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Claim closure

Your disabling claim will be closed when your accepted condition is "medically stationary." That means no further improvement would reasonably be expected from medical treatment or the passage of time. We will communicate with your doctor to confirm whether or not you have reached medically stationary status.

Closure also could happen if you've had no medical treatment for 30 days.

Benefits

Closure doesn't necessarily mean that your benefits end. You may be eligible for a permanent disability award, vocational services, or medical treatment. Talk to your adjuster if you have questions about these post-closure benefits.

Permanent disabilities

At closure, if you have a permanent loss of use or function (you have not returned to normal or preinjury status), you may have permanent partial disability (PPD).

You may be eligible for payments for your PPD; these payments are based on a formula set by law and are not a settlement. The amount will depend on the severity of the disability, calculated as a percentage of whole body impairment.

If, due to your injury, you can't return to any form of gainful and suitable employment on a permanent basis, you may qualify for permanent total disability (PTD) benefits for as long as you remain totally disabled. These benefits are based on your average weekly wage at the time of the injury.

Categories of PPD benefits

Impairment

Benefits are awarded when you have reduced range of motion, strength, or sensation, or if you have surgery.

Work disability

Benefits may be awarded in addition to impairment benefits if you are permanently disabled from returning to your regular work. These benefits take into consideration your age, education, job skills, and the nature of your regular work.

Vocational benefits

Permanent work restrictions

Your doctor may decide that you aren't able to return to your regular job on a permanent basis. If your employer is unable to accommodate your permanent restrictions, you may be eligible for additional benefits, including vocational services and/or the Preferred Worker Program.

Vocational assistance

Vocational assistance may involve help in finding work with your current skills or it may mean retraining for a new job. Vocational assistance may include any of the services, goods, allowances, and wage-loss payments used to assist you in returning to work.

If you have permanent work restrictions due to your injury, a review of your eligibility for retraining or other employment assistance may occur. You have the right to request an eligibility evaluation for vocational services.

If you have any questions regarding your entitlement to these benefits, please contact your claims adjuster.

Preferred Worker Program (PWP) 

The Preferred Worker Program provides financial incentives to employers who hire injured workers with permanent disabilities. The Oregon Department of Consumer and Business Services (DCBS) will notify you if you are eligible, or you can contact DCBS directly at 800.445.3948 to inquire about this program. You can also contact your SAIF adjuster.

Learn more about how PWP is a true win-win that provides benefits for qualifying injured workers and employers.

Medical treatment

At the time of closure, or even after your claim has been closed, your doctor may recommend further medical treatment. Treatment following claim closure is often referred to as "palliative" care. The purpose of this kind of medical treatment is to reduce or moderate your otherwise stable condition so that you may stay in the workforce.

If your condition gets worse (Aggravation rights)

In some instances, your condition may worsen to the point that your doctor will recommend reopening your claim. This is referred to as an aggravation.

A claim can only be reopened for the accepted condition(s). Your physician must provide evidence that your accepted condition has worsened beyond the measurements previously identified. SAIF may have up to 60 days to evaluate your claim for reopening and may require that you see an independent medical examiner (IME).

If your claim is a disabling claim, it can be reopened up to five years from the date your claim was first closed (or five years from the date of injury on a nondisabling claim), based on a request from you and information on your worsened condition from a doctor.

If your accepted condition worsens more than five years after the first closure date on a disabling claim, you may be entitled to additional benefits under a separate process called "Board's Own Motion." Contact your adjuster for more information.

Reopening is not an option if your claim has been settled.

Appeals

If you disagree with the decision to close your claim, you will have 60 days from the date the Notice of Closure was mailed to appeal the closure decision. Information about how to appeal is included in the Notice of Closure.

Your adjuster will call you to discuss closure, but, as always, feel free to contact us if you have questions.

From saif.com

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