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.
Contents:
Overview
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.
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 which 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 you to remain off work during your recovery, the benefits you 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 you receive is determined by your average weekly wage. There are minimum and maximum biweekly benefits.
Temporary partial disability (TPD)
At the time you return to transitional work, if you are not earning your pre-injury average weekly wage, you become entitled to partial time loss benefits. These benefits continue while you are recovering and have not been released to return to your regular work or are not earning your full wage.
Permanent partial disability (PPD)
When an attending physician determines that you have reached medical stability and your claim is ready for closure, an examination is done to determine permanent effects of the injury on your ability to function. This loss of function is determined as a percentage of whole body impairment for benefit calculations.
Permanent total disability (PTD)
If you are unable to return to gainful and suitable employment, you may qualify for PTD benefits. These benefits are based on your average weekly wage at the time of their 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, 2008 to June 30, 2009 | |
|---|---|
| Temporary Total Disability (TTD) | |
| Injured Worker | 66-2/3% wages paid weekly |
| Maximum | $2,102.42 biweekly |
| Minimum | 90% wages or $100 biweekly, whichever is less |
| Permanent Partial Disability | |
| Impairment | Percent of whole body impairment x 100 x Oregon Average Weekly Wage ($790.38). |
|
Work Disability (Cannot return to regular work due to the accepted condition.) |
|
| Permanent Total Disability | |
| Injured Worker | 66-2/3% wages paid monthly |
| Maximum | $3,438.15 / monthly |
| Minimum | 90% wages or $217.50 / month, whichever is less. |
| Spouse and children after death of PTD | Same as Fatal below |
| Fatal | |
| Spouse | $2,292.22 / monthly |
| Each child | $343.82 / monthly |
| Maximum spouse and children | $4,584.09 / monthly |
| Each child (when no spousal benefit paid) | $859.54 / monthly |
| Burial allowance | $7,903.80 |
| Remarriage allowance (Based on 36 x monthly benefit) |
$82,519.92 |
| Oregon Average Weekly Wage | |
| $790.38 | |
Prescriptions
Prescription drug coverage
First Fill
Pharmacy bills will be handled through the Oregon Prescription Drug Program (OPDP) and paid by SAIF, even if the claim is later denied. There will be no out-of-pocket costs to the injured worker or to the policyholder for the prescriptions, unless a medication not covered by First Fill is prescribed.
- View the First Fill prescription drug list.
- Locate a First Fill pharmacy in your area.
Oregon Prescription Drug Program (OPDP)
Note: This program will be effective March 4, 2008.Beginning in March 2008, SAIF Corporation will use the Oregon Prescription Drug Program (OPDP) to administer pharmacy benefits for the approximately 45,000 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
Workers can save time, travel, and hassle by having their regular, ongoing prescription medications delivered to their homes for no extra charge by using Wellpartner. Non-work-related prescriptions can be added to orders for work-related prescriptions, but the worker will be responsible for payment of those items. Prescriptions are delivered in seven to 10 business days.To order using Wellpartner:
- Workers can register by calling Wellpartner at 800.417.8806 or signing up at www.wellpartner.com.
- Workers can fill out an order form and mail it to Wellpartner with their original prescription(s). Download the form
- Doctors can call in prescription(s) to Wellpartner at 866.935.5797, or fax them to 866.624.5797.
Reimbursements
Injured workers can be reimbursed for out-of-pocket expenses.- Other prescriptions: You may send your prescription receipts to SAIF for reimbursement. Alternatively pharmacies can direct-bill SAIF for most prescriptions through RESTAT.
- Other expenses: Depending on the circumstance, you 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 or (F-3056s) .