ORS 656.262: Claim Deadlines, Acceptance, Denial, and Penalties

Oregon Revised Statute 656.262 is the rulebook for how a workers’ compensation claim moves through the system once an employer learns about an injury. It gives the insurer or self-insured employer 60 calendar days to issue a written acceptance or denial, requires temporary disability payments to begin within 14 days when a physician authorizes them, dictates what acceptance and denial notices must contain, and allows penalties of up to 25% of benefits owed when an insurer unreasonably delays or refuses to pay.¹ The statute also places an affirmative duty on you to cooperate with the insurer’s investigation, and the consequences for failing to do so are severe.

The 60-Day Deadline to Accept or Deny

The insurer or self-insured employer has 60 calendar days after gaining notice or knowledge of a claim to issue a written acceptance or denial. The clock starts when a supervisor or manager learns enough to reasonably conclude a work-related injury may have occurred, not when a formal claim form is signed.¹ Those 60 days run on calendar days with no pause for routine administrative delays.

One exception matters. If you fail to cooperate with the insurer’s investigation, the 60-day clock stops running until you resume cooperation. The insurer cannot be penalized for delay that you caused, and the investigation period can stretch well beyond 60 days if cooperation breaks down.²

Once a claim is accepted, the insurer generally cannot revoke it. There are two exceptions. If the acceptance was obtained through your fraud or misrepresentation, the insurer can revoke at any time. If the insurer accepted in good faith but later discovers evidence that the claim isn’t compensable, it can revoke acceptance and issue a denial within two years of the original acceptance date. In either case, if you challenge the revocation at a hearing, the insurer carries the burden of proving its grounds.¹

When Temporary Disability Payments Must Start

You don’t have to wait for the full 60-day decision to start receiving income replacement. If your attending physician authorizes temporary disability, the insurer must issue the first payment within 14 days after the employer has notice of both the claim and your disability.¹ The physician authorization is the piece most people miss. The 14-day clock doesn’t start just because you reported the injury. Your doctor has to confirm you cannot work.

These payments equal 66⅔% of your pre-injury wages, subject to a cap of 133% of the statewide average weekly wage. The floor is 90% of your actual wages or $50 per week, whichever is less. For injuries occurring through June 30, 2026, the maximum weekly benefit is $1,884.69.³⁴ Temporary disability stops when your physician no longer authorizes it or when your claim is closed.

Making these interim payments does not count as the insurer admitting liability. The insurer can still deny the claim after investigation without the payments being treated as evidence of acceptance. If the claim is ultimately denied, the payments stop going forward.

What an Acceptance Notice Must Include

An acceptance notice is not a stamp of approval. It must specify the exact medical conditions the insurer is covering, tell you whether the claim is classified as disabling or nondisabling, and inform you of your reinstatement rights under Oregon employment law. It must also describe the Expedited Claim Service, explain your hearing and aggravation rights for nondisabling injuries, and let you know about the Reemployment Assistance Program.²

The requirement to list specific conditions matters. A notice that says “back injury” without naming the actual diagnosis may not adequately define the scope of coverage, which can cause trouble later when you seek treatment for related conditions. The insurer can update the acceptance over time: if your treating physician identifies an additional compensable condition after the initial acceptance, the insurer should modify the notice to reflect it.²

What a Denial Notice Must Include, and the Hearing Clock

A denial notice must state the reason for the denial, inform you about the Expedited Claim Service, and explain your hearing rights.² A copy goes to the employer, and the insurer must also notify the Director of the Department of Consumer and Business Services. If any required element is missing, the notice may be legally defective, which can affect the timeline for challenging it.

If your claim is denied, you have 60 days from the date the denial is mailed to request a hearing before the Workers’ Compensation Board. Miss that deadline and your claim is generally unenforceable, with one safety valve: you can file up to 180 days after mailing if you demonstrate good cause for not meeting the 60-day window.⁵ The clock starts when the denial is mailed, not when you receive it, so check your mail regularly if a decision is pending.

Hearing requests can be filed by mail, email, fax, hand delivery to any permanently staffed Workers’ Compensation Board office, or through the WCB’s online portal. The request must be in writing, signed by you or someone acting on your behalf, and include your address.⁶ When a denial of a previously accepted claim is overturned, temporary total disability benefits are owed retroactively from the date those benefits were cut off.

Your Duty to Cooperate With the Investigation

ORS 656.262 places an affirmative duty on you to cooperate with the insurer’s investigation. That means submitting to in-person and phone interviews, providing requested information, and generally assisting with the process. If you have an attorney, you’re entitled to have them present during any interview or deposition, and the insurer pays the attorney a reasonable hourly fee for that time.²

The consequences of refusing to cooperate are heavy. The Director of the Department of Consumer and Business Services can suspend all or part of your benefits after sending you a notice. If you still don’t cooperate within 30 days of that notice, the insurer can deny the claim outright based on your failure to cooperate. To get back into the system after such a denial, you’d need to request an expedited hearing and prove either that you did fully cooperate, that you had reasons beyond your control for not cooperating, or that the investigative demands were unreasonable.² If the judge finds you didn’t cooperate, the denial stands and you lose your right to a hearing on the merits.

Medical Bills While the Claim Is Pending

A common misconception is that all medical bills are covered while a claim is pending. They are not. Under ORS 656.262(6)(a), compensation during the pending period does not include the cost of medical benefits, except as provided under ORS 656.247, which addresses limited medical payments before a claim decision.¹ Employers may also choose to pay for medical services on nondisabling claims up to a maximum amount set annually by the Director, currently based on an adjusted base of $1,500.²

Once a claim is accepted, the insurer must provide all medical services for conditions caused in material part by the injury, for as long as the nature of the injury or the recovery process requires.⁷

Penalties for Unreasonable Delay

When an insurer unreasonably delays or refuses to pay compensation, attorney fees, or costs, or drags out an acceptance or denial past the 60-day window without justification, it faces a penalty of up to 25% of the benefits then due. The statute also allows the worker to recover reasonable attorney fees on top of the penalty. Those fees are capped at $4,000 absent extraordinary circumstances, and the cap adjusts annually based on changes to Oregon’s average weekly wage.²

The key word is “unreasonable.” An insurer that is legitimately waiting on medical records or investigating conflicting evidence within the 60-day window is not behaving unreasonably. An insurer that has everything it needs and sits on the file past the deadline is. The Director of the Department of Consumer and Business Services has exclusive jurisdiction over penalty proceedings when the only issue is whether a penalty and attorney fees should be assessed.² Insurers also face civil penalties under ORS 656.745 and potential sanctions under ORS 656.447 for failing to process claims in accordance with the administrative rules.⁸

Occupational Diseases Follow a Different Filing Clock

ORS 656.262 governs how claims are processed once filed, but injuries that develop gradually have their own filing deadline worth flagging. For occupational diseases, you must file a claim within one year of whichever date comes later: the date you first discovered (or should have discovered) the disease, or the date you became disabled or were informed by a physician that you have an occupational disease.⁹ If the disease causes death, the worker’s beneficiary gets one year from discovering the cause of death was occupational. The “should have discovered” standard can start the clock before you actually make the connection, so acting quickly on any suspicion that a chronic condition is work-related protects your rights.

1
Oregon State Legislature. Oregon Code 656.262 – Processing of Claims and Payment of Compensation
2
Oregon Public Law. Oregon Code ORS 656.262 – Processing of Claims and Payment of Compensation
3
Oregon Public Law. Oregon Code ORS 656.210 – Temporary Total Disability
4
Oregon Department of Consumer and Business Services. Bulletin 111 – Benefit Amounts and Calculations
5
Oregon State Legislature. Oregon Code 656.319 – Time Within Which Hearing Must Be Requested
6
Workers’ Compensation Board. Instructions for Filing a Hearing Request
7
Oregon Public Law. Oregon Code ORS 656.245 – Medical Services to Be Provided
8
Oregon Department of Consumer and Business Services. Oregon Administrative Rules Chapter 436 Division 060 – Claims Administration
9
Oregon State Legislature. Oregon Revised Statutes Chapter 656 – Workers Compensation