June 24, 2015

Time Loss in Oregon Workers' Compensation

How Much Time Loss Will I Get?

If you are missing work because of a workers' compensation claim, the insurer should be paying you time loss.  The time loss rate is 2/3 of your average weekly wage, tax-free.

Example:  If you work 40 hours per week at $10 per hour, you average weekly wage is $400 and your time loss rate is $268 per week.

How to Calculate Average Weekly Wage for Time Loss

Your average.weekly wage is the average wage you earned (before taxes) in the 52 weeks prior to the work injury.  If you worked less than 52 weeks, it is the average of the weeks you did work.

However, if you have worked less than 30 days for a company when you are injured, the average weekly wage is based on what you would have expected to earn.  This is because it is common for the first few weeks of a job to be training and less hours than normal and you should not be penalized for that.

Break in Earnings

If you had a break in your earnings in the last year, that period should not be counted against you for purposes of calculating your average weekly wages.  Examples of breaks include leave for pregnancy or other medical reasons, a prior workers' comp claim or other similar reason.

How Often Should Time Loss be Paid?

Every 14 days.  The insurer should pay time loss within 14 days of receiving your first work restrictions.  They should continue to pay you every 14 days as long as you are off work.  If you are working light duty or less hours, they should still pay you every 14 days to make up the difference.

What Do I Do if my Time Loss Rate is Wrong or the Insurer is not Paying Every 14 Days?

Talk to an attorney.  There are penalties available for late payment of time loss (even if it is only 1 day) and for having the time loss rate wrong.  However, you will need an attorney to help you file a Request for Hearing to get the penalties.

If you have any more questions or think you need help with a time loss issue with your workers' compensation claim, call for a free attorney consultation.  (503) 975-5535.

June 9, 2015

What is an MCO in Oregon Workers' Compensation?

The Role of MCOs in Oregon Workers' Compensation Claims

So, you have just received a letter from the insurance company saying you are now in an MCO (Managed Care Organization).  The letter says you must now choose a new provider from their list.

You are rightly wondering what is going on and what this means for your workers' compensation claim.

Will I have to change my attending physician?

Maybe.  If your current attending physician is within the MCO network, you will not have to switch.  If your attending physician is not in the network, you must switch unless they have been your primary doctor from before your work injury.

What if I can't get in to see one of the doctors on the MCO list?

This is a common problem and is extremely frustrating.  The best thing to do is to e-mail the claim adjuster explaining the problem and listing the doctors you have tried to reach.  Continue to use e-mail to communicate so there is a paper trail showing that you cannot get it to an MCO doctor.  The adjuster should help you get set up with a new doctor.

Tip:  Continue to see your original attending physician until you get in with a new doctor so that your time loss is continuous.