Oregon Workers' Compensation Information



Please Note: for Claims assistance or questions about coverage and exemptions You will need to call one of the numbers listed below.

Also be aware that the Workers' Compensation Assistance Offices in different states may go by different names such as "Industrial Accidents".
These are the only numbers that we are aware of and have available for Oregon Workers' Compensation.

Oregon Workers' Compensation Telephone Directory


Workers' Compensation Division: 503-947-7585

Workers' Compensation Division - Toll Free: 800-452-0288

Workers' Compensation Employer Compliance: 888-877-5670

Workers' Compensation Appellate Review: 503-947-7817

Re-Employment Assistance - Toll Free: 800-445-3948

Re-Employment Assistance : 503-947-7588

Vocational Assistance Disputes - Salem: 503-947-7812

Vocational Assistance Disputes - Medford: 541-776-6032

Ombudsman for Injured Workers Toll Free: 800-927-1271

Small Business Ombudsman: 503-378-4209

Managed Care Organizations - (MCO) - Workers Questions: 503-947-7840

Managed Care Organizations - (MCO) - Workers questions - Toll Fee & Email: 800-452-0288

Managed Care Organizations - MCO) - Providers Questions: 503-947-7606

Managed Care Organizations - (MCO) - Providers Questions - Toll Free & Email: 855-350-4636

Independent Medical Exam (IME) Questions: 503-947-7537

WC Division - Self-Insurance: 503-947-7815

WC Division - Self-Insurance - Toll Free & Email Address: 888-877-5670

Fraud - WC Performance Section: 503-947-7810

WC Division - Filing Claims: 503-947-7840

WC Division - Filing Claims - Toll Free: 800-452-0288

Appellate Review Unit: 503-947-7816

Appellate Review Unit - Toll Free: 800-452-0288

Workers' Benefit Fund - phone & Email Address: 503-378-2372

Re-Employment Assistance : 503-947-7588

Re-Employment Assistance - Toll Free: 800-445-3948

Vocational Assistance - Toll Free & Email Address: 800-452-0288

Preferred Worker Program (PWP) - Toll Free & Email Address: 800-452-0288

Employer at Injury Program (EAIP) - Toll Free & Email Address: 800-452-0288

Employer Compliance : 888-877-5670

Employer Coverage Search: 503-947-7814

Employer Compliance (Subjectivity, extraterritorial reciprocity): 503-947-7815

Electronic Data Interchange (EDI): 503-947-7742

Ombudsman for Injured Workers: 503-378-3351

Ombudsman Small Business: 503-378-4209

Medical Resolution: 503-947-7606

Insurer/Self Insured Reimbursement Programs: 503-947-7189

Self-Insured Employer Certification: 503-947-7057

Judicial Assistant to Administrative Law Judge Bruce Smith (Medford): 541-776-6217

Judicial Assistant to Administrative Law Judge Aliza Bethlamy (Portland): 971-673-0944

Judicial Assistant to Administrative Law Judge Elizabeth Fulsher (Portland): 971-673-0936

Judicial Assistant to Administrative Law Judge Jacqueline Jacobson (Portland): 971-673-0924

Judicial Assistant to Administrative Law Judge Mark Mills (Portland): 971-673-0941

Judicial Assistant to Administrative Law Judge Jenny Ogawa (Portland): 971-673-0941

Judicial Assistant to Administrative Law Judge Darren Otto (Portland): 971-673-0932

Judicial Assistant to Administrative Law Judge Jill Riechers (Portland): 971-673-0924

Judicial Assistant to Administrative Law Judge Nicholus Sencer (Portland): 971-673-0936

Judicial Assistant to Administrative Law Judge Holly Somers (Portland): 971-673-0944

Judicial Assistant to Administrative Law Judge Geoffrey Wren (Portland): 971-673-0944

Judicial Assistant to Administrative Law Judge Martha Brown (Salem): 503-934-0098

Judicial Assistant to Administrative Law Judge Joy Dougherty (Salem): 503-934-0104

Judicial Assistant to Administrative Law Judge Trish Fleischman (Salem): 503-934-0101

Judicial Assistant to Administrative Law Judge Halah Ilias - Salem: 503-934-0099

Judicial Assistant to Administrative Law Judge Monte Marshall: 503-934-0098

Judicial Assistant to Administrative Law Judge Greg Naugle (Salem): 503-934-0101

Judicial Assistant to Administrative Law Judge Kirk Spangler (Salem): 503-934-0099

Administrative Law Judge Office - Salem - Toll Free: 877-311-8061

Administrative Law Judge Office - Portland - Toll Free: 866-880-2078

Administrative Law Judge Office - Eugene: 541-686-7989

Administrative Law Judge Office Assistant - Eugene: 541-686-7841

Administrative Law Judge Office - Medford: 541-776-6217

Administrative Law Judge Office - Portland: 971-673-0900

Administrative Law Judge Office - Salem: 503-378-3308

Board Review (Salem): 503-373-1684

Filing New Req. - Salem: 503-373-1600

Board Review Line: 503-934-0103

Request for Hearing - Salem: 503-373-1600

Mediation Program Coordinator: 503-934-0104

OSHA - Toll Free Inside Oregon Only: 800-922-2689

Bulletins, Forms: 503-947-7623

Managed Care Organizations (MCO): 503-947-7650

Dept. Consumer Business Svcs. Director & Insurance Commissioner Andrew Stolfi: 503-378-4140

Insurance (State) Commissioner - Toll Free & Mailing Address: 888-877-4894

OSHA - Oregon State Plan applies to Public & Private Employees - Salem Office: 503-378-3272

Judicial Assistant to Administrative Law Judge Ian Brown (Portland): 971-673-0932

Public Records Request: 503-378-4100

Small Business Ombudsman for WC: 971-673-2895

Forms & Publications


Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,600 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

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Some "Revision Dates" may be displayed as part of the Description.

NOTICE

Starting Aug. 1, 2017, all insurer-prepared Forms 801 and 1502 received will be reviewed for required information. Any insurer-prepared Form 801 or 1502 that is missing required information or is illegible, will be rejected by the division and returned to the claim processor by mail within 24 hours.

Rejected forms are considered not filed. The division will attach a checklist to each returned form stating the reason for rejection.

Rejected forms will be mailed to the same address that is used for Insurer Delinquency Reports. The division expects claim processors to review these rejected forms in a timely manner, make corrections, and resubmit complete documents as soon as possible to comply with OAR 436-060-0011.

Delay in correcting and resubmitting rejected documents could impact the insurer's performance at audit and may result in civil penalties under OAR 436-060-0200(3) and (8).

(801) Report of Injury or Illness 1/21
(801s) Report of Injury or Illness (Spanish) 1/21
(158) Corrections and Changes Notification 12/13
(824) Surety Bond 1/17
(827) Worker's and Health Care Provider's Report for Workers' Compensation Claims 1/21
(827s) Worker's and Health Care Provider's Report for Workers' Compensation Claims (Spanish) 1/21
(900.21.xls) Workers' Compensation Payroll and Assessment Quarterly Report Retrospective Rating Plan (Effective 7/1/21- 6/30/22) 5/21
(900.22.xlxs) Workers' Compensation Payroll And Assessment Quarterly Report Retrospective Rating Plan (Effective 7/1/22 - 6/30/23) 5/22
(910.xls) Premium Assessment Report 3/22
(937.21.xls) Workers' Compensation Payroll and Assessment Quarterly Report Normal Plan(Effective 7/1/21 - 6/30/22) 5/21
(937.22.xlxs) Workers Compensation Payroll and Assessment Quarterly Report Normal Plan (Effective 7/1/22 - 6/30/23) 5/22
(1081) Return To Work Plan - Training 5/22
(1083) Return To Work Plan - Direct Employment 5/22
(1174) Application for Approval of Lump-sum Payment of Award 1/08
(1352) Insurer's Notification of Business in Oregon 2/18
(1502) Insurer's Report 4/20
(1503) Insurer Notice of Closure Summary 1/10
(1614) Report of Gross Annual Income 1/08
(1644) Notice of Closure 5/15
(1644s) Notice of Closure (Spanish) 5/15
(1644c) Correcting Notice of Closure 5/15
(1644p) Notice of Closure, Permanent Total Disability Reduction 1/10
(1644r) Rescinding Notice of Closure 5/15
(1810) Surety Rider 1/17
(1865) Endorsement to Include Legal Entity in Self-Insured Certification 2/18
(1866) Group Self-Insured Indemnity Agreement 11/12
(1867) Application to Become a Self-Insured Employer Group: Private Employers 3/17
(1868) Application for Self Insurance 3/17
(1869) Endorsement to Self-Insured Group Application 3/17
(1880) Vocational Assistance Certification Program Individual Certification under OAR 436-120 2/18
(1966) Reopened Claims Reserve Reimbursement Request 2/16
(2066) Notice of Closure: Own Motion Claim 2/16
(2190) Preferred Worker Wage Subsidy Agreement 1/17
(2190s) Preferred Worker Wage Subsidy Agreement (Spanish) 1/17
(2223a) Worker Request for Reconsideration 11/15
(2223a-s) Worker Request for Reconsideration (Spanish) 11/15
(2223b) Insurer Request for Reconsideration 11/15
(2234) Oregon Defense Legal Costs Survey- Complete & File Online N/D
(2235) Workers' Compensation Flowchart 5/11
(2278C) Spinal (Cervical) Range of Motion 2/20
(2278L) Spinal (Lumbar) Range of Motion 2/20
(2278T) Spinal (Thoracic) Range of Motion 2/20
(2279) Range of Motion and Deformity/Deviation; Amputation and Sensation of the Upper Extremity 2/20
(2312) Visual Impairment 2/20
(2332) Request to Change Attending Physician or Authorized Nurse Practitioner 1/18
(2333) Insurer's Request for Director Approval of an Insurer Medical Examination 3/15
(2350) Preferred Worker Obtained Employment Purchase Agreement 1/17
(2350s) Preferred Worker Obtained Employment Purchase Agreement (Spanish) 1/17
(2360) Employer-at-Injury Program (EAIP) Reimbursement Request Form 1/22
(2465) Worker Leasing Notice to the Department of Consumer & Business Services 8/18
(2466) Application for Worker Leasing Company License 7/18
(2466a) Attachment A to Application for Worker Leasing Company License 6/16
(2466b) Attachment B to Application for Worker Leasing Company License 5/04
(2466c) Attachment C to Application for Worker Leasing Company License, Tax Information Authorization 1/18
(2476) Request for Release of Medical Records for Oregon Workers' Compensation Claim 3/12
(2476s) Request for Release of Medical Records for Oregon Workers' Compensation Claim (Spanish) 3/12
(2737) Notice of Intent to Form a Managed Care Organization 6/15
(2800) Vocational Closure Report 5/22
(2807) Insurer Notice of Closure Worksheet 1/10
(2807a) Insurer Notice of Closure Worksheet 1/10
(2808) Claim Reserve Worksheet 1/22
(2809.xls) Self-Insurer Report of Losses Experience Rating Period 1/22
(2810.xls) Self-insurer Report of Losses Non-Experience Rating Period 1/22
(2814) Authorization of Vocational Assistance Provider 3/13
(2839) Request for Hearing - Workers' Compensation Division 4/18
(2842) Request for Dispute Resolution Medical Issues and Medical Fees 12/15
(2842a) Medical Fee Dispute Resolution Request and Worksheet 12/15
(2882) Nurse Practitioner Statement 3/18
(2937.xls) Claims Reserved in Excess of Self-Insured Retention 1/22
(2943) Worker Request for Claim Classification Review 4/20
(2943s) Worker Request for Claim Classification Review (Spanish) 4/20
(2968) Preferred Worker Program Wage Subsidy Reimbursement Request 2/12
(3014) Preferred Worker Program Quarterly Claim Cost Reimbursement Request 1/17
(3014x) Preferred Worker Program Quarterly Claim Cost Reimbursement Request(Extra Page) 5/15
(3058) Notice to Worker 5/22
(3058s) Notice to Worker (Spanish) 5/22
(3088) Request for WCD claim file information 4/20
(3210) Workers" Compensation Medical Forms Order Form 3/12
(3227) Invasive Medical Procedure Authorization (English and Spanish) 10/15
(3228) Elective Surgery Notification 4/19
(3245) Return-to-Work Status 2/16
(3270) Endorsement to Worker Leasing Notice 8/18
(3271) Termination of Workers' Compensation Coverage to Client of Worker Leasing Company 8/18
(3285.xls) Request For Reimbursement from the Retroactive Program 9/17
(3293) Preferred Worker Program Obtained Employment Purchase Agreement Moving Assistance 1/17
(3501) Notice of Voluntary Reopening Own Motion Claim 2/16
(3504) Supplemental Disability Benefits Quarterly Reimbursement Request 11/09
(3529) Memorandum of Understanding 7/03
(3530) Supplemental Disability Election Notification 11/09
(3531) Physician Authorization Supplemental Disability 9/03
(3640a) Irrevocable Standby Letter of Credit 8/06
(3648) Chiropractor's Statement of Certification 3/18
(3650) Physician Assistant's Statement of Certification 3/18
(3651) Naturopath's Statement of Certification 3/18
(3659) Fee Discount Agreement 12/08
(3921) Request for Reimbursement of Expenses 7/22
(3921s) Request for Reimbursement of Expenses (Spanish) 7/22
(3923) Important information about Independent Medical Exams-Includes Form 3923a,-IME Observer Form 11/17
(3923a) IME Observer Form 2/17
(4015) Medical Billing Data EDI Trading Partner Profile 10/13
(4025) Worker Requested Medical Exam Guide 3/17
(4023) Security Agreement and Notice to Intermediary 10/03
(4122) Preferred Worker Worksite Creation Agreement 1/17
(4619) Request for Approval of Training Program 11/16
(4821) Oregon Proof of Coverage EDI Insurer Profile 8/08
(4841) Lower Extremity Range of Motion 2/20
(4842) Shoulder Range of Motion 2/20
(4875) Preferred Worker Placement Assistance Agreement 2/17
(4903) Preferred Worker Job Offer Letter 1/17
(4909) Pharmaceutical Clinical Justifications for Workers' Compensation 4/14
(4929) Service Company's Notification of Business in Oregon 2/18
(4965) Exemption Provision Waiver 2/21
(4966) Indemnity Agreement by the Parent Corporation for Wholly Owned or Majority Owned Subsidiary 9/17
(4979) Proof of Coverage EDI Transmission Profile 4/15
(differed) Injured Worker/RepresentativeResponsible to Assist in Investigation; Suspension of Compensation and Notice to Worker 4/20
(5135) Preferred Worker Program Placement Payment Request 1/17
(5188) Insurer Contact Update 2/17
(injprac) Insanitary or Injurious Practices, Refusal of Treatment or Failure to Participate in Rehabilitation 4/20
(missime) Failure to Attend or to Cooperate with an IME 4/20
(cdaformat2) Claim Disposition Agreement 2020
(omrecommedation2006b) Carrier's Own Motion Recommendation 1/06
(postcardpac2) Claims Disposition Agreement (CDA) Postcard 1/08
(reqbdreview) Request for Board Review 4/06
(response) Response to Issues 5/16
(rights) Notice of Rights and Procedures in Contested Workers' Compensation Cases N/D
(rights-sp) Notice of Rights and Procedures in Contested Workers' Compensation Cases (Spanish) N/D
(costform) Cost Bill Form 1/08
(subpoena1) Subpoena to Compel Attendance and Testimony at Hearing 12/05
(subpoena2) Subpoena to Compel the Production of Documents or Objects other than Individually Identifiable Health Information 12/05
(subpoena3) Subpoena to Compel the Production ofIndividually Identifiable Health Information 12/05
(worseningscenarios) Worsened Condition Claims / Claim Processing Scenarios N/D
(5042) Claim Move Notice: Changing locations of processing or storing of claims 2/17
(2876) Understanding Claim Closure and Your Rights 1/18
(2876s) Understanding Claim Closure and Your Rights-Spanish Version 1/18
(5215) Service Company Contact Update 6/17
(5332) Notice to Beneficiary of Entitlement to Benefits 5/22
(5425) Elective Surgery Notification 4/19
(5377) Workers Compensation Multilingual Help Page 4/19
(5507) Workers have a right to file for workers compensation for COVID-19 11/20
(5507sp) Workers have a right to file for workers compensation for COVID-19-Spanish 11/20
(5512.xls) COVID-19 Claim Reporting for Experience Rating Exclusion 1/22
(5626.xlxs) Denied Claim Reporting for Experience Rating Exclusion 1/22

OAR Chapter 436 Workers' Compensation Division (436-001-0003 through 436-170-0300)

OAR Chapter 438 Workers' Compensation Board (438-005-0005 through 438-085-0870)

Chapter 656 Workers' Compensation (656.001 - 656.990)

Chapter 654 Occupational Safety and Health (654.001 - 654.991)

Misc. Related Statutes