Injuries at Work or On The Job – Changes in Insurance Rules 

Work injuries are not just for construction workers. If you have pain at work, in an office, on a job site – during or after the work day – or even next morning, it should be evaluated as a work injury. Important changes in the Oregon Worker’s Compensation Rules can help you get the care that you need, and protect your rights. At Blue Heron Chiropractic, we take the time to explain these important distinctions to you, in order to avoid the problems that so many people get into in this situation. This blog will discuss the rule changes and also clarify some distinctions about on the job injuries, and mention how Blue Heron Chiropractic and Dr. Dana Sibilla, DC DABCO FIANM approaches work injury and time loss. A future blog will go through the details of how a claim will progress, and how to fill out the paperwork properly. Until then, we can talk about it in the clinic. 

What is the insurance issue with work injuries?

We frequently meet patients who have been injured on the job who have been told by their employer that their care must be put through their private insurance. Alternatively, they are told that “since worker’s compensation is so difficult, you don’t want to make a claim”. Sometimes, they are even pressured at work. All of these tactics are not only wrong, they are illegal – but since they are delivered straight-faced by bosses or human resources, they seem to be true. They are not. Workers are being taken advantage of every day; they are denied care and even put at risk of serious financial difficulty or job loss.

So what is the insurance issue? Basically, private insurance does not cover for injuries sustained while you are on the clock for an employer (who has their own insurance for you, by law) or are earning a wage for the injury activity. This includes the way a car personal insurance policy does not cover when you are driving a cab for a fare – that requires “work insurance” – even if you are self employed.  So, if you injure (or even re-injure) your back lifting a box at work, this is a claim that must be made through Worker’s Compensation insurance (that by the way, you have already paid for out of your salary).   If this claim is filed through personal insurance, it requires the physician or biller to “lie by omission” on the billing form. When the insurance carrier audits and finds out that it was a work injury, they will – every time – require the doctor’s office to pay back the billings, reverting it to you. That’s one of the ways we hear about someone ending up owing hundreds or thousands of dollars to a carrier like Blue Cross Blue Shield (for example). How they find out is they investigate almost every claim using human researchers, or artificial intelligence (AI).   The way to get around this problem is to call the injury what it is – a work injury – and to file the claim properly according to the Oregon Worker’s Compensation Rules. 

What is the problem with misfiling a work injury as a home/personal injury?

Deliberately filing a work injury as a private injury is insurance fraud, in no uncertain terms. Even accidentally filing it wrong is still not correct and leaves you vulnerable. The entire claim, and all the medical bills, will pile up and may either be rejected by insurance – making them payable by you – or, even worse, they will be paid to the doctor’s office, audited, and then revert to you and you go into collections. The other reality is even harsher – job risk. The reality is that an employer is not happy to have an injured employee; they are less productive and a future risk. You could be fired at the next review or denied a promotion in the future, without ever knowing why.  But with a filed Worker’s Comp claim, the employer cannot discriminate or retaliate against the employee. There are rules that need to be followed. There are essentially no rules when you use your own insurance. And why should you use your vacation days or paid time off when the job should be accountable for the people it injures?

Workers Comp laws have changed as of January 1, 2023.

Previously, the number of employees at a company changed some of the accountability for injuries or discrimination on the job. Also, any person acting on behalf of the employer will be prohibited from actions taken against the worker, instead of just the employer. The law also protects any worker who even inquires about workers compensation benefits, as well as those who apply for benefits.  If you need further information about this you may want to consult with the Bureau of Labor & Industries (BOLI) at (971) 245-3844 or help@boli.state.or.us; we will also help you understand this. 

Workers have the right to choose their care provider.

Injured Workers have the right to choose their own provider. Employers and insurers cannot require workers to go to a specific doctor, specific clinic, or facility, or even a company doctor. Workers may seek care for a work – related injury or illness from their own health care provider – including a Chiropractor – an urgent care clinic, or an emergency room. If workers claims are eventually enrolled in a Managed Care Organization (MCO),  while they may eventually be required to choose a provider from within the MCO, the MCO is required to allow the patient’s personal provider to operate and bill the claim under the terms all the MCO, for at least a portion of the claim.   Employers are also not entitled to a worker’s medical records – unless the worker signs away that confidentiality –  and the worker is not required to sign away permission to their past records. If the employer retaliates or discriminates against the employee because they refused to release their past personal records  – including, for example, their psychotherapy records or an injury decades ago as a child –  the employee may be entitled to significant financial or job compensation.

How much does the Employer pay for Worker’s Compensation Insurance?

Unless the employer has filed as a self-insured entity (usually only very large, powerful companies like bus transportation companies) Then they are required to have a worker’s compensation policy in effect to protect their employees, and employees are typically charged weekly out of their paychecks for a portion of the workers comp insurance. In 2023, the workers benefit fund insurance rate is going down for employers by an average of 3.2% compared to 2022.

Why is holding an employer accountable for a work injury important?

You could end up owing big money for a claim that was fraudulently filed, or lose your job because an employer can fire you in Oregon without cause as a retaliation for being injured if your dont file Work Comp. Other people are also not protected, and others will be hurt by the same system of discrimination, all in the name of the employer making more money and paying you less. We want to support your health, protect your rights, protect your job, and protect your finances. We also don’t want to commit insurance fraud, or let you accidentally do the same thing. Remember, not knowing the law does not make the law applicable to you.  We can help you with all of this at Blue Heron Clinic.

How long has Blue Heron Chiropractic been treating work Injuries?

Doctor Sibilla has been treating work injuries the right way since 1996.  We aim to be good at what we do, and thus we try to be as informed as possible about the new laws, and employee insurance benefits. Our aim is to help educate you to get this filed right the first time.

How is Blue Heron handling the COVID-19 Pandemic at this time?

All the staff you encounter at Blue Herin including Doctor Sibilla are fully vaccinated with updated boosters; Dana’s on his fifth shot to date. We are still currently masking inside the clinic, as is required for all healthcare facilities. If you don’t have an appropriate mask, we will provide you with one. Access Chiropractic safely and securely at Blue Heron Chiropractic & Healing Arts Center, with Dr. Dana Sibilla, DC DABCO FIANM.