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Request for Release of Medical Records for Oregon Workers' Compensation Claim

State:
Oregon
Control #:
OR-SKU-1768
Format:
Word
Instant download
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Description

Request for Release of Medical Records for Oregon Workers' Compensation Claim

Request for Release of Medical Records for Oregon Workers' Compensation Claim is a form used in the state of Oregon when an injured worker requests that their medical records be forwarded to the Oregon Workers' Compensation Department. This request is necessary to facilitate a valid workers' compensation claim. The form includes the injured worker's personal information, physician's contact details, and a release of records to the Oregon Workers' Compensation Department. There are two types of Request for Release of Medical Records for Oregon Workers' Compensation Claim: Standard Request for Release of Medical Records Form and Employer's Request for Release of Medical Records Form. The Standard Request for Release of Medical Records Form is used when an injured worker is requesting medical records from their primary care provider. The Employer's Request for Release of Medical Records Form is used when an employer is requesting medical records from an injured worker's treating physician or other health care provider.

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FAQ

Oregon's State Workers' Compensation Benefits $100,000 per occurrence for bodily injury: This coverage is for any one employee. $100,000 per employee for bodily disease: This coverage is for any one employee.

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.

Oregon law protects employees who are injured on the job. Workers cannot be discriminated against because of workplace injury or illness. That means your job should be protected if you are injured on the job. Most Oregon employers are prohibited from discriminating against employees because of workplace injuries.

In 2023, this assessment is 2.2 cents per hour worked. Employers and employees split the cost. Employers report and pay the WBF assessment directly to the state with other state payroll taxes.

This bulletin provides updated benefit rates based on the Oregon state average weekly wage. This bulletin replaces Bulletin No. 111 dated . July 1, 2023, through June 30, 2024, the SAWW used to compute workers' compensation benefits is $1,295.86.

Oregon's Workers' Compensation Act is no different. If you suffer an industrial injury, statute provides that ?notice of an accident resulting in an injury or death shall be given immediately by the worker or beneficiary of the worker to the employer, but not later than 90 days after the accident.? ORS 656.265(1)(a).

?You have a right to choose your own medical provider. If your claim is enrolled in a managed care organization (MCO), you can still choose your own doctor within the MCO. Your employer and insurer cannot require you to seek care or direct your care to a specific provider.

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Request for Release of Medical Records for Oregon Workers' Compensation Claim