Oregon workers' compensation is governed by ORS chapter 656, administered by the Director of the Department of Consumer and Business Services. Disputed claims go to the Workers' Compensation Board. Oregon is not a monopolistic state: employers buy coverage from authorized private insurers or from SAIF Corporation, or they self-insure. This guide covers the Oregon rules. The standard policy, rating and federal programs are in the national Workers Compensation guide.

Who must provide coverage

• An employer with one or more subject workers is a subject employer (ORS 656.023).
• A subject employer can comply in two ways (656.017):
  • Be carrier-insured, with an authorized insurer or SAIF.
  • Be self-insured.
• An employer that complies gets exclusive remedy protection for work injuries (656.018).

Nonsubject workers (656.027) include:

• Domestic servants in a private home.
• Casual workers: total labor cost in any 30-day period under $1,000, adjusted annually.
• Members of a multi-member LLC, except those doing construction work on real property, who are subject workers.

An employer may elect to cover nonsubject workers (656.039).

SAIF and the assigned risk plan

• SAIF Corporation (State Accident Insurance Fund) is an independent public corporation that writes workers' comp in competition with private insurers (656.751). It also covers state employees (656.017(2)).
• Assigned risk plan: an employer that insurers object to covering gets coverage through the plan, which SAIF and insurers share (656.730).
• An insurer that refuses its share of the plan has its authority to write workers' comp revoked.

Self-insurance (ORS 656.407)

• The employer must show adequate claims staff and the financial ability to pay compensation promptly.
• It must post security at least equal to normal expected annual claim liabilities, and never less than $100,000.

Compensable injuries and occupational disease

Compensable injury (656.005(7))

• An accidental injury arising out of and in the course of employment that requires medical services or causes disability or death.
• Injuries in recreational or social activities done mainly for personal pleasure are excluded.

Notice of accident (656.265)

• The worker notifies the employer immediately, and no later than 90 days after the accident.

Occupational disease (656.802, 656.807)

• Employment conditions must be the major contributing cause.
• The claim is void unless filed within 1 year of the later of discovering the disease, or disability or being told of it by a physician.

Benefits

The Workers with Disabilities Program encourages employers to hire workers with disabilities (656.628).

Claims handling and appeals

• Whether an insurer's investigation was reasonable is judged on the claim record at the time of denial (OAR 836-080-0250).
• Appeals of Administrative Law Judge orders go to the Workers' Compensation Board (656.726).
• If an insurer becomes insolvent, the Oregon Insurance Guaranty Association pays covered workers' comp claims in full, less Workers' Benefit Fund payments (ORS 734.570).

Common exam traps

• Not monopolistic. SAIF competes with private insurers. It is an independent public corporation, not a state agency.
• One worker makes an employer subject.
• TTD: 66 2/3%, capped at 133% of the state average weekly wage. 3-day waiting period, waived after 14 days of disability or an inpatient stay.
• Notice: immediately, and no later than 90 days. Occupational disease claims: 1 year.
• Occupational disease requires major contributing cause.