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.
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.
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
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.
compensation law provides for various benefits which fall into four main
(1) replacement income
(2) medical care expenses;
(3) vocational rehabilitation
(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.
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.
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
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
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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 $14,000.00, 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.