Workers’ comp overview

In short, workers' compensation insurance provides benefits like medical treatment and income replacement for workers who are injured or suffer an occupational disease as a result of their work. At the same time, it shields employers from liability lawsuits that might result from work-related injuries or illnesses.

How it works

A claim for benefits can be filed in three ways:

• An injured worker completes a F801 with or through their employer.
• A medical provider completes a F827 at the first medical visit.
• An injured worker files it through his or her attorney.  

Claims are categorized as:

• Injuries, which are mostly the result of a traumatic event but can also be a condition that develops over a discreet period of time, or,
• Occupational diseases, which are conditions secondary to workplace exposures, activities, or environments that arise over a period of time (months or years)

How workers' comp rules are made 

• The state legislature makes laws relating to the workers' compensation system. 
• The Oregon Department of Consumer and Business Services (DCBS), which regulates the workers' compensation system, applies those laws, primarily through Oregon administrative rules (OARs).
• The Medical Advisory Committee (MAC) is comprised of representatives of the health care community, plus one representative each for injured workers, employers, insurers, and MCOs. They meet regularly with WCD to provide advice to the director on matters relating to the provision of medical care to workers.

OARs for medical providers

The Oregon administrative rules that apply to medical providers are:

• OAR 436.008  - Electronic Medical Billing
• OAR 436.009  - Medical fees
• OAR 436.010  - Medical services
• OAR 436.015  - Managed care organizations