Workers’ Compensation Dictionary of Common Terms

The judge who presides over a workers’ compensation hearing when a claimant contests a denial, a claim closure, or another disputed issue. The ALJ’s decision (Opinion & Order or “O&O”) can be appealed to the Workers’ Compensation Board.

If a claimant’s accepted condition pathologically worsens, they may have a compensable aggravation claim. The major contributing cause of the pathological worsening must be attributable to an injury or event occurring in the course and scope of employment. A claimant can file an aggravation claim by completing a Form 827 with their attending physician.

An attending physician is the medical provider primarily in charge of directing the care and treatment of the injured party’s work-related injury. There are certain restrictions regarding who you may see, and you can only have a maximum of three different attending physicians over the life of your claim. An attending physician has three essential duties: (1) authorizing light-duty/off-work restrictions; (2) referring the patient to diagnostics, surgery, physical therapy, and other specialists; and (3) determining physical impairment and permanent work-restrictions once the patient reaches maximum medical improvement and has become medically stationary.

The figure used to calculate a claimant’s temporary disability payments, based on earnings at the time of injury. Miscalculating the AWW is one of the more common sources of underpaid time-loss benefits.

The process of appealing an ALJ’s hearing decision to the Workers’ Compensation Board. A further appeal from the Board goes to the Oregon Court of Appeals.

Any party pursuing benefits under the workers’ compensation system. This may include injured workers or the surviving family members of workers who were fatally injured on the job.

The settlement of an accepted claim wherein a claimant sells back all rights to the accepted claim except reasonable and necessary medical services. This settlement takes place in exchange for an agreed-upon sum of tax-free settlement proceeds.

A claim in which a work injury combines with a pre-existing condition to cause or worsen a disability. Combined conditions are evaluated under a different, often more contested, standard than a straightforward injury claim, since the insurer may argue the pre-existing condition — not the work event — is the primary cause.

The short-hand term used to describe an injury or occupational disease that belongs in Oregon’s workers’ compensation system. A compensable injury is any injury that arises out of, and occurs during, employment. It either requires medical care, results in an inability to work, or leads to death. A compensable occupational disease is a disease or infection that occurs during the course of employment and is caused by substances or activities to which an employee is not ordinarily subjected or exposed to. The employee must have been exposed doing something other than regular, actual employment, though the disease must require medical services, result in an inability to work, or cause the worker’s death.

The 60-day period after which the insurer receives official notice of an employee’s claim. During the 60-day period, the insurer investigates the compensability of the employee’s claim.

The formal document issued by the insurer stating the determination that the claimant did not suffer a compensable injury, occupational disease, or death. A claimant must request a hearing within 60 days of the date the denial issued or else that denial will become final.

The settlement of a denied claim wherein a claimant agrees to allow the denial of his or her claim to become final in exchange for an agreed-upon sum of tax-free settlement proceeds.

The principle underlying Oregon’s no-fault workers’ compensation system — in exchange for guaranteed benefits regardless of fault, an injured worker generally cannot separately sue their employer for negligence over the same injury.

The formal proceeding before an Administrative Law Judge where a claimant contests an insurer’s denial, claim closure, or other disputed determination. Evidence, medical records, and witness testimony may all be presented.

A medical evaluation the insurer arranges with a doctor of its choosing, often used to challenge or contradict a claimant’s attending physician on issues like causation, necessity of treatment, or degree of impairment.

Under Oregon workers’ compensation law, an injury is a condition that arose suddenly from a discrete, identifiable event, or series of events, while in the course and scope of a person’s employment.

The insurer is the workers’ compensation insurance company an employer uses for workers’ compensation coverage. Some Oregon employers may be self-insured. Click here to do a coverage search of your employer.

Temporary disability and medical service benefits received during the deferred status of a claim.

Work assigned to accommodate a claimant’s medical restrictions, allowing them to return to some form of employment before they’re fully recovered. Whether an offered light-duty position is legitimate and appropriate is a frequent source of dispute.

The legal standard used to determine compensability in combined-condition and occupational disease claims — the work-related factor must be the primary cause of the disability or need for treatment, not merely a contributing one.

A doctor appointed by the Workers’ Compensation Division during a reconsideration to independently re-measure a claimant’s ratable impairment.

Employees have the right to receive medical services as they relate to the accepted conditions or disease, so long as those medical services are reasonable and necessary. Medical services include diagnostics, curative treatment, and palliative care. Medical services may also include prosthetics and durable medical equipment.

Eventually a worker’s recovery from the accepted conditions or occupational disease will plateau and they will reach maximum medical improvement. Once it is determined that no further material improvement would reasonably be expected from medical treatment or the passage of time, you are considered medically stationary.

The formal document issued by the insurer acknowledging that a claimant suffered a compensable injury, occupational disease, or death. The NOA will enumerate the conditions or disease determined to be compensable. If the insurer updates its NOA, it will issue a Modified Notice of Acceptance (MNOA).

The formal document the insurer issues once it has been determined that the worker is medically stationary and there is sufficient information in the medical records to determine the extent of the worker’s ratable impairment. The NOC will outline the date the worker became medically stationary, periods of time for which the worker was entitled to temporary disability, and the amount of the worker’s permanent disability award, if any. You have 60 days to request reconsideration of a NOC.

Under Oregon WC law, an occupational disease is a physical or mental condition attributable to repetitive work exposure. Your lifetime work activity must be the major contributing cause of the occupational disease for which you now seek compensation. If you find out you suffer from an occupational disease, you must file a claim for that condition within one year of learning that you suffer from a work-related ailment.

If a claimant suffers a pathological worsening, need for treatment, or inability to work after the 5-year aggravation rights period expires, a claimant may still be due benefits and have his or her claim reopened upon the Board’s own motion.

Medical treatment intended to relieve pain or manage symptoms of an accepted condition, rather than to cure or materially improve it. Palliative care is sometimes disputed once a claimant is medically stationary.

Permanent disability is categorized as either partial permanent disability (PPD) or permanent total disability (PTD). It is determined by taking the injured person’s ratable impairment, and applying other factors such as date of injury, details about the job where injury occurred, and whether the worker will be able to return to work. The return to work may include a return to full-duty or might require a permanent work restriction once the worker has reached medically stationary status. This is a non-discretionary tax-free award the insurer pays an injured worker if there is ratable impairment or permanent work restrictions due to the compensable claim.

A pre-existing condition can be any type of condition a person was diagnosed with or received treatment for in the past. For example, a worker may have an existing arthritic condition that existed before her employment, which might contribute to her current inability to work. Pre-existing conditions can affect your eligibility to receive workers’ compensation benefits.

A state program offering incentives to employers who hire or rehire workers with permanent disabilities from a work injury, intended to help injured workers get back into the workforce.

Ratable impairment is the impairment recognized and measured by Oregon’s relevant administrative rules. The process of rating impairment intends to measure the difference caused by the accepted claim pre-injury to post-injury. Common ratable impairments include the loss of range of motion, sensation, or strength attributable to the accepted claim. Ratable impairment does not include pain and suffering.

Reconsideration is the process by which a claimant can challenge the NOC to the Workers’ Compensation Division. If you request reconsideration, the WCD will sometimes send you one of their doctors called a “medical arbiter” to remeasure your ratable impairment, if one exists. The WCD will either affirm, modify, or rescind the NOC after it “audits” the NOC in a document called an Order on Reconsideration.

The formal step a claimant takes to contest a denial or other adverse determination, generally due within 60 days of the decision being appealed. Missing this deadline typically makes the determination final.

Oregon’s state-chartered, nonprofit workers’ compensation insurance company. Many Oregon employers carry coverage through SAIF rather than a private insurer.

An employer approved by the state to cover its own workers’ compensation claims directly, rather than purchasing a policy from an insurance carrier or SAIF.

A written agreement between a claimant and insurer resolving one or more disputed issues in a claim, often used to settle a specific dispute (such as a closure or a denial) without a full hearing.

Commonly referred to as time loss, temporary disability benefits are paid when a WC claim results in an inability to work — i.e., disability. Temporary disability is categorized as either temporary total disability (TTD) or temporary partial disability (TPD), depending on your restrictions and your employer’s ability to accommodate those restrictions. Temporary total disability is two-thirds of the employee’s average weekly wage at injury. Temporary partial disability is two-thirds of the difference between the employee’s average weekly wage at injury and your post-injury earnings. The attending physician can authorize work restrictions, thus entitling you to temporary benefits.

is two-thirds of the difference between the employee’s average weekly wage at injury and your post-injury earnings. The attending physician can authorize work restrictions, thus entitling you to temporary benefits.

is two-thirds of the employee’s average weekly wage at injury.

A claim against someone other than the employer or a coworker — such as an equipment manufacturer, contractor, or property owner — whose negligence contributed to a work injury. Third-party claims can provide compensation beyond standard workers’ compensation benefits, subject to the insurer’s lien rights.

Vocational rehabilitation is a job-training benefit that may be available to a claimant if certain requirements are met. The claimant must have been issued a permanent work restriction upon becoming medically stationary and the employer at injury must be unable to offer permanent light-duty work accommodating any such permanent work restrictions. Also, the claimant must not be able to return to the work force making at least 80% of his or her wages at injury because of a permanent work restriction. If those prerequisites are met, the insurer will pay for tuition and out-of-pocket expenses relating to the vocational rehabilitation. The insurer will also pay total temporary disability during any periods of time during which the claimant is attending courses.

The judicial branch of Oregon’s workers’ compensation system, responsible for reviewing ALJ hearing decisions and resolving disputes such as claim denials and disputed wage payments.

The administrative branch of Oregon’s workers’ compensation system, which regulates claims processing, reconsiderations, and medical treatment disputes.