Oregon Required Postings and Forms
The adjusting of the claims in this state are handled by Broadspire. Once a claim is reported to EMPLOYERS, the report will be sent to Broadspire for assignment. The contact information for Broadspire is:
Please post the following notices, both in English and Spanish, in a conspicuous location frequented by employees such as the break room, lunch room or time clock. If you have multiple office locations be sure to post the notices at each location.
- Workers' Compensation Notice of Compliance Poster - The Oregon Workers' Compensation Division will send this poster to you by mail after they receive your proof of compensation coverage from EMPLOYERS.
The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:
- Form 440-801 Report of Job Injury or Illness (English and Spanish). Your employee must complete the top portion of this form and you must complete the bottom half of the form. You need to provide a copy of this form to your injured employee, and you should keep a copy for your records. You need to notify EMPLOYERS within five days of knowledge of the claim. You need to use this form to notify EMPLOYERS of every work-related injury or illness suffered by an employee, regardless of severity. Work-related fatalities and catastrophes must be reported to Oregon OSHA within eight hours and any accident that results in overnight hospitalization must be reported to Oregon OSHA within 24 hours.
- Wage Statement. This form enables us to calculate the correct compensation that may be owed to your injured employee. Please complete the form and submit it to EMPLOYERS within 14 days after your knowledge of any accident that has caused your employee to be disabled for more than seven calendar days.
- Accident Investigation Report. This basic accident form should be completed by the employee’s supervisor/manager as soon after the accident as possible. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should keep a copy on file for your records.
The following document needs to be provided to your employee when he/she sustains a work-related injury:
- Form 440-3283 A Guide for Workers Recently Hurt on the Job (English and Spanish). You are required to provide this guide to all employees injured on the job. This guide provides the injured employee with the following types of information: how to file a claim, how to get medical treatment, limitations on medical treatment, workers’ compensation benefits in general, and where to go to get information about their claim.
- Off-Site Transitional Duty Program - Helping Your Injured Employees Get Back to Work
A successful transition back to work relies on the collaborative efforts of the manager/supervisor, the injured employee and their adjuster. As a manager/supervisor, learn what you can do to help facilitate a successful return to work.