Workers' compensation overview

How it works

Workers' compensation insurance protects workers by paying for medical treatment and lost wages, and it protects employers by shielding them from liability lawsuits that might result from work-related injuries or illnesses.

Employers pay premiums to workers' compensation insurance companies like SAIF, and those premiums pay for most of the benefits that injured workers receive.

If the injured worker receives medical treatment, a claim must be filed. The medical provider must verify that the injury or occupational disease occurred as a result of the employee's work in order for a claim to be valid.

A workplace injury can be traumatic (caused by an accident), cumulative (caused by repetitive motion), or an occupational disease (such as loss of hearing). If a previous workplace injury is aggravated, the worker may be able to reopen the original claim.

How workers' comp rules are made

By law, Oregon employers must carry workers' compensation insurance or be self-insured.

The state legislature makes laws relating to the workers' compensation system, such as determining the level of benefits and who qualifies for them. The Oregon Department of Consumer and Business Services (DCBS), which regulates the workers' compensation system, applies those laws, primarily through Oregon administrative rules (OARs). In general, DCBS makes certain that employers provide insurance and ensures that injured workers receive the benefits to which they are entitled.

OARs for medical providers

The Oregon administrative rules that apply to medical providers are:

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