What is the three-day waiting period?
Three consecutive CALENDAR DAYS with the first day being the day the worker LOSES TIME or WAGES from work as a result of the compensable injury
How are the three day waiting period determined?
- It begins with the first day the worker loses time or wages due to their injury
- three CONSECUTIVE CALENDAR days
When is the three-day waiting period payable?
The worker is:
-authorized and totally disabled for a period of 14 consecutive days
- admitted as an inpatient to a hospital within 14 days of the onset of total disability
- leaving during the first half of the shift and does not return, pay one-half of the initial workday lost.NO compensation is due if IW leaves during second half of the shift
When is the first time-loss payment due by SAIF’s best practice?
13 days
After the first time-loss payment is issued, how often is the time-loss benefit paid?
every 14 days
When are time-loss benefits NOT payable
- a person has withdrawn from the workforce.
- AP or ANP or type B provider, is UNABLE to verify the worker’s inability to work
- incarceration due to commission of a crime
These are are examples of situations when an adjuster may do the following action ____
- Type B provider time frames have expired
- the claim is denied.
- worker is released to regular work.
- Bona fide job offer is made for MOD work and worker refuses it
- The terminated worker process has been completed
- The claim is closed
stop paying time-loss benefits
For how many days or office visits can a TYPE B PROVIDER provide medical services
MEDICAL SERVICES: 60 days or 18 office visits from the date of the first visit on the initial claim.
For how many days or office visits can a TYPE B PROVIDER provide authorize time loss benefits?
TIME LOSS: 30 days from the date of the first office visit on the initial claim.
Can an emergency room physician authorize time loss benefits? if so, for how many days?
Yes, for up to 14 days from the emergency room visit
For how many days can an ANP provide medical services?
MEDICAL SERVICES: 180 days from the date of the first visit on the initial claim
For how many days can an ANP authorize time loss benefits?
Time loss: 180 days from the date of the first visit on the initial claim
How many attending physicians can a worker have during the life of a claim?
three total- the initial AP followed by two changes
OAR 436-010-0220 (2) and (3)
How many days do insurers have to pay medical bills in an ACCEPTED CLAIM?
45 days from the receipt of the bill
How many days do insurers have, to pay medical bills that were received PRIOR TO the claim decision once the claim has been accepted?
14 days from the claim of acceptance
How many days do insurers have, to pay worker reimbursements?
30 days from the receipt of the request for reimbursement
What types of things can a worker request reimbursement for?
- MEALS
- LODGING
- USE OF PUBLIC TRANSPORTATION
- PRESCRIPTIONS
- OTHER OUT OF POCKET, claims related expenses
What is the time frame for an injured worker to request reimbursement?
2 years from
- the date the cost incurred
- date the claim or medical cond. was DETERMINED COMPENSABLE
SAIF currently contracts which MCOs?
- CareMark Comp (CMC)
- Kaiser-on-the-job
- Majoris Health Systems
Who must approve the MCO and how are the MCO services certified?
DCBC approves MCO
Certified: by Geographical Areas (GSAs)
