Get the inside scoop from workers’ compensation lawyers
Washington is one of only four states in the country to administer its own workers’ compensation system. Although it does have its drawbacks, every employer in the state must carry insurance to cover their employees and (at least in theory) is in charge of overseeing and enforcing that requirement.
If you’ve read many of my posts, you know I have been critical of the Department of Labor & Industries (L&I); this system is in dire need of overhaul and has been for some time. That said, Washington has a workers’ compensation system, which 90% of workers in this country simply can’t say about their state. So we’re already one step ahead.
What is workers’ compensation?
The workers’ compensation system in Washington State is an insurance program designed to provide financial protection and support to employees who suffer work-related injuries or illnesses. This system was created under the Washington State Industrial Insurance Act to ensure that workers are entitled to medical treatment, wage replacement, and vocational rehabilitation in the event of a workplace accident. The Washington State Department of L&I oversees it all.
Notably, Washington’s workers’ compensation program is “no-fault.” Employees are generally eligible for benefits regardless of whether unsafe practices, faulty equipment, or even negligence caused the injury.
Filing a workers’ compensation claim
Generally, your doctor will help you file your claim. They will submit the required medical documentation to show that you suffered an on-the-job injury and are seeking coverage. Your claim will be assigned to a claim manager at the Department of L&I or through a self-insured employer [SIE] third-party administrator like Sedgwick, Helmsman, Penser, etc.
The L&I or SIE will (should) assess your claim to determine what treatment your doctor recommends, whether that treatment is related to your industrial injury or occupational disease, and whether you are entitled to wage replacement benefits (aka time loss payments). If your claim is allowed, you may be entitled to several benefits depending on the nature of your claim, your doctor’s treatment plans, and, ultimately, your ability (or lack thereof) to return to work.
Five workers’ compensation benefits you should know
Benefit 1: Medical expenses coverage
To be covered by L&I, your doctor’s treatment plan must meet certain criteria. Initially, the doctor requesting the treatment must be part of the L&I Medical Provider Network. This doesn’t mean they work for L&I; it just means that they are a provider who accepts L&I insurance and has agreed to conform to medical treatment guidelines produced by the Department of L&I.
A doctor does not need to be a part of the network to help you file your claim, so you can see your family doctor or any other provider after your injury to get the process started. If they are not a network member, you must select a new provider within the network to become the “attending physician” on your claim.
If the treatment your doctor requests is considered “proper and necessary” for your condition, it should be covered.
Benefit 2: Wage replacement
You may be entitled to time loss payments if your doctor determines you cannot work due to industrial injury or occupational disease. If so, the amount you receive will be calculated based on your income and family situation. In short, you will receive 60% of your income, plus an additional 5% if you are married, and 2% per dependent child living with you up to a maximum of five children.
This means, at most, you will receive only 75% of what you earned when you were injured. These payments should continue as long as your doctor certifies that you are unable to work due to your industrial injury.
If your doctor determines that you cannot return to your job of injury, you may be entitled to vocational rehabilitation.
Benefit 3: Vocational rehabilitation
Just because a vocational rehabilitation counselor or “VRC” has been assigned to your case does not mean you’re on your way to retraining benefits. In fact, VRCs will work with your employer and doctor to see if there is any way you can return to work with that employer as soon as possible. In theory, this is a good thing, and if the VRC and employer listen to you and your doctor, this can be a best-case scenario.
Unfortunately, these circumstances may not be possible from a medical standpoint, and your VRC will start looking at transferable skills. These skills you’ve previously acquired may enable you to return to work in a job you already have experience doing and fits within your medical restrictions.
I need to take a minute here to note that this process is fraught with the possibility of being forced back into a work situation through questionable use of the “light duty” job; see my blog about it here.
If your doctor and VRC determine that you cannot return to work with your employer of injury or via transferable skills, you may receive retraining benefits, including up to approximately $20,000 to use for tuition and related expenses, as well as time loss payments while you’re in retraining.
Benefit 4: Pension benefits
Your doctor may determine that you cannot return to the workforce at the same work pattern (full or part-time) you previously employed. If so, a pension may be granted. This benefit provides income equivalent to your time loss rate for the rest of your life.
Benefit 5: Survivor benefits
If a worker loses their life because of an industrial injury or occupational disease, survivor benefits should be granted to the spouse or child of the deceased worker. These benefits vary and depend on several factors and may include a one-time payment (equal to 100% of the average monthly wage in Washington State), monthly payments for survivors, and burial benefits.
Additionally, suppose an injured worker was previously awarded a pension and chose to reserve some of that award for their spouse or surviving children. In that case, the spouse and children may also receive survivor’s benefits even if the pensioned injured worker dies of unrelated causes.
Don’t leave money on the table
I have used the word should a lot in this article. I’ve mentioned benefits and coverage that should be afforded injured workers or their families after suffering injuries on the job. Unfortunately, what should happen and what actually happens are often not the same.
As I mentioned at the beginning, we have a system in Washington, and compared to other states, it’s a step forward. However, it is still an insurance system, which means “the other side” is always motivated to save money, which means avoiding paying out on your claim.