What is Workers Compensation?
If you suffer a work-related injury or illness that requires treatment, you are eligible to receive benefits from the state workers compensation program. Workers compensation laws provide money to pay for medical expenses and to replace lost income. You are not required to prove that the injuries were caused by negligence of the employer in order to recover under the workers compensation laws. The fact that you may have been negligent does not normally prevent you from receiving benefits. However, the benefits under these laws are limited.
What Injuries Are Not Covered?
In general, injuries resulting from employee intoxication or the use of illegal drugs are not covered by workers compensation. There are other situations in which workers compensation will not pay medical expenses or lost wages. They include self-inflicted injuries, injuries suffered while a worker was committing a serious crime, and injuries suffered while an employee was not on the job.
The workers compensation system pays replacement income and for medical expenses of employees who are injured or become ill as a result of their jobs. Benefits may also be paid to children of workers and to survivors of workers who are killed on the job. Workers compensation also protects employers from lawsuits for those injuries or deaths. Some employers are allowed to self-insure. This means the employer will be responsible for directly paying all benefits according to state law.
How Do I File A Workers Compensation Claim?
Filing a workers compensation claim is easy and it does not involve suing your employer. The physician who treated you must report the industrial injury to the Department of Labor and Industries which administers the workers compensation law. However, you should make certain a claim is filed. If your employer is self-insured, a special form is needed. Otherwise, the state form is filled out by you and the doctor. If accepted, the doctor’s fees and any disability payments are paid according to a fee schedule set by the state. If you are temporarily unable to work due to the injury, you will begin receiving checks to cover your wage loss. The payments typically begin within two weeks after your claim is approved.
Am I Receiving All Of My Benefits?
Washington workers compensation law provides for various benefits which fall into four main categories:
(1) replacement income benefits;
(2) medical care expenses;
(3) vocational rehabilitation costs, and
(4) payments for loss of bodily function
Within each category there are a number of benefits to which you may be entitled. Income benefits include time loss benefits, loss of earning power benefits and pension benefits.
Medical care expenses may include health care provider fees, emergency care, hospital fees, diagnostic or other testing, physical therapy and prescription medication. You can be eligible for medical expenses even if you do not receive income replacement benefits. Some injured workers may also be eligible for vocational rehabilitation benefits. Loss of function benefits are sometimes found when you have reached a fixed and stable medical condition and have returned to work. These are sums of money calculated by the percentage of function you have lost. The best way to determine if you are receiving all the appropriate benefits is to ask us to review your file (at no cost) and then schedule a conference with one of our attorneys.
Handling Your Own Case
If your workers compensation claim is denied or benefits are denied or not calculated correctly or denied, then you have the right to appeal or protest the decision. You are allowed to research and organize your documentation and you can present your own case. However, it would normally be in your best interest to hire a lawyer who specializes in workers compensation law, rather than trying to handle an appeal on your own. There are time limits and procedure requirements which must be dealt with. Formal Rules of Evidence apply. It is dangerous to do this without the help of an attorney.
Claim Filing Time Limits
You should get immediate medical care if your work-related injury or illness requires it. You should then file a claim. Washington has a statute of limitations on workers injury cases; one year from the date of injury. You must report your claim within the time limit or the claim will be lost forever. After your claim has been processed, all the medical care pertaining to your illness or injury will be paid for and there is almost no limitation on this coverage. If you are unable to work, you are entitled to disability payments to make up for lost wages. Time loss benefits start as soon as you have lost three consecutive days of work.
More Details About Payments
Your workers compensation benefits take several forms. Here are a few of the most common types of payments:
Costs of medical care will be paid and that includes the services of medical doctors, osteopaths, podiatrists, hospitals, nurses, physical therapists, dentists, chiropractors, and the use of prosthetic devices.
Temporary disability payments are a percentage of the amount you earned when injured. The benefits are tax-free and substitute for the income you would have earned had you not been injured. If your injury prevents you from returning to your job, you may be entitled to vocational rehabilitation.
If you have a permanent partial disability, you may receive a lump sum payment of workers compensation benefits. These payments will vary greatly with the nature and extent of your injury.
If you can no longer obtain and perform gainful employment in the competitive labor market you may be entitled to vocational rehabilitation or life-long pension benefits. Compensation benefits will be paid to the surviving spouse and /or dependents of workers who are killed in the course of employment or as the result of a work-related injury or occupational disease.
To be covered by workers compensation, a disability or disease need not be caused by a sudden accident such as a fall. Equally common are claims for conditions due to distinctive work conditions or exposure to unsanitary or poor working conditions. For example, if work exposure to chemicals on the job has aggravated an already existing condition or caused a new problem with your health you may be eligible for workers compensation benefits.
Re-Injury & Re-Opening Your Case
If you have already filed a workers compensation claim and it has been closed, you can apply to reopen your claim if your condition has become aggravated (“objectively worsened”.) This is your right for at least seven years from the first closure of the claim. However, in order to win this type of case, you will have to prove, through medical testimony, that objective worsening has occurred. On the other hand, if you re-injure the same area on the job, a new claim should be filed. Sometimes both an aggravation application and a new injury claim should be filed. This is often complex and you may want to hire a lawyer to advise and help you with a re-injury claim.
To be covered by workers compensation, an injury must be caused by a sudden accident. An occupational disease must be due to distinctive conditions of employment; for example, exposure to materials at work, repetitive actions, prolonged standing, etc. Dropping a crate on your foot is a sudden accident, and lifting fifty pound boxes all day every day is a repetitive motion that can cause various health problems. Pre-existing conditions that are aggravated by injuries or distinctive work conditions are also covered.
Selecting An Attorney
It is important to have an experienced and knowledgeable attorney representing your interests. When you meet with the attorney, be sure to ask how much of his or her practice is devoted to workers compensation law. Also, determine if the attorney has actually tried workers compensation cases, before the Board of Industrial Insurance Appeals and the court system. Find out how many. Ask how the attorney plans to proceed with your case.
A qualified attorney will be pleased to discuss his or her qualifications, experience and practice with you. You should consider hiring an attorney if your claim is rejected, if you are not receiving benefits, if the final award is too low, or if you have been fired, suspended or otherwise disciplined for filing a claim as an injured employee. Even if you are receiving workers compensation benefits, it may be a good idea to consult with an attorney to ensure your are receiving the maximum benefits available under the law.
Social Security Benefits
Social security disability insurance provides some income for people who are unable to work because of a physical or mental disability. Like other social security benefits, the amount of the monthly disability check is determined by your age and earnings record. Workers with high total incomes may have to pay federal income taxes on their social security disability benefits. You will want to contact the Internal Revenue Service for more information on taxes. There is no consideration given to the minimum amount of money needed to survive.
Can I Draw Social Security Disability & Workers Compensation At The Same Time?
Social security and workers compensation are separate programs. The social security disability insurance program does not recognize degrees of wage-earning capability as the workers compensation program does. Under the rules of social security, an employee is either able to work, in which case he or she does not qualify for benefits, or the employee cannot work and will be granted social security disability benefits. A disability does not need to be work related in order for an employee to collect benefits from social security.
If you are trying to collect workers compensation benefits, the illness or injury you have sustained must be work-related. Employees are covered their first day on the job by workers compensation. Social security benefits are only paid to workers and their families when the worker has enough credits to qualify.
What Is The “Offset” Of Workers Compensation With Social Security & Disability Insurance?
Workers compensation and social security disability are separate programs, and their eligibility requirements and benefits vary a great deal. You are permitted to collect social security disability payments and, at the same time, workers compensation payments. However, while you are receiving these benefits, one of the payments may be reduced.
Salary While Off Work Due To Injury
If you cannot work at all due to injuries received on the job, you will be compensated for the income you will lose. Typically, you will be paid 60 percent of your average wage and the value of health care benefits. You receive additional amounts if you are married and/or have children. There are minimums and maximums. The employee becomes eligible for wage loss replacement benefits as soon as he or she has lost three days work because of an injury covered by workers compensation.
On-The-Job Auto Accidents
Workers Compensation laws generally define a work-related injury to include any injury sustained while on the job and this includes errand duties. If you are injured in an automobile accident while working, you may be entitled to workers compensation benefits. It is acceptable to file a claim even if you were at fault in the accident. However, if you were not at fault, you may also have a separate personal injury claim against the negligent driver of the other vehicle. The rights and benefits covered under state negligence laws and workers compensation laws differ.
There are a few exceptions to the rule that workers compensation is your exclusive remedy for a work-related injury or illness. If your injury was caused by the negligence of a third-party, (someone other than your employer or a coworker), you are free to sue that person for damages. For example, someone runs a red light and hits the company truck you are driving while making deliveries. You are injured and you are eligible for workers compensation. You can also sue the person who caused your injury. If you receive money, the state or self-insured employer will have a right to be reimbursed for some or all of the benefits they paid. However, you will always receive at least 25 percent of the total settlement after fees and costs are deducted.
Permanent Disability Awards (PPD)
After your physician has determined you have reached maximum recovery, you may be defined as having a permanent partial disability. If this is the case, you might be entitled to additional workers compensation benefits. Washington law provides for permanent partial impairment benefits. A rating of the disability, according to the workers compensation law, determines the benefit payment you will receive. There are definite monetary compensation schedules for specific disabilities. For example, a worker is awarded a set amount for the loss of an index finger and a set amount for loss of use of an arm. Sometimes your doctor will be asked to give an opinion about permanent partial disability. Many times the Department of Labor and Industries uses hired doctors (called Independent Medical Evaluations) to evaluate injured workers for permanent partial disabilities. It is often helpful to talk to an attorney before attending an Independent Medical Evaluation.
What Are Structured Settlements?
The Department defines structured settlements as an “alternative to monthly time-loss benefits …. this is when you and L & I agree to a sum of money that you would receive in a series of fixed, cash payments, over a relatively short period of time.” Injured workers who are 50 or older and have an accepted claim that is at least 180 days old are eligible. This process is usually initiated by the injured worker completing a Structured Settlement Application. As a practical matter, your medical condition usually is required to be fixed and stable. If you are not represented by an attorney, you are required to show that the structured settlement is in your “best interest.” This “best interest” process usually starts with the injured worker completing an Income and Expense Form. After settlement negotiations are completed, the injured worker is required to sign a Settlement Agreement, which is approximately 10 to 15 pages in length. This agreement must be approved by a judge at the Board of Industrial Insurance Appeals. Structured settlements can be a complicated process. It is often helpful to talk to an attorney before negotiating a settlement.
Carpal Tunnel Syndrome
It is important for a physician or specialist to determine if you have carpal tunnel syndrome. Carpal tunnel syndrome is often an occupational disease, which is covered by workers compensation. If your doctor feels your condition was caused or aggravated by work you should generally file a claim.
Changing Health Care Providers
Washington state workers compensation law allows you to choose your health care provider and to change providers after initial treatment has begun. You need to file a written request to change medical providers with the Department of Labor and Industries. It is important to understand your rights and the specific requirements for medical care according to state laws.
Wrongful Discharge Or Discrimination Claims
If you feel you were discriminated against due to an injury sustained on the job or a disability, you should consult an attorney who is experienced in discrimination law. It is unlawful in Washington State for an employee to be fired, suspended or disciplined for filing a workers compensation claim. Suspension or termination does not eliminate the employer’s obligation to provide you with workers compensation benefits you are already entitled to receive. We will happily provide you with a referral to a lawyer whose practice deals with unlawful termination.
Does My Spouse Have Any Rights To My Workers Compensation Benefits?
Compensation benefits are paid to the surviving spouse of a worker who has been killed in the course of employment or as a result of a work-related injury. If the worker died as a result of an occupational illness, the spouse will receive death benefits. In addition, if an employee dies due to a workplace accident, his or her estate will receive burial expenses. If you are placed on a life time pension, you can name your spouse as a beneficiary in the event of your death.
Medical Treatment Benefits
The Department of Labor and Industries and self-insured employers are required by law to pay for all medical treatment an employee needs to recover from a work related injury or illness. This is true even if the treatments continue after the employee has returned to work.
If limitations, caused by your injury or disease, combined in light of your previous education and work experience, prevent you from obtaining a job, you may be entitled to vocational rehabilitation benefits. Those benefits include education, on-the-job training and other types of training which the Department has determined would help you return to employment. The process involves an assessment of whether you can return to employment without retraining. If you cannot, then a vocational plan is developed to help you return you to work. The plan can cover training for up to two years and about $17,500.00, for expenses, at this time. While in a plan, you continue to receive time loss benefits. When a plan is developed, you are given the option to proceed with the plan or have your claim closed with certain limited benefits. We strongly advise you to consult with an attorney, if you are considering not participating in a vocational plan. It is also a good idea to consult an attorney at the start of the vocational process.
What Are Option 2 Vocational Benefits?
If you are found eligible for vocational retraining, you will have two options:
1) Participate in a retraining plan and continue to receive time loss payments while you participate; or 2) Receive “time loss like” benefits for nine months and have access to limited retraining funds to develop retraining on your own at an accredited / licensed institution or Labor and Industries approved program anytime within five years. These “time loss like” benefits are called “vocational awards.” The main distinctions are your claim will be closed, but you can work while receiving your Option 2 vocational award. You cannot work while you are receiving time loss benefits. The vocational awards are paid bi-weekly, over nine months, and are equivalent to your time loss benefits.