OCCPAP - Oregon Contractors Classification Premium Adjustment Program
OAR - Oregon Administrative Rule
OD - Occupational disease
ODL - Oregon driver's license
OGSERP - Oregon Group Supplemental Experience Rating Program
OJT - On-the-job training
OM - Own motion
ORS - Oregon Revised Statute
OSHA - Occupational Safety and Health Administration
Used in determining whether a claim meets the statutory definition of a compensable condition. It includes, but is not limited to, range of motion, atrophy, muscle strength, muscle spasm, and diagnostic evidence substantiated by clinical findings.
Any disease or infection which arises out of and in the course of employment to which the employee is not ordinarily subjected or exposed other than during the period of regular, active employment (e.g. repeated exposure to toxic chemicals that cause respiratory problems). The worker must prove that employment conditions were the major contributing cause (more than 50 percent) of the disease or its worsening. Existence of the disease or worsening of a pre-existing disease must be established by medical evidence supported by objective findings.
Occupational Safety and Health Administration (OSHA)
Agency created by the federal Department of Labor, as a result of the OSHA Act of 1970, to administer and enforce safety and health standards.
Opinion and order
Legal document from the Workers' Compensation Board Hearings Division providing a ruling on a litigated issue(s) before an administrative law judge.
Oregon Occupational Safety and Health Division (OR-OSHA)
A division of the Department of Consumer and Business Services that sets and enforces safety and health regulations for Oregon employers. OR-OSHA administers the Oregon Safe Employment Act (OSEA).
Own motion claim
The Workers' Compensation Board (WCB) has continuing jurisdiction over claims in which the aggravation rights have expired. The board may, on its own motion, modify, change, or terminate former findings, orders, or awards if in its opinion such action is justified. This term is frequently used when the WCB has ordered a claim reopened after the aggravation period has expired. May also be called "Board's own motion."
PA - Physician's assistant
PCP - Primary care physician
PE - Personal Election
PPD - Permanent partial disability
PPE - Personal Protective Equipment
PTD - Permanent total disability
PWP - Preferred Worker Program
The total dollars paid for a claim. Paid losses do not include outstanding reserves.
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Medical services rendered to reduce or moderate temporarily the intensity of an otherwise stable condition. Palliative care is appropriate when a worker requires medical treatment to continue current employment or participation in a vocational training program. The worker's attending physician must request pre-approval for this treatment from the employer's insurance company. Palliative care does not include those medical services rendered to diagnose, heal, or permanently alleviate or eliminate a medical condition.
In major part, a denial of a specific condition or treatment in an accepted claim because it is not related to or caused by the accepted injury or occupational disease.
An insurer or self-insured employer appointed by the Workers' Compensation Division to be temporarily responsible for paying benefits due to an injured worker when several insurers and/or employers are involved in a dispute over which party is responsible for the worker's injury or disease. When the dispute is resolved by either legal order or stipulation, the insurer found responsible is obligated to reimburse the paying agent. This appointment occurs only if responsibility for the injury or disease is in dispute. A paying agent will not be named if compensability is also at issue. Generally, the insurer with the lowest compensation rate will be selected as the paying agent.
A record of wages payable to workers for their services, including vacation pay, bonus pay, commissions, value of exchange labor, amounts paid under profit sharing agreements, and the reasonable value of board, rent, housing, lodging, or similar advantage received from the employer.
A form completed by the insured and given to the insurance carrier, covering a specified period and showing amounts of payroll paid to employees by classification.
Permanent partial disability (PPD)
When an injury results in a permanent - but not total - disability through the permanent loss of use or function or through the loss of future earning capacity.
Permanent total disability (PTD)
The loss of use or function of any portion of the body which permanently incapacitates the worker from regularly performing work at a gainful and suitable occupation. A suitable occupation is one that pays wages equal to 66 2/3 of the worker's weekly average wage or the federal poverty guidelines for a family of three, whichever is less, and which the worker has the ability, training, or experience to perform. Each claim where PTD has been awarded is re-examined by the insurer or self-insurer at least every two years from the date of the PTD order. This review can result in an affirmation of the previously awarded PTD benefits or a rescission of the PTD benefits.
The legal document that represents the coverage contract between an insurance carrier and an employer. It states rights, provisions and responsibilities of the two parties.
The period of time between the effective and expiration dates of a policy.
Any person or business entity to whom a policy is issued.
According to Oregon Revised Statutes, "preexisting condition" means, for all industrial injury claims, any injury, disease, congenital abnormality, personality disorder or similar condition that contributes to disability or need for treatment, provided that:
(A) Except for claims in which a preexisting condition is arthritis or an arthritic condition, the worker has been diagnosed with such condition, or has obtained medical services for the symptoms of the condition regardless of diagnosis; and
(B)(i) In claims for an initial injury or omitted condition, the diagnosis or treatment precedes the initial injury;
(ii) In claims for a new medical condition, the diagnosis or treatment precedes the onset of the new medical condition; or
(iii) In claims for a worsening pursuant to ORS 656.273 or 656.278, the diagnosis or treatment precedes the onset of the worsened condition.
(b) "Preexisting condition" means, for all occupational disease claims, any injury, disease, congenital abnormality, personality disorder or similar condition that contributes to disability or need for treatment and that precedes the onset of the claimed occupational disease, or precedes a claim for worsening in such claims pursuant to ORS 656.273 or 656.278.
(c) For the purposes of industrial injury claims, a condition does not contribute to disability or need for treatment if the condition merely renders the worker more susceptible to the injury. (ORS 656.005)
A worker who, because of a compensable injury, is unable to return to regular employment without substantial modifications to their work or work-site.
Preferred Worker Program
A program designed to encourage employers to hire injured workers that have a permanent disability who are unable to return to work without assistance. Self-insured employers or the insurance carriers of employers who hire "preferred workers" receive reimbursement from the Workers' Benefit Fund for claim costs of injuries incurred by these workers for three years from date of hire. In addition, the employer does not pay insurance premiums or premium assessments on the payroll of the preferred worker. This program is funded through the cents-per-hour assessment charged to employers and employees.
The cost of coverage. A premium is the rate per unit of coverage multiplied by the number of units of insurance purchased.
The review of the financial and payroll records of our policyholders to determine whether the payroll classification and levels of exposure within those classifications are properly reported to an insurance carrier.
A credit allowed to an insured based on premium volume which reflects the decrease in handling costs as the size of a risk increases.
Primary care physician
A physician qualified to be an attending physician (see Attending Physician) who is a general practitioner, family practitioner, or internal medicine practitioner. When an injured worker is subject to seeking care from a managed care organization (MCO), she can choose to treat with a primary care physician who does not belong to the MCO if the physician maintains the worker's medical records and has a documented history of prior treatment to the worker and agrees to abide by the terms and conditions of the MCO.
Any privately held insurance company offering workers' compensation coverage.