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Notice of Closure Worksheet - Injury On or After January 1, 2005 - Oregon

Notice of Closure Worksheet - Injury On or After January 1, 2005 - Oregon-2025

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The document is a Notice of Closure Worksheet used for calculating benefits related to workers' compensation claims, specifically for injuries occurring on or after January 1, 2005. It includes sections for personal information, details about the insurer, types of notices, prior awards of permanent partial disability (PPD), and various calculations related to impairment and work disability benefits. The worksheet serves as a tool for insurers to determine the financial compensation owed to injured workers but is not a legal order and cannot be appealed.

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Click ‘Get Form’ to open the Notice of Closure Worksheet in the editor.
Begin by entering the insurer's name, address, and phone number at the top of the form. This information is crucial for communication regarding your claim.
In Section 1, fill in the worker’s legal name, date of birth, and WCD file number. Ensure accuracy as this data is essential for identification.
Proceed to Section 2 where you will indicate time loss details and prior awards of permanent partial disability (PPD). Be sure to check all applicable boxes.
In Section 4, document any impairment factors relevant to your case. Include body part codes and computations as necessary.
Complete Sections 5 through 9 by following the instructions provided for each section. Pay attention to calculations for benefits based on your specific circumstances.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a notice of tort in Oregon?

Oregon tort claims are notices basically the official notice for a public body (usually the state of Oregon) that someone believes they have grounds for a lawsuit. This is not the lawsuit itself, which will later need to be proved, but just the first step in the process.

What is the statute for tort claim notice in Oregon?

A notice of claim must be filed within very specific time limits: A notice of claim for personal injury and property damage must be filed within 180 days of the incident giving rise to the claim. A notice of claim involving a wrongful death must be filed within one year.

What is necessary to prove a tort claim?

In order to state a valid claim, the claimant must demonstrate that (1) he was injured or his property was damaged by a federal government employee; (2) the employee was acting within the scope of his official duties; (3) the employee was acting negligently or wrongfully; and (4) the negligent or wrongful act

How long do you have to report a work injury in Oregon?

Oregon law allows a worker 90 days to file a claim for any injury they have sustained on the job. You file a claim by completing an 801-claim form. The responsibility is on the worker, not the employer, to file a claim.

What is section 30.275 of the Oregon Revised Statutes?

Section 30.275 - Notice of claim; time of notice; time of action (1) No action arising from any act or omission of a public body or an officer, employee or agent of a public body within the scope of ORS 30.260 to 30.300 shall be maintained unless notice of claim is given as required by this section.

How long do you have to file a tort claim in Oregon?

In Oregon, the time limit for submitting a notice of tort claim is 180 days from the date of your injury for injury claims. In a wrongful death claim, the time limit is one year from the date of wrongful death.

Notice of Closure Worksheet - Injury On or After January 1, 2005 - Oregon-2025

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