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A Guide for Workers Recently Hurt on the Job

How do I file a claim?

If I can’t work, will I receive payments for lost

•

wages?

Notify your employer and a health care provider

•

of your choice about your job-related injury or

You may be unable to work due to your job-

illness as soon as possible. Your employer cannot

related injury or illness. In order for you to receive

choose your health care provider for you.

payments for time off work, your health care

provider must send written authorization to the

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Ask your employer the name of its workers’

insurer.

compensation insurer.

•

Generally, you will not be paid for the first three

•

Complete Form 801, “Report of Job Injury or

calendar days for time off work.

Illness,” available from your employer and Form

•

827, “Worker’s and Health Care Provider’s

You may be paid for lost wages for the first three

Report for Workers’ Compensation Claims,”

calendar days if you are off work for 14

available from your health care provider.

consecutive days or hospitalized overnight.

•

How do I get medical treatment?

If your claim is denied within the first 14 days,

•

you will not be paid for any lost wages.

You may receive medical treatment from the

health care provider of your choice, including:

•

Keep your employer informed about what is going

Authorized nurse practitioners

on and cooperate with efforts to return you to a

Chiropractic physicians

modified- or light-duty job.

Medical doctors

Naturopathic physicians

What if I have questions about my claim?

•

Oral surgeons

The insurance company or your employer should

Osteopathic doctors

be able to answer your questions.

Physician assistants

•

If you have questions, concerns, or complaints,

Podiatric physicians

you may also call any of the numbers below:

Other health care providers

Ombudsman for Injured Workers:

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The insurance company may enroll you in a

An advocate for injured workers

managed care organization at any time. If it does,

Toll-free: 800-927-1271

you will receive more information about your

E-mail: oiw.questions@state.or.us

medical treatment options.

Workers’ Compensation Compliance Section

Are there limitations to my medical treatment?

Toll-free: 800-452-0288

•

Health care providers may be limited in how

E-mail: workcomp.questions@state.or.us

long they may treat you and whether they may

authorize payments for time off work. Check

with your health care provider about any

limitations that may apply.

•

If your claim is denied, you may have to pay for

your medical treatment.

Do I have to provide my Social Security number on Forms 801 and 827? What will it be used for? You do not need to have an

SSN to get workers’ compensation benefits. If you have an SSN, and don’t provide it, the Workers’ Compensation Division (WCD) of

the Department of Consumer and Business Services will get it from your employer, the workers’ compensation insurer, or other

sources. WCD may use your SSN for: quality assessment, correct identification and processing of claims, compliance, research, injured

worker program administration, matching data with other state agencies to measure WCD program effectiveness, injury prevention

activities, and to provide to federal agencies in the Medicare program for their use as required by federal law. The following laws

authorize WCD to get your SSN: the Privacy Act of 1974, 5 USC § 552a, Section (7)(a)(2)(B); Oregon Revised Statutes chapter 656;

and Oregon Administrative Rules chapter 436 (Workers’ Compensation Board Administrative Order No. 4-1967).

440-3283 (07/10/DCBS/WCD/WEB)

Form 827 - Worker'S And Health Care Provider'S Report For Workers' Compensation Claims Page 4

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