Injured worker benefits

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 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, 2011
Temporary Total Disability (TTD) for workers entitled to TTD benefits on or after July 1, 2011
Injured Worker	66-2/3% wages paid weekly
Maximum	$2,241.10 biweekly
Minimum	90% wages or $100 biweekly, whichever is less
Permanent Partial Disability (PPD) Dates of injury or after July 1, 2011
Impairment	Percent of whole body impairment x 100 x Oregon Average Weekly Wage ($842.52).
Work Disability (Cannot return to regular work due to the accepted condition.)	Percent of whole body impairment + factor for age, education and adaptability x 150 x worker's weekly wage. Maximum worker wage factor = 133 percent of Oregon Average Weekly Wage ($1,120.55). Minimum worker wage factor = 50 percent of Oregon Average Weekly Wage ($421.26) Note: Workers may qualify for both Impairment and Work Disability awards.
Permanent Total Disability (PTD) Date of injury on or after July 1, 2011 Note: Benefits based on state average weekly wage in effect at the time of injury
Injured Worker	66-2/3% wages paid monthly
Maximum	$3,664.96 / monthly
Minimum	90% wages 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, 2011
Spouse or registered domestic partner	$2,443.43 / monthly
Each child	$366.50 / monthly
Maximum spouse and children	$4,886.49 / monthly
Each child (when no spousal benefit paid)	$916.24 / monthly
Children age 18 to 23 – without a living parent	$2,443.43 / monthly, while attending higher education.
Burial allowance	$16,850.40 (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
	$842.52

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.

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)

 

SAIF Corporation uses 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

Save time, travel, and hassle by having your regular, ongoing prescription medications delivered to your home for no extra charge by using BioScrip or Postal Prescription Services (PPS) mail-order pharmacies.

Both BioScrop and PPS offer benefits to help you easily and conveniently order prescription medications.

    To order using BioScrip

• Use the BioScrip order form. Prescriptions related to your workers’ comp claim are free, so you don’t need to provide payment information.
• Your order will be delivered in seven to 10 business days. You will be notified if your order is delayed beyond 72 hours.
• Standard shipping is free.
• Web users will receive refill reminders by email.
• Call BioScrip customer service at 877.316.8921, 24 hours a day, for help.

    To order using PPS

• Use the PPS order form. Prescriptions related to your workers’ comp claim are free, so you don’t need to provide payment information.
• Your order will be delivered in seven to 10 business days. You will be notified if your 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 6:00 a.m. – 6:00 p.m. Monday – Friday; 9:00 a.m. – 2:00 p.m. Saturday.

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) .

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.