Frequently Asked Questions

There is no out-of-pocket legal fee cost to you up front because we work on a contingency fee basis. In a contingent fee arrangement, you as a client do not pay legal fees unless and until we win, and then we receive a percentage of your recovery as the legal fee. If you lose your case, there is no legal fee at all for the lawyer.

Workers’ compensation was conceived as an insurance program. Employers viewed it as a way to stabilize liability risks and costs by simply paying a fixed annual premium to cover all work injuries that might arise during the course of the coming year. Labor groups saw such programs as a way to obtain relatively quick and sure compensation for work-related injuries without resort to expensive litigation or having to prove negligence to obtain benefits. The mutual tradeoffs between labor and management that resulted in the workers’ compensation system are sometimes called the “Great Bargain.”

Workers’ compensation law is state-specific. Nevertheless, the various state workers’ compensation systems are all based on three basic principles. They are (1) no-fault liability, (2) exclusive remedy, and (3) mandatory coverage.

⦁ No-fault liability means except for special statutory exceptions, the fact an injury might have been caused by a worker’s own carelessness is no bar to receiving benefits.

⦁ Applying for benefits under the workers’ compensation insurance policy is the worker’s “exclusive remedy” for such injuries. Generally speaking, if a worker attempts to bring civil lawsuits for work-related injuries, his or her cases would be summarily dismissed. Negligence of the employer or coworkers is not enough to sue.

⦁ Today, almost all states require every employer to carry workers’ compensation insurance.

A worker may receive several types of claim benefits under a compensable workers’ compensation claim. These include medical services, temporary disability, permanent disability, fatal benefits and vocational assistance.

•  Medical services are paid based on a fee schedule set by the Department.
• Temporary disability benefits provide income to help replace a worker’s wage loss while disabled because of a compensable injury. Such benefits are also known as “time loss benefits.”
• When a compensable injury causes permanent impairment to the function of a body part or organ, the law entitles a worker to an award of permanent partial disability benefits or PPD. If the work injury results in the permanent incapacitation of a worker from regularly performing work at a gainful and suitable occupation, the worker may receive permanent total disability or PTD (which is essentially time loss benefits for life).
• There is a schedule of benefits for the spouses and certain specified dependents or beneficiaries of workers who suffer fatal work injuries.
• Vocational assistance is available to those workers who, because of the compensable injury, cannot return to their regular job. This is aimed at restoring the worker to employment of a type and wage as close as possible to the job-at-injury.

Oregon has a three-way workers’ compensation insurance system, meaning Oregon employers may obtain mandatory workers’ compensation coverage from any one of three sources.

• SAIF Corporation: Originally, the state collected all premiums and paid all claims from a government fund. Over time, the legislature converted this state agency into a non-profit “quasi-public” insurance company run as a separate corporation. Most small employers buy their workers’ compensation insurance policies from SAIF.
• Private Insurers: Unlike some states, Oregon permits private insurance companies to sell workers’ compensation insurance to employers. Mid-sized and larger employers usually use these companies because they employ people in sufficient numbers to give them leverage in qualifying for favorable premium rates or terms.
• Self-insurance: Many of the state’s largest employers (including a number of school districts and local governments) have chosen to “self-insure.” Such self-insured employers may hire their own staff to process claims.

Oregon regulates its workers’ compensation system as aggressively as any other state in the nature. The three main governmental bodies involved in regulating or litigating disputes within the workers’ compensation system are:

• The Department of Consumer & Business Services/Workers’ Compensation Division or the Department: This agency is responsible for promulgating and, to some extent enforcing, Oregon Administrative Rules related to workers’ compensation. The Medical Resolution Team (MRT) within the Division handles the majority of medical services and billing disputes (e.g., whether a medical service is reasonable and appropriate, and whether a bill is correctly audited by the insurance company).
• The Worker’s Compensation Board or the Board: This is a separate agency that conducts certain types of formal litigation among the parties involved in the system. Claim denials are litigated before the Board.
• The courts, including the Court of Appeals and Oregon Supreme Court: When parties disagree with decisions they receive from the Department or the Board, they may usually appeal through the Oregon court system.

A common misconception is that a claim can only be filed based on an acute injurious event at work (e.g., a slip and fall injury that results in a knee contusion). Oregon law also allows claims based on occupational disease. An occupational disease generally results from cumulative effects of repeated work-related exposure (e.g., hearing loss from being exposed to injurious loud noise for many years). To put it in simple terms, an injury arises from an identifiable event, whereas an occupational disease results from conditions that develop gradually over time rather than suddenly. Under Oregon law, a mental disorder is generally considered an occupational disease. If you believe you have an occupational disease due to your employment conditions, please contact our office for more information.

The formula for calculating time-loss payments is determined by the state and is frequently updated. Generally speaking, your pay rate or average weekly wage is based on your pre-injury wage earnings for up to 52 weeks before the date of injury. There are special rules that deal with unique wage scenarios such as a pay rate or job change before the injury, gaps in wage history, and a lack of wage data (e.g., employed for less than four weeks at the time of injury.) The time loss rate is often miscalculated by the insurance company. If you believe you are being underpaid by the insurance company, please contact our office for more information.

If you receive a written modified job offer approved by your attending physician, you should consider returning to the light duty job—a refusal will likely result in a deduction of your time loss benefits as if you had taken the modified job.

This question touches on one of the most complex and heavily litigated areas of workers’ compensation law—combined condition. A combined condition occurs when a preexisting condition combines with a compensable condition. A combined condition may cause disability or prolong treatment. For example, if you sprain your knee at work, your accepted knee sprain may combine with some preexisting knee arthritis to complicate and prolong your recovery course. Noteworthy is that the underlying arthritis may be considered a preexisting condition under the law even you had no prior problems with arthritis or required any treatment. The insurance company may deny your claim or benefits on the basis that your preexisting condition has taken over as the primary cause of your need for treatment. If this happens to you, we should consider seeking legal assistance.

Permanent impairment involves loss of use or function of a body part or system stemming from your work injury. Most common types of impairment include range of motion loss, decreased muscle strength and sensory deficits. Oregon does not utilize the AMA guidelines for rating impairment; rather, the state has adopted comprehensive administrative rules for rating physical impairment. Additionally, if you have become physically unable to return to your job-at-injury as a result of your compensable injury, you may be entitled to work disability PPD, which could significantly increase the dollar amount of your PPD award. PPD is awarded when the insurance company closes your claim. If you disagree with the PPD amount awarded by the Notice of Closure, make sure you timely appeal the closure by filing a Request for Reconsideration or seek legal assistance.

Generally, at claim closure, if you have not retuned to or been released to the regular job held at the time of your injury and you have not returned to other jobs with your employer at injury, the insurance company has an obligation to refer you to a certified vocational counselor for a vocational eligibility evaluation. The vocational counselor will make an eligibility finding. If you lack the necessary physical capacities, knowledge, skills and abilities to be employed in a job that would pay you a “suitable wage,” there is a good chance you may be eligible for vocational retraining. If you have been found ineligible for vocational assistance and disagree with this determination, make sure you timely appeal the ineligibility finding to the Employment Services Team of the Workers’ Compensation Division or seek legal assistance.

Medical benefits for your compensable condition are for life. However, when you have reached a medically stationary status (which triggers claim closure), your treatment usually becomes palliative in nature, meaning medical services are provided to temporarily reduce or moderate the intensity of an otherwise stable medical condition. Your attending physician must fulfill certain reporting requirements to the insurance company for palliative care to be authorized and approved. If the insurance company denies your palliative care request, there is a process to appeal the decision. Please contact our office for more information.

The proper valuation of a claim requires an in-depth knowledge of the different types of claims benefits and years of experience. Insurance companies are notorious for extending low-ball offers. By working collaboratively with your medical provider, our attorneys can help you work up your case and significantly increase the settlement value of your claim. We can also ensure you fully understand the legal ramifications of a settlement to avoid “buyer’s remorse” after signing a final binding settlement. Please contact our office so you can be fully compensated for your injury.

SSDI benefits are for disabled people who have spent at least a portion of their life working and paying into the federal Social Security system. Supplemental Security Income (SSI) is a welfare program that provides some monthly benefits to people with limited income who are disabled, blind, or age 65 and older.

SGA stands for substantial gainful activity (SGA). Simply put, to be eligible for disability benefits, a person must be unable to engage in SGA. For most folks the monthly SGA amount for 2019 is $1,220.00. This means if you are capable of earning more than this amount, you will not be found eligible for either SSDI or SSI benefits.

No, you can complete the initial application online or by visiting a local Social Security Office yourself. However, our attorneys can work with your medical provider and gather necessary information to support your application, which will greatly improve the chances of obtaining a favorable decision.

The majority of the claims are denied at the initial application stage and reconsideration stage. You will then progress on to a disability hearing before an Administrative Law Judge (ALJ). The ALJ will generally question you about your background, work history, medical problems and daily activities. Having attorney representation at hearing is crucial. Your attorney can properly prepare you for the hearing and present expert testimony to support your entitlement for disability benefits, which will substantially improve your odds of being approved.

When a favorable decision is finally reached, accrued retroactive benefits are paid from the filing date through the date of the decision.  In SSDI cases the past due benefits are paid in a single lump sum payment.  In SSI cases the past due benefits are paid in installments to avoid loss of entitlement based on the income requirements for SSI eligibility.  Our attorneys accept a portion of those past due benefits as payment for services (i.e., contingency basis), which means the immediate cost of obtaining representation is limited to the costs of obtaining medical records and expert opinions.  The Social Security Administration (SSA) will review the fee agreement you sign to ensure it meets the fee agreement guidelines.

There is no out-of-pocket legal fee cost to you up front because we work on a contingency fee basis. In a contingent fee arrangement, you as a client do not pay legal fees unless and until we win, and then we receive a percentage of your recovery as the legal fee. If you lose your case, there is no legal fee at all for the lawyer.

Negligence is the legal concept that forms the framework of fault in most personal injury cases. Oregon has what is called a comparative fault statute. As long as the fault allocated to you is less than 51%, your recovery will not be barred entirely. However, your damages will be reduced in proportion to the degree of your fault or negligence.

Oregon law allows you to recover several types of economic and noneconomic damages, including but not limited to, loss of income, loss of future earning capacity, pain and suffering, emotional distress, and loss of enjoyment of life as a result of the accident. Please contact our office for more information on what you may recover.

PIP stands for Personal Injury Protection. It is a mandatory form of auto insurance coverage in Oregon. If you have a car insurance policy purchased in this state, you have PIP coverage under the policy. PIP provides coverage for certain benefits (e.g., medical expenses, lost income, funeral expenses) without regard to fault. PIP is an important financial resource to you because you may have interim expenses that need to be covered until you resolve your case with the at-fault driver. Please contact our office to learn more about how PIP works and the extent of benefits it covers.

Your most likely and realistic remedy is to pursue a claim under the UM/UIM coverage under your own auto insurance policy. Oregon law requires each driver to have at least $25,000.00 in uninsured motorist coverage. If the driver at-fault is underinsured (meaning his liability coverage falls short of fully compensating you), you may be able to pursue “gap coverage” under your own underinsured motorist coverage (UIM).

The statute of limitations bars claims after a certain period of time has passed following an accident. In Oregon, the statute of limitations for personal injury cases generally gives an injured person two years from the date of the injury to file a civil lawsuit for damages.

Our fees are charged at an hourly rate based on the nature and complexity of the matter. In some cases, a refundable retainer may be required.

There are multiple ways to structure your business, including but not limited to, sole proprietorship, general partnership, limited, limited liability partnership, C corporation, S corporation, professional corporation, limited liability company. Choosing the right business requires consideration of multiple factors. The most important of these include protection from personal liability for business debts and claims, managerial control, formalities and expenses, and taxation. Our attorneys can go over the pros and cons of each type of organizational structure to help you identify what best suits your needs.

One of the primary reasons to incorporate is to enjoy limited liability protection. Generally speaking, the liability of owners of corporation and LLCs should not exceed the amount of money invested in the company. “Piercing the corporation veil” refers to a situation in which courts set aside limited liability and hold the business owners personally liable for the debts or liability of the business. Courts do not take this step lightly, and only apply this exception to limited liability if some fairly egregious actions have occurred (e.g., fraud against creditors for personal gain).

You can check the availability of a business name in Oregon through the Office of Secretary of State at the following link: https://sos.oregon.gov/business/pages/find.aspx.

Despite the name, a buy-sell agreement has nothing to do with buying or selling a company. A buy-sell agreement is a legally binding contract between owners of a business and addresses the sale of an owner’s share of a business. The sale may be triggered upon an owner’s retirement, bankruptcy, divorce, disability, or death. Buy-sell provisions are also commonly found in a partnership agreement, shareholders’ agreement, or operating agreement. A good buy-sell agreement minimizes the disruption to a business when something unexpected happens to one of its owners. If you co-own a business with one or more people, you should definitely consider a buy-sell agreement to protect the business you worked hard to build.

Not always. For starters, under Oregon law, the duration of non-compete agreement may not exceed 18 months after your employment ends. Additionally, a non-compete agreement may be found void if it does not meet the specific statutory requirements under ORS 653.295. Please contact our office if you have questions about your employment contract.