10. If I have an injury that qualifies under Workers' Compensation, does it qualify for FMLA and OFLA?
It depends. If the injury meets the definition of a serious health condition and you qualify for family and medical leave, the employer must designate your time off as FMLA and OFLA and you will be eligible for the protections the laws offer.
Can I be charged for medical treatment?
You can be charged for medical costs if:
- Treatment of conditions is not related to an accepted injury or illness.
- Treatment has not been prescribed by your attending physician. This would include, but not be limited to, treatment of non attending physicians that continues after SAIF has notified you to change.
- Palliative care, which is not covered by Workers' Compensation law and not approved by SAIF. This includes most treatments after you are medically stationary.
- Treatment not covered by an MCO contract.
How will I know if my claim has been accepted or denied?
SAIF will evaluate your claim and decide to accept or deny it. This decision must be made within 60 days. In some cases it may take up to 60 days to gather the medical or employment information needed to make a decision. If your claim is denied, you will be given a specific amount of time to appeal the decision.
What are the medical benefits?
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 available online at SAIF.
If your claim is denied, all benefits will stop. You are not eligible for benefit payments while your claim is in a denied status.
What are the time loss benefits for a temporary total disability?
If your doctor tells you to stop working, but thinks you will recover and return to work, you have a Temporary Total Disability and are eligible for "time-loss" benefits.
You are eligible for time-loss benefits after the first three calendar days you cannot work, beginning with the first day you lose time from work because of the injury or illness. If you are unable to work for fourteen (14) straight days or are admitted as an inpatient to a hospital during your first time-loss period, time-loss benefits are paid back to the first day you missed work. (Also see "What is temporary partial disability (TPD)?" and "What is temporary total disability (TTD)?" for additional information)
What do I do if I get hurt on the job?
The first thing to do is report the injury or accident immediately. Tell your supervisor about the injury and how it happened. Your supervisor is then required to complete the OSU Report of Accident.
What happens when a worker is fatally injured on the job?
When a worker is fatally injured on the job and leaves behind a spouse, dependent child, or other qualified beneficiary they will receive benefits if the claim is accepted. These benefits also will include a burial allowance.
What if I am unable to return to my regular work due to my work injury?
If you are given permanent restrictions and unable to return to your job at injury, then you may be eligible for reemployment or reinstatement under the Continued Benefits for Injured Workers rules. You may also be referred to the Office of Affirmative Action to begin the interactive process to see if you qualify for accommodations under the Americans with Disabilities Act.
What if I need medical treatment?
If you need medical treatment, tell your doctor on your first visit that your injury happened on the job or that you believe your illness is work-related. The doctor must tell you if there are any limits to the amount of medical services he or she can provide. A completed Employee Status Report form must be completed by the attending physician on the claim at each appointment, and at a minimum of every 30 days until the claim is closed, or a denial is finalized
When do I file a workers' compensation claim?
ONLY when you seek medical treatment. If you do not see a doctor, you do not file a claim. However, you are still required to report the injury/illness to your supervisor immediately!
The administrative office in your department or college should have a supply of the claim form titled Workers' Compensation Claim Form 801 - SAIF Corporation. You complete the worker portion, your supervisor or other assigned person in the department completes the employer portion. The completed 801 claim form should be sent to Employee Benefits 204 Kerr Administration Building, OSU Campus within 24 hours of an injury or notification of an injury/illness. When necessary, the completed forms can be faxed to 541-737-0553; originals should still be sent to Employee Benefits. The Office of Human Resources will coordinate claims and will submit the completed forms to our workers’ compensation carrier, SAIF .
Who can file a workers' compensation claim?
Primarily only student workers, temporary and permanent employees (both faculty and staff; academic and classified) employed by OSU and paid from Oregon University System (formerly OSSHE) payroll. However, there are exceptions. For more information contact Employee Benefits.
Who must report on-the-job injuries and illnesses?
ALL regular employees, students, student workers, visitors, volunteers, temporary employees (both faculty and staff; academic and classified).
