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What bills should you pay?

First, make sure your injury has been reported to SAIF. Give your doctor (or doctors) your claim number and ask that medical bills be sent to SAIF until a decision is made on your claim.

Depending on the circumstance, you may or may not be responsible for paying a medical bill. If your claim has been accepted, you should not have to pay any out-of-pocket expenses associated with treatment related to your accepted condition.

While your claim is in deferred status (see below), medical providers can bill SAIF and may also send you copies of bills, but cannot require you to pay them, (unless your claim is later denied). If you receive a bill and are not sure what to do, contact your adjuster.

In an accepted claim, you may be responsible for the payment of bills if you seek treatment that is:

  • Not related to your accepted condition
  • Not prescribed by a qualified attending physician
  • From a doctor who is not a member of a managed care organization (MCO) if your claim is enrolled in an MCO
  • Experimental, outmoded, unscientific, or unproven
  • Palliative care after your claim is closed and without prior approval from SAIF or the Oregon Workers' Compensation Division

Claim status and medical bills

Deferred | While your claim is being evaluated, medical providers should not bill you for treatment and cannot demand payment. (Be sure they are aware it's a workers' comp claim.)

Accepted | If your claim is accepted, your doctors will be reimbursed for medically reasonable and necessary treatment related to your accepted condition. (In Oregon, the amount of the payment is determined by the Oregon Workers' Compensation Fee Schedule.)

Denied | If your claim is denied, all benefits related to the condition will stop. Any bills SAIF has received will be denied and you or your health insurance company will be responsible for paying them. You are not eligible for benefit payments except for interim medical benefits if you are also covered by a qualified health plan. If you appeal the denial, you do not have to pay for medical services while the appeal is in process and/or until the denial is final.

If you don't know your claim status, log in to MyClaim to find out. 

Reimbursements

Go to Getting reimbursed to find out how and when you can be reimbursed for medical expenses related to your claim.

If you do not have insurance

You can get help with medical care even if you are not covered by any health insurance at the time of your injury.

  • The Oregon Prescription Drug Program (OPDP) is available to Oregon residents who do not have prescription drug coverage.
  • The Oregon Health Plan (OHP) provides health care coverage to low-income Oregonians at little or no cost. See the OHP website to find out if you are eligible and how to apply.

Related resources

From saif.com

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