September 4, 2014

What is Permanent Impairment? What is PPD?

What is Permanent Impairment in Oregon Workers' Compensation?

Permanent Impairment (which is often called PPD for short) is a financial award for a disabling work injury.

PPD Described

Although there is no pain and suffering compensation in Oregon workers' compensation, there is some compensation owed to an injured worker when their injury is permanently disabling.  This compensation is called Permanent Impairment or PPD.

PPD is not something that is negotiated or proven with testimony.  It is decided by the measurable impairment findings of the attending physician when the injury is medically stationary.  The impairment findings are then assigned a percentage based on how disabled the injured worker is.  An additional percentage amount may be added for loss of regular use of a body part or for a surgery.  Although the percentages are combined together, they are not actually added.  There is a formula that combines the different percentages of impairment types to come up with a "whole body" percentage.  This combined percentage is then multiplied by Oregon's Average Weekly Wage to come up with the award amount.

The percentage amounts are determined by the Oregon Workers' Compensation statutes which specify the percentage of impairment for every type of disability.  

The insurance company must calculate an injured worker's PPD and then pay it when a claim is medically stationary.  The PPD award will be set out in a Notice of Closure which will be mailed to the injured worker, the doctor, and his or her attorney.

Example

This is a complicated system, so let me give an example:

An injured work has a L4-5 herniated disc for which she needed surgery.  When she is medically stationary, her attending physician determines she has lost 5 percent of the range of motion of her low back.  She also has a slight loss of sensation due to the surgery, which equals another 2 percent.  The surgery (because it affected two spine levels of the back) equals another 10 percent.  These percents are combined to equal 15 percent "whole body" impairment (remember the percentages are combined using a formula, not added).

This 15 percent impairment is multiplied by $888.38 (Oregon's Average Weekly Wage as of July 1, 2014) for a total impairment award of $13,325.70.  This amount is the PPD award.

Lump Sum and Taxes

It is good to remember that you may always request your PPD award be paid in a lump sum and that the award is tax-free.

Workers' Compensation Attorney

If you have questions about a PPD award or a Notice of Closure, it is always a good idea to have an attorney review it for you.  I am happy to review a Notice of Closure free of charge.  Just give me a call at (503) 975-5535.

August 8, 2014

Non-Disabling vs. Disabling Workers' Compensation Claims

What is the Difference Between Non-Disabling and Disabling Workers' Compensation Claims in Oregon?

I get this question a lot...and the good news is that the answer is pretty straightforward:

Why the Non-Disabling or Disabling Classification?

The insurer classifies the claim as either non-disabling or disabling because only disabling workers' compensation claims must be formally closed.  Non-disabling claims just kind of peter out when the treatment is concluded - there is no need for a formal closure of the claim.

Non-Disabling Workers' Compensation Claims

A claim is non-disabling if the injured worker is not entitled to time loss (i.e., they are not missing work for the injury) and the injured worker is not expected to have permanent impairment from the injury.

So, if you have a relatively minor strain, do light duty for a week or two, but do not miss work and then get better, your claim would be classified as non-disabling.  You would be entitled to have all your medical treatment covered.

Disabling Workers' Compensation Claims

A claim is disabling if the injured worker is entitled to time loss (misses work for the injury) or they are expected to have permanent impairment from the injury.

So, if you sustained a disc herniation and missed work while it was healing, the claim would be disabling.  Also, if you did not miss work but had a surgery, the claim would be disabling because you would be expected to have some permanent impairment.  Your would be entitled to time loss and permanent impairment, as well as medical treatment.

Reclassification of Workers' Compensation Claim from Non-Disabling to Disabling

It is pretty common that a claim is classified as non-disabling when it should be disabling.  When this happens, you will need to request reclassification.  (Sometimes the insurer will reclassify the claim automatically, but sometimes they do not.)

If your claim needs to be reclassified, you will likely need a workers' compensation attorney to assist you.  The process of requesting reclassification is pretty simple, but the results (i.e., your claim becoming disabling) is significant in terms of your workers' compensation benefits.  If your claim needs to be reclassified, you should contact an attorney right away so you do not miss out on any of these benefits.

Please call us for a free consultation at (503) 975-5535 if you have any questions or need help reclassifying your workers' compensation claim.



July 18, 2014

How Much is My Workers' Compensation Claim Worth?

Wondering How Much You Could Settle Your Workers' Compensation Claim For?

This is a difficult question and the answer definitely is different for every case.  But, there are a few ways that the value of a case can be broken down.

First, it is important to remember that no one (not the injured worker or the insurance company) has to settle.  It is always an option but never a right.

Second, a settlement has to have value for both parties.  In other words, it is worth it to both the injured worker and the insurance company.  It is usually worth it to the insurance company because they get to close a file (stop processing the claim), pay a finite amount and not risk any further litigation.  It is worth it to the injured worker because they get a lump sum dollar amount, the amount is guaranteed, and there is no risk of losing the claim completely with litigation.  Keep in mind these are general scenarios and each case has different factors that come into play.

Finally, the value of a settlement is generally less than the insurer's exposure (i.e., how much they might have to pay over the lifetime of the workers' comp claim).  The value is also usually a little more than the injured worker would receive in terms of a dollar amount.  For example, an injured worker with an accepted claim would get time loss, but they would not receive the dollar amount for the medical payments,etc.  Whereas, if the injured worker settled, the lump sum would include those amounts.

Here is more info on the types of workers' compensation settlements: Oregon Workers' Compensation Settlements

Do I Need a Lawyer to Settle My Workers' Compensation Case?

Yes, If you wish to try to settle your workers' compensation case, you will want a workers' compensation lawyer to help you.

If you have any questions or want to talk to a lawyer about settling your workers' compensation case, feel free to call anytime for a free consultation.  (503) 975-5535

July 16, 2014

I Filed a Workers' Compensation Claim - What Happens Next?

I Filed a Workers' Compensation Claim - What Happens Next?

So, you have filed a workers' compensation claim using an 801 or 827 Form and are wondering what happens next...

The first thing to remember is that the workers' compensation insurer now has 60 days to accept or deny your workers' compensation claim.  I recommend marking 60 days on your calendar immediately.

While your claim is being investigated and processed, you should receive medical benefits and time loss.  If your claim is accepted, these benefits will continue.  If it is denied, they will end unless you successfully appeal your denial with a workers' compensation attorney.  You should expect to provide an recorded interview about your injury and go to an exam set up with a doctor working for the workers' comp insurer.  These are standard procedures for investigations of workers' compensation claims.

There are three scenarios that may come next:

Claim Accepted

First, your claim may be accepted.  This is the best-case scenario.  If this happens you should receive all your benefits including time loss and medical care.  However, you do want to make sure your claim is properly accepted.  The Initial Notice of Acceptance will state what conditions that claim is accepted for (i.e., low back strain, etc).  If the condition(s) is incorrect or does not include all your injuries, you will want to contact a workers' compensation attorney for assistance.

Claim Denied

Second, your claim may be denied.  If this happens you will receive a letter stating it is a "denial."  If you receive a denial, you will want to immediately contact a workers' compensation lawyer to help you appeal the denial.

Unfortunately, it is pretty common for workers' compensation claims to be denied.  If this happens, don't worry, but do call a lawyer.

You Hearing Nothing

Third, you may hear nothing about your claim after you file it.  This happens sometimes when claims get lost or the employer fails to comply properly with the law.  If it has been 60 days and your claim has not been accepted or denied, your claim becomes "de facto denied."  This basically means that the insurer - by doing nothing - has denied your claim.

In this scenario, you will definitely need a workers' compensation lawyer to help you appeal the "de facto denial."

As always, feel free to call for a free consultation with a workers' compensation attorney: (503) 975-5535


How to File a Workers' Compensation Claim in Oregon

How to File a Workers' Compensation Claim in Oregon

There are essentially three ways to file a workers' compensation claim in Oregon:

1.  Through the Employer

The most common way to file a workers' compensation claim is through your employer.  This generally involves filling out and signing an 801 Form which the employer then sends to their workers' comp insurer for investigation.

Your employer must have 801 Forms on hand for when an injury is reported.  They should give you one immediately upon reporting your injury. If they do not, I recommend seeking medical attention as soon as possible and using an 827 Form at the doctor office to file your claim.

2.  Through the Doctor

Another common way to file a claim for workers' compensation benefits in Oregon is through your doctor's office.  Most doctors will ask you if your injury is work related.  If you answer yes, they will complete an 827 Form which you will also sign.  This form gets sent directly to the workers' comp insurer by the doctor's office.  Filling out an 827 Form at your doctor office counts as officially filing a claim.

3.  Through the Workers' Compensation Board

A final way to file a claim is directly through the Workers' Compensation Board of Oregon.  This is a "last resort" place to file a claim and usually only is needed when your employer refuses to acknowledge your claim or does not have workers' compensation insurer.  (It is illegal for an employer to not carry workers' compensation coverage for its employees.)

If you are in this situation, I recommend contacting a workers' compensation attorney or the Oregon Ombudsman for Injured Workers.

My phone number if (503) 975-5535 if you have any questions or need assistance with a claim.

January 20, 2014

Oregon Workers' Compensation Settlements - What is a Stipulation?

Stipulation (Stipulated Settlement)

A Stipulation is a type of workers' compensation settlement that generally settles a time loss or other benefits dispute, or that confirms a reversal of a workers' compensation denial.  Most importantly, a Stipulation is not a complete settlement of an accepted or denied claim.  In other words, it will not make a claim go away.  Rather, it resolves a small portion of a claim - a dispute within a claim, not the whole claim.

Time Loss Stipulations

If you have pending litigation dealing with time loss, a Stipulation is used to resolve the litigation prior to hearing.  These types of disputes generally involve the time loss rate, entitlement to time loss, penalties for late payment of time loss, and attorney fees.  For example, you may have filed a Request for Hearing alleging your time loss rate should be higher, that you are owed $1,000 in late time loss, and that you should receive a 25 percent penalty.  Assuming the insurer agrees they were in the wrong, this dispute would be resolved with a Stipulation.  The Stipulation would be a signed document confirming the agreed-upon time loss rate, the amount owed, and any penalties due.  It would also clarify that it resolved the pending 
litigation so there would no longer be a need for a hearing.

Reversal of Denial Stipulations

Another common type of Stipulation involves reversing a denial of your claim or a denial of a new medical condition claim.  For example,you may have received a denial of your workers' compensation claim and appealed it.  If, prior to the hearing date, the insurer decides to reverse the denial, they will do so via a Stipulation.  Basically, the Stipulation would confirm the insurer is going to accept the claim and pay your attorney their fee.  It would also clarify that it resolved the pending litigation so there would no longer be a need for a hearing.

Attorney Fees and Costs

Attorney fees in Stipulations generally do not come out of your benefits.  They are generally accounted for separately and paid separately, although they will be noted in the Stipulation.  For example, if your Stipulation grants you an amount of unpaid time loss, your attorney will not be entitled to a portion of that owed time loss.  Rather, they will be granted a separate dollar amount as their fee.

Likewise, if your Stipulation deals with a reversal of a denial, the attorney will be granted an attorney fee within the document.  But, they will not be entitled to any percentage of the benefits you will receive for having an accepted claim.

Do You Need and Attorney to Settle Your Workers' Compensation Claim?

Yes.  It is always a good idea to have an attorney help you settle your workers' compensation claim.  The attorney will help you get a better settlement and make sure you do not give up more rights than you should.

Will my Workers' Compensation Settlement be Taxed?

No, proceeds from your workers' compensation settlement will not be taxed.  Under Oregon law, it is not considered taxable income.

If you have questions about settling your workers' compensation claim, call us for a free consultation: (503) 975-5535.