I often receive calls from an injured worker that go something like this:
"I received some paper work from the insurance company. They want me to sign this and send it back to them. It says I will get a check, and they told me that I will be covered for medical treatment for the rest of my life. What should I do?"
Like everything else, it is not that simple. If you boil it down, Oregon Workers' Compensation is a statute, and a set of rules. An injured worker's rights begin and end with those rules. One area the rules cover is settlement, and I want to give a brief summary of the kinds of settlements available in the Oregon Workers' Compensation system. The key here is to be careful.
The first type of settlement is a claims disposition agreement, also called a "CDA." This settlement applies to claims that are accepted. This means that the insurance company has taken responsibility for a certain medical condition, and is providing benefits for that specific medical problem from the on the job injury. If you agree to a CDA, you are selling all of your benefits, except for the medical services benefit. A lot of people think that the medical care is guaranteed, but it is not. Instead, you are keeping the right to make a claim for medical care, and the insurance company could decide to deny your request for medical care down the road, long after the case is settled. You can appeal any denial of medical care, but the point is that there are no guarantees.
What you are giving up by signing a CDA is all the other benefits. That includes time loss, permanent partial disability, and vocational benefits. So, if a few years after your settlement, you need a surgery, AND, the insurance company agrees to pay for it, you get the medical bills paid, but you are not paid for your time off work. CDAs may be a good option, but you have to consider your future, and the value of the benefits you are giving up.
The second settlement in Oregon Worker's Compensation is a disputed claims settlement, also called a "DCS." This is for claims that are denied. For example, you may file a claim for an on the job injury, and for a number of reasons, the insurance company may deny that claim. After you file your request for hearing, the injured worker and the insurance company may want to settle. With a DCS, the injured worker is agreeing to let the claim denial stand, but in exchange for payment of money. When I evaluate a settlement offer like this, I consider the value of the benefits you would enjoy if you won at the hearing, as well as your chances of prevailing at the hearing. Unlike the CDA, all you get in a DCS is payment of money. As far as medical expense, disability, and job training, you are on your own.
The one nice thing about these settlements is that Oregon Workers' Compensation law requires that the State of Oregon approve these settlements. That provides some safeguard for the injured worker. Also, if you have an attorney, the fee is regulated by statute as well. Still, you need to approach settling these cases with caution. Once you sign on the dotted line, that's it.