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  • Dcbs Oregon Surcharge Report Form

Get Dcbs Oregon Surcharge Report Form

Oregon.gov Mail report with payment to DCBS Fiscal Services P. O. Box 14610 Salem OR 97309-0445 SURCHARGE INFORMATION See reverse side for instructions.

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As of Jan. 1, 2022, Oregon has the 10th lowest average workers' compensation rates. Oregon's average rates are 73 percent of the national median rate.

However, the general rule provides that the insurance company obtains your wage records for the 52 weeks prior to the date you were injured. The insurance company then calculates the total wages earned, and divides that amount by the number of weeks (52).

Form DWC-7 is a notice to provide injured workers with rights, benefits and contact information.

​Tell your employer about your work-related injury or illness right away. Fill out Form 801 “Report of Job Injury or Illness” and turn it in to your employer. Your employer should send it to its workers' compensation insurance carrier within five days of your notice.

In 2017, the Oregon Legislature enacted HB 2391, which established a 1.5 percent assessment on the gross amount of premiums derived from health benefit plans delivered or issued for delivery in Oregon.

In 2024, the WBF assessment is 2.0 cents per hour worked Employers report and pay the WBF assessment directly to the state with other state payroll taxes on Form OQ (Oregon Quarterly) on Frances Online.

Authorization to release medical records By signing this form, you authorize health care providers and other custodians of claim records to release relevant records to the workers' compensation insurer, self-insured employer, claim administrator, and the Oregon Department of Consumer and Business Services.

The 2022 Workers Benefit Fund (WBF) assessment rate is 2.2 cents per hour. Go online at https://. oregon.gov/dcbs/cost/Pages/index.aspx for current rate notice.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232