Benefits
Workers injured on the job may be eligible for several kinds of benefits, including time-loss benefits, coverage of medical treatment, and more. SAIF works side by side with you and your employer to be sure you receive the appropriate care and payment.
Contents:
Overview
Time loss
If your injuries require you to miss work, you may be eligible for temporary disability benefits (also called time loss benefits) if your attending physician authorizes you to be away from work.The formula for calculating time loss benefits is determined by the state and is described on the wage benefits page.
Medical coverage
If your claim is accepted, your medical providers will be reimbursed for treatment related to your accepted condition. (In Oregon, the amount of the payment is determined by the Oregon Workers' Compensation Fee Schedule.)If your claim is denied, all benefits will stop. You are not eligible for benefit payments while your claim is in a denied status, except for interim medical benefits if you are also covered by a qualified health plan. Contact your adjuster if you have questions about this benefit.
Managed care organizations (MCOs)
MCOs contract with doctors and other health care providers for medical services to covered employees with work-related injuries or illnesses. MCOs emphasize quality medical care, disability management, and cost containment.If your claim is accepted, you will generally be required to seek treatment from an MCO provider or a qualified general practitioner, family practitioner, authorized nurse practitioner, or internist with whom you have a history of prior treatment.
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. If you receive temporary disability, a cost of living adjustment occurs on July 1 of each year. The increase is tied to the average weekly wage in Oregon. See Benefit table below.Remember, an attending physician or authorized nurse practitioner must verify you are physically unable to work in order to receive this benefit.
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 and 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
Temporary total disability (TTD)
When an attending physician or authorized nurse practitioner authorizes you to remain totally off work during your recovery, the benefits you receive are called temporary total disability. 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 stopped as of the date of the denial.
The amount you receive is determined by your average weekly wage. There are minimum and maximum biweekly benefits.
Supplemental Disability
If you had additional Oregon subject jobs at the time of your injury, you may be eligible to receive additional disability payments. You must notify us about the other jobs within 30 days of our receipt of the initial claim and provide proof of wages paid on the other jobs: check stubs or payroll records.
Temporary partial disability (TPD)
As you recover from your condition, your doctor may release you to resume some work. At the time you return to transitional work, if you are not earning your pre-injury average weekly wage, you are eligible for temporary partial disability benefits. These benefits continue while you are recovering and have not been released to return to your regular work while you are not earning your full wage and your claim remains open.
Permanent partial disability (PPD)
When you are determined to be medically stationary, your claim is ready for closure. An examination is done to determine whether you have a permanent loss of use or function as a result of your injury. This permanent 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 any form of gainful and suitable employment held in the past, you may qualify for PTD benefits. These benefits are based on your average weekly wage at the time of the injury but are paid monthly instead of biweekly. Generally, they are for significant and serious injuries, such as paraplegia, quadriplegia, or traumatic brain injuries.
Fatal or survivor's benefits
When a worker is fatally injured on the job and leaves behind a spouse or registered domestic partner, dependent child, or other qualified beneficiary they will receive benefits if the claim is accepted. These benefits also will include a burial allowance.
Benefit table
| Effective July 1, 2007 to June 30, 2008 | |
|---|---|
| Temporary Total Disability (TTD) | |
| Injured Worker | 66-2/3% wages paid weekly |
| Maximum | $2,013.08 biweekly |
| Minimum | 90% wages or $100 biweekly, whichever is less |
| Permanent Partial Disability (Dates of injury on or after January 1, 2005) | |
| Impairment | Percent of whole body impairment x 100 x Oregon Average Weekly Wage ($756.80). |
Work Disability (Cannot return to regular work due to the accepted condition.) |
|
| Permanent Total Disability | |
| Injured Worker | 66-2/3% wages paid monthly |
| Maximum | $3,292.08/monthly |
| Minimum | 90% wages or $217.50 / month, whichever is less. |
| Spouse and children after death of PTD | Same as Fatal below |
| Fatal | |
| Spouse or registered domestic partner | $2,194.83 / monthly |
| Each child | $329.21 / monthly |
| Maximum spouse and children | $4,389.33 / monthly |
| Each child (when no spousal benefit paid) | $823.02 / monthly |
| Burial allowance | $7,568.00 |
| Remarriage allowance (Based on 36 x monthly benefit) | $79,013.88 |
| Oregon Average Weekly Wage | |
| $756.80 | |