WORKPLACE INJURIES

FILING A CLAIM

  1. Tell your employer right away about your injury.

  2. Fill out Form 801 and turn it in to your employer. You can print out a form here or ask for one from your employer. Your employer must turn it in to the insurer within five days of being notified of your injury.

  3. When you come to Premier Care Chiropractic after your injury, please let us know it is a work-related injury.

  4. You and Dr. Gallucci will complete Oregon Form 827.  Premier Care will turn in the form to the insurer within three working days.

  5. The insurer has 60 days from the day you file the 801 claim form with your employer to accept or deny your claim.  If your claim is accepted, the insurer will send a Notice of Acceptance listing the medical conditions accepted.  If your claim is denied, the insurer will send you a letter explaining why it was denied and what your appeal rights are.

Premier Care Chiropractic

524 SE 14th Avenue Portland, OR 97214 (971) 544-7058

OFFICE HOURS

Mon – Fri:
9:30am – 7:30pm

Saturday:
By appointment only

YOUR RIGHTS AND RESPONSIBILITIES

Worker rights

  • You have the right to file a workers’ compensation claim. 

  • Your employer cannot force you to not file a claim.

  • Your employer cannot force you to say your injury did not happen while working.

  • Your employer cannot force you to work as an independent contractor, partner, or corporate officer to avoid filing a workers’ compensation claim.

  • Your employer must send your claim (Form 801​) to its insurer within five days of being notified of your injury.

  • You have the right to seek medical treatment. This may be your own doctor or a doctor of a managed care organization (MCO), depending on your employer’s workers’ compensation insurance policy.

  • You have the right to return to work if you are released for work by your doctor.

  • If you are partially or totally disabled due to your injury, you have the right to disability (time-loss) pay.

  • If you do not agree with the insurer’s decision about your claim, you have the right to appeal the decision. 

  • You have the right to be represented by an attorney at no cost for attorney’s fees. 

Worker responsibilities

  • Read all letters and notices about your claim.

  • Pay attention to all appointments, time limits, and dates.

  • If you fail to take action or if you miss a deadline, you may lose your rights to workers’ compensation benefits.

  • Keep copies of all letters you send and receive.

  • Keep all medical appointments.

  • Contact your employer immediately when your doctor releases you for work.

FOR MORE INFORMATION

Please visit the State of Oregon: Workers’ Compensation Division website

Premier Care Chiropractic

524 SE 14th Avenue Portland, OR 97214 (971) 544-7058

OFFICE HOURS

Mon – Fri:
9:30am – 7:30pm

Saturday:
By appointment only