Notice Of Closure Worksheet {2807}

2807 - NOTICE OF CLOSURE WORKSHEET (Dates of injury prior to Jan. 1, 2005). This is a detailed, internal worksheet used by workers’ compensation insurers in Oregon to calculate and document the benefits awarded to an injured worker at the time a claim is being closed. It is not a legal order and cannot be appealed, but it provides the technical basis for the official Notice of Closure. The worksheet records a range of information necessary to determine any entitlement to time-loss (temporary total or partial disability), permanent partial disability (PPD), and other benefits. It includes the worker’s identifying details, injury and claim dates, prior awards, authorized time-loss periods, and medical status updates. The insurer uses this form to assess medical findings—such as impairments due to range of motion loss, strength loss, chronic conditions, or surgical outcomes—and to apply standardized disability ratings to the affected body parts using Oregon Administrative Rules (OAR 436-035). If unscheduled PPD is involved, the form also calculates social-vocational factors like age, education, and adaptability, which affect the final disability value. Each part of the form helps the insurer convert percentage impairments into degrees of disability and ultimately into monetary values based on the date of injury and applicable rate schedules. Although this worksheet contains all the calculations and justification behind a closure decision, it serves solely as a reference and supplement to the official Notice of Closure, which the worker receives and may appeal. It ensures that insurers follow consistent and transparent processes under Oregon law when determining a worker's compensation benefits at claim closure. www.FormsWorkflow.com