A guide for workers recently hurt on the job
The following information is provided by SAIF at the request of the
Workers’ Compensation Division
400 HIGH ST. SE, SALEM, OR 97312
Form 3283* | SAIF 12.20 (440-3283, 01/21/DCBS/WCD/WEB) for distribution with Form 801.
*This form was modied by SAIF Corporation, and has been approved for use by the Oregon Workers’ Compensation Division.
Do I have to provide my Social Security number on Forms 801 and 827? What will it be used for?
You do not need to have an SSN to get workers’ compensation benets. If you have an SSN, the Workers’ Compensation Division
(WCD) of the Department of Consumer and Business Services will get it from your employer, the workers’ compensation insurer,
or other sources. WCD may use your SSN for the following: quality assessment, correct identication and processing of claims,
compliance, research, injured worker program administration, matching data with other state agencies to measure WCD program
eectiveness, injury prevention activities, and to provide to federal agencies in the Medicare program for their use as required by federal
law. The following laws authorize WCD to get your SSN: the Privacy Act of 1974, 5 USC § 552a, Section (7)(a)(2)(B); Oregon Revised
Statutes chapter 656; and Oregon Administrative Rules chapter 436 (Workers’ Compensation Board Administrative Order No. 4-1967).
How do I le a claim?
• Notify your employer and a health care provider of your
choice about your job-related injury or illness as soon as
possible. Your employer cannot choose your health care
provider for you
• Ask your employer the name of its workers’ compensation
• Complete Form 801, “Report of Job Injury or Illness,”
available from your employer and Form 827, “Workers’
and Health Care Provider’s Report for Workers’
Compensation Claim,” available from your health care
How do I get medical treatment?
• You may receive medical treatment from the health care
provider of your choice, including:
– Authorized nurse practitioners
– Chiropractic physicians
– Medical doctors
– Naturopathic physicians
– Oral surgeons
– Osteopathic physicians
– Physician assistants
– Podiatric physicians
– Other health care providers
• The insurance company may enroll you in a managed care
organization at any time. If it does, you will receive more
information about your medical treatment options.
Are there limitations to my medical treatment?
• Health care providers may be limited in how long they
may treat you and whether they may authorize payments
for time o work. Check with your health care provider
about any limitations that may apply.
• If your claim is denied, you may have to pay for your
If I can’t work, will I receive payments for
• You may be unable to work due to your job-related
injury or illness. In order for you to receive payments
for time o work, your health care provider must send
written authorization to the insurer.
• Generally, you will not be paid for the rst three calendar
days for time o work.
• You may be paid for lost wages for the rst three
calendar days if you are o work for 14 consecutive days
or hospitalized overnight.
• If your claim is denied within the rst 14 days, you will
not be paid for any lost wages.
• Keep your employer informed about what is going on
and cooperate with eorts to return you to a modied-
or light-duty job.
What if I have questions about my claim?
• SAIF or your employer should be able to answer
your questions. Call SAIF at 800.285.8525.
• If you have questions, concerns, or complaints,
you may also call any of the numbers below:
Ombudsman for Injured Workers:
(an advocate for injured workers)
Workers’ Compensation Resolution Section