Instructions on how to file a disability claim with Fire and Police Disability and Retirement.
Notify your supervisor of the injury or illness
- Notify your supervisor or bureau designee about your injury or illness as soon as possible.
- Complete an injury log (Police) or an injury report (Fire).
Complete the Disability In Line of Duty (DILD) form
Immediately, or within 30-days from your injury/illness, complete a Disability in the Line of Duty (DILD) form in its entirety, sign, and date the form.
Send copy to FPDR and original to your supervisor
Fax the DILD to FPDR at 503-823-5166 or email a legible photo of the signed DILD to FPDR at firstname.lastname@example.org.
If you send a DILD to FPDR via email, follow up with a phone call to 503-823-6823, to ensure that we have received a legible copy of the DILD.
Keep a copy for your records. Give the original form to your supervisor to route through proper Bureau channels
Seek medical attention immediately
Take the purple packet containing the Attending Physician's Report and Work Status Report to the doctor to complete and submit to FPDR. You may receive medical treatment from your primary care physician or a health care provider of your choice who is within your private health plan network.
- How to select medical care
- Important notification about medical treatment providers
- Attending Physician's Report
- Work Status Report
- If you need to go to an emergency room or urgent care facility, you may be treated by a Nurse Practitioner for non-life-threatening injuries. This is allowed for the initial visit. Follow up care should be provided by a MD, DO, DPM or Chiropractor.
FPDR and Moda Health have a Coordination of Benefits program for members who have personal health care benefits outside of the Kaiser Permanente system. FPDR will initiate access to the coordination of benefits program when available to reduce the time needed to obtain urgent diagnostics or other emergent care for work related injuries/illnesses.
The urgency of medical treatment is determined by the doctor or provider prescribing the care and is not directed by FPDR or its staff.
You may also fax the DILD form to us: