whom the worker has a history of prior treatment.

Claim settlements

Claim disposition agreements (CDAs) Injured workers may elect to negotiate a settlement to their claim, where they waive certain rights in exchange for a specified amount of money. Medical treatment for the worker will continue to be paid after a CDA.

Benefit table  

Benefit calculations for injured workers

The amount of benefits is established by the state legislature. The date of the accident determines the benefits to be paid, except for temporary total disability, which is adjusted July 1 of each year based on the average weekly wage in Oregon. See Benefit table below.

Remember, an attending physician or authorized nurse practitioner must approve these benefits.

Timeline

If SAIF has received notification of the injury, the initial check will be mailed no later than 14 days from the date you inform your employer of the injury or became unable to work because of the injury (unless the claim is denied by the 14th day). Subsequent checks are mailed every two weeks.

Types of benefits

There are several types of benefits paid for replacement of wages or loss of income:

Temporary total disability or time loss (TTD)
When an attending physician or authorized nurse practitioner authorizes an employee to remain off work during recovery, the benefits they receive are called "time-loss benefits." If authorized, time-loss benefits are paid during the time the claim is deferred, and then continue if the claim is accepted. If the claim is denied, the benefits are discontinued.

The amount the employee receives is determined by the average weekly wage. There are minimum and maximum biweekly benefits.

Temporary partial disability (TPD)
At the time the employee returns to transitional work, if they are not earning their preinjury average weekly wage, they become entitled to partial time-loss benefits. These benefits continue while they are recovering and have not been released to return to regular work or are not earning their full wage.

Permanent partial disability (PPD)
When an attending physician determines that the employee has reached medical stability and the claim is ready for closure, an examination is done to determine permanent effects of the injury on their ability to function. This loss of function is determined as a percentage of whole body impairment for benefit calculations.

Permanent total disability (PTD)
An injured worker unable to return to gainful and suitable employment may qualify for PTD benefits. These benefits are based on the average weekly wage at the time of the injury but are paid monthly instead of biweekly.

Fatal or survivor's benefits
When a worker is fatally injured on the job and leaves behind a spouse and/or dependent child, they will receive benefits if the claim is accepted.

Benefit table 

Effective July 1, 2016
Temporary total disability (TTD) for workers entitled to TTD benefits on or after July 1, 2016 (for dates of injury on or after July 1, 2016)
 Injured Worker 66-2/3 percent wages paid weekly
 Maximum     $2,591.37 biweekly
 Minimum  90 percent wages or $100 biweekly, whichever is less
Permanent partial disability (PPD) | Dates of injury on or after July 1, 2016
Impairment Percent of whole body impairment x 100 x Oregon Average Weekly Wage ($974.20).

Work disability

(Cannot return to
regular work due to
the accepted condition)

  • Percent of whole body impairment, plus factor for age, education, and adaptability x 150 x worker's weekly wage
  • Maximum worker wage factor = 133 percent of Oregon Average Weekly Wage ($1,295.69)
  • Minimum worker wage factor = 50 percent of Oregon Average Weekly Wage ($487.10)
Note: Workers may qualify for both impairment and work disability awards.
Permanent total disability (PTD) | Date of injury on or after July 1, 2016
Note: benefits based on state average weekly wage in effect at the time of injury
Injured worker 66-2/3 percent wages paid monthly
Maximum   $4,237.77 monthly
Minimum 90 percent of worker's weekly wage at the time of injury or $217.50/month, whichever is less
Spouse and children after death of PTD Same as Fatal below
Fatal | Date of injury on or after July 1, 2016
Spouse or registered domestic partner $2,825.32 monthly
Each child $423.78 monthly
Maximum spouse and children $5,620.22 monthly
Each child (when no spousal benefit paid) $1,059.44 monthly
Children age 18 to 23 without a living parent $2,825.32 monthly, while attending higher education
Burial allowance $19,484.00 (unpaid balance paid to the worker's estate)
Remarriage allowance 36 times the spouse or domestic partner’s monthly benefit, payable in a lump sum
Oregon average weekly wage
  $974.20
Prescriptions 

Prescription drug coverage

First Fill

Injured workers are eligible for the First Fill pharmacy program, which provides a limited number of cost-effective prescription drugs for work-related injuries or illnesses until a decision has been made on their claim. If you submit the claim online and you provide the worker’s email address (or print the confirmation form for the worker) this benefit can be available to the worker within three hours of filing.

Pharmacy bills are handled through the Oregon Prescription Drug Program (OPDP) and paid by SAIF, even if the claim is later denied. If the claim is accepted, the cost of the prescriptions is applied to the claim. There are no out-of-pocket costs to the employer for the prescriptions unless a medication not covered by First Fill is prescribed.

Oregon Prescription Drug Program (OPDP)

SAIF uses the Oregon Prescription Drug Program (OPDP) to administer pharmacy benefits for the injured workers that SAIF serves each year. Injured workers will not have to pay out of their own pocket for prescriptions related to their workplace injury. Most major and local pharmacies participate in the program.

To learn more about how OPDP can help you and your family, visit the State of Oregon OPDP website.

Wellpartner mail order pharmacy

Injured workers can save time, travel, and hassle by having regular, ongoing prescription medications delivered to their home for no extra charge by using Postal Prescription Services (PPS) mail-order pharmacy. PPS offers benefits to help easily and conveniently order prescription medications.

    To order using PPS

  • Use the PPS order form. Prescriptions related to workers’ comp claims are free, so they don’t need to provide payment information.
  • The order will be delivered in seven to 10 business days. They will be notified if the order is delayed beyond 72 hours.
  • Standard shipping is free.
  • Customers have access to Kroger/Fred Meyer/QFC pharmacies for up to a 10-day emergency supply.
  • Call PPS customer service at 800.552.6694 for help. Hours are 6 a.m. to 6 p.m. Monday – Friday; 9 a.m. to 2 p.m. Saturday.

Reimbursements

Injured workers can be reimbursed for out-of-pocket expenses.  

  • Other prescriptions: They may send prescription receipts to SAIF for reimbursement. Alternatively pharmacies can direct-bill SAIF for most prescriptions through RESTAT.
  • Other expenses: Depending on the circumstance, an injured worker could be eligible to receive reimbursement for travel, hotel, and meal expenses. Contact SAIF for more information or download the Request for Reimbursement of Expenses form (F-3056) in English or (F-3056s) Spanish.

Questions

If you have a question about benefits, don't hesitate to contact us at 800.285.8525, or email us at saifinfo@saif.com.