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Filing a Claim
An employee who sustains an injury while working may file a workers’ compensation claim if he or she seeks professional medical treatment and/or obtains a doctor’s authorization for time loss. Under select circumstances, students may be eligible for workers’ compensation benefits (please contact Safety and Risk Services for further information).
To file a claim, a worker and his or her supervisor will need to complete a workers’ compensation claim form (Form 801) and submit it to Safety and Risk Services. Contact Nickie Blasdell for Form 801. By law, the Form 801 must be filed within 5 days of notice or knowledge of a claim. Responsibility for reporting the incident is with the employee, supervisor or a Public Safety Officer. If an employee is hospitalized due to an on-the-job injury, Safety and Risk Services must be notified immediately.
A PCC internal Injury/Illness Incident Report and a Supervisor’s Accident Investigation Report must also be completed and accompany the Form 801. Please reference the How to Complete a Workers’ Compensation Form section below for specific instructions regarding how to complete the Form 801.
Safety and Risk Services will submit the Form 801 to Public Risk Consultants (PRC) who provides claims administration services for the College. PRC will review the claim and in conjunction with College management will make a claim determination within parameters established by the State of Oregon. Claims are accepted or denied within 60 days of the employer’s date of knowledge. If the claim is accepted, time loss payments continue for as long as the attending physician verifies the worker’s inability to work or the claim closes. If the claim is denied, the worker is issued a denial letter which outlines the basis for the denial and the worker’s appeal rights.
Temporary Disability Payments
An injured worker will receive temporary disability payments if his or her doctor notifies the College that he or she cannot work due to their injuries or releases the individual to modified work that results in a loss of wages. Oregon law requires a three-day waiting period for these benefits. An employee will not be paid for the first three calendar days of lost wages unless his or her doctor does not release them to do any type of work for at least 14 days from the time they left work or if the person is an inpatient in a hospital during the first 14 days of total disability.
The injured worker who is eligible for temporary disability payments will receive two-thirds of his or her regular pay. An employee may use available paid leave to cover the remaining one-third of their salary. The employee will not receive more than 100% of his/her regular compensation through any combination of paid leaves with workers’ compensation time loss benefits.
Return to Work
When the injured worker is ready to be released by his or her physician to return to the job, it is necessary for the supervisor to review the work release. Often return-to-work releases are conditional and may not enable the injured person to resume his or her total work assignment. Some departments may not have light duty or modified work assignments available.
If there is a job description for modified work, a copy should be forwarded to the employee’s treating physician for review. Once the physician has approved the job duty list the employee is then ready to return to work under the conditions that have been outlined. If the employee is released to assume job duties without restriction the physician should note this on the return to work release. The work release must show the exact date the employee is released for work and the number of hours if less than full time.
How to Complete a Workers' Compensation Claim Form (Form 801)
Fill out a Form 801 only if there has been medical treatment by an outside medical professional (not just first aid administered at the time of the injury) and/or time loss authorized by a medical provider. Instructions for completing and submitting the form are as follows:
Claimant (Injured Worker)
Complete the 'Worker' section of the form including your signature. Afterward, give the form to your supervisor for completion of the 'Employer' section. Your supervisor will give you a copy of the completed form. If you do not intend to file a workers’ compensation claim with the College’s claims administrator, do not sign the signature line.
Complete the 'Employer' section of the form with the following exceptions. Do not complete the FEIN numbers, insurance policy number and the OSHA 300 log case number. It is very important that you complete all other areas. It is imperative that on-the-job injuries resulting in hospitalization are reported on a Form 801 immediately. Failure to report in a timely manner may result in the assignment of a penalty to the College. “The date employer knew of claim” refers to the date you became aware that the injured employee sought medical treatment and/or when you knew the worker decided to file a claim. Please give the worker a copy of the completed form.
Submit the claim form within five days of notice or knowledge of claim to: Nickie Blasdell, Safety and Risk Services, DC 2nd floor. Safety and Risk Services will ensure that the form is submitted to the College’s claims administrator. Please fax the document to 971-722-2861 and follow-up with the original paper work in the mail if you think sending the documents will create a delay in filing.