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WORKERS COMP FAQ

I was injured at work but my boss said it would be less expensive if he just paid my medical bills out of pocket. What should I do?

You should file a workers’ compensation claim. By filing a workers’ comp claim, you may be eligible for several different types of benefits, not just medical treatment. For example, you are entitled to wage replacement benefits that are a percentage of the wages you were earning at the time of your injury. If you have a permanent impairment as a result of your injury, you will get compensated for it. Also, if you suffer an aggravation or re-injury again down the road, your rights will be affected if you didn’t report the injury as work-related. So it never makes sense not to file a claim even if your employer tells you it’s less expensive for him.

Can I choose my own doctor?

Yes, Washington’s workers’ compensation statute allows you to choose your own doctor. However, those doctors must be part of the Labor and Industries’ network, which you can find here. While Labor and Industries or Self-Insured Employers may send you for an evaluation with a doctor they pick, they do not have the ability to designate the doctors who treat you. Even if your employer tells you to go to a particular clinic for treatment, you don’t have to to there.

How long do I have to file a claim?

For an injury claim, you have one year from the date of injury to file a claim. For an occupational disease claim, you have two years from the date a doctor diagnoses the occupational disease.

I haven’t been able to work for the past three months and my employer cancelled my health insurance. Can they do that?

Generally speaking, yes. If this happens you should tell your claims manager. Your time-loss rate will be increased to compensate you (in part) for the loss of health insurance.

I have a very stressful job and have had to start taking anti-anxiety meds. Can I file a workers’ compensation claim for stress?

No. You cannot open a claim for work-related stress.

I was injured at work last year and have been unable to work since. I’ve developed depression as a result of not working and not being able to do the activities I used to enjoy. Will L&I cover my medications and counseling?

Yes. If you develop a psychiatric condition like depression or anxiety as a result of your injury and your loss of function, that condition is allowable under your claim. Not only must L&I or your self-insured employer pay for treatment, your psychiatric condition must be considered when determining whether you can work.

L&I has asked me to undergo an independent medical examination (IME). What is that?

Periodically, L&I or a self-insured employer will require a claimant to undergo an examination with a so-called “Independent” Medical Examiner. These are doctors who perform evaluations mostly for L&I, self-insured employers, and insurance companies. While they call themselves “Independent,” their opinions and reports almost always favor L&I. Do not assume that this examiner is truly fair or independent.

There are many different reasons for an IME. It may be to a get second opinion on a treatment plan. It may also be to determine whether you have reached maximum medical improvement (MMI). The doctor may be evaluating you for a permanent partial disability award (ratings examination) or to determine whether you physically are able to perform a particular job.

Do I have to go to the IME?

Generally speaking, you should attend “Independent” Medical Evaluations that the Department of Labor and Industries or self-insured employer schedules, because failure to do so can result in the loss of your benefits (like time-loss and payment of medical expenses). There are certain situations, however, when we advise our clients not to attend these exams.

I used to be a pipefitter and made $40 per hour. My vocational counselor says I can work in a convenience store, so I’m not eligible for retraining. Is that right? Don’t they have to retrain me to do a job that pays what I used to earn?

No. Unfortunately L&I is not required to take your earning capacity into consideration when determining whether you can work or whether you qualify for retraining.

My employer has given me a light duty job, but it pays less than the job I was doing when I was injured? Can I get partial benefits?

Yes. If the light duty job pays less than your job of injury, you are entitled to what are called loss-of-earning-power (LEP) benefits. LEP benefits are 80% of the difference between your pre-injury wages and your current wages. So if you earned $500 per week prior to your injury, but are only earning $200 currently, then you are eligible for LEP benefits of $240 per week (80% of $300). Keep in mind, though, that LEP benefits are available only while your claim is open. Once your claim is closed, you no longer receive these benefits.

My doctor has given me light-duty restrictions, but my employer says there aren’t any light-duty jobs available. What am I supposed to do? Do I have to work my regular job?

No. You are not required to return to work at a job that exceeds your doctors’ restrictions. If your employer cannot accommodate your light-duty restrictions, you are entitled to continue to receive time-loss benefits.

My doctor and the IME doctors agree I can’t work at my job of injury anymore? Will I get retraining?

Not necessarily. For you to qualify for retraining, L&I must conclude that you cannot currently perform any work that exists in your labor market. If L&I decides that you can work in a job other than your job of injury (even if it’s a job you’ve never done before), then you will not be retrained.

I’ve been approved for retraining. What are my retraining options?

You and your vocational counselor will work together to identify a retraining goal that meets L&I’s requirements. L&I must approve your retraining program. There are limits to both the length of the retraining program, and the cost. Currently, retraining programs must be completed within two years, and can cost up to $17,500.00. You continue to receive your time-loss benefits while you’re going through your retraining program.

What if I don’t want to go through retraining? Do I have to?

No. If you’re approved for vocational retraining, you don’t have to do it. If you choose not to go through the retraining program that L&I has approved, your claim will be closed and you will receive a vocational award equivalent to 9 months of time-loss payments. If you want to pursue retraining on your own, you have 5 years to use L&I’s vocational benefit (currently $17,500) on an L&I-approved retraining plan.

The independent medical examination (IME) says I’m at Maximum Medical Improvement (MMI). What now?

MMI means very simply that you have recovered as much as you’re likely to recover. Ideally, you will recover fully from the injury and return to the job you were doing when you were injured. Sometimes, that doesn’t happen in which case you may be entitled to a Permanent Partial Disability Award (PPD) or vocational benefits under Washington’s worker compensation statute.

What is a Permanent Partial Disability (PPD) award and how is it determined?

If you have a permanent impairment as a result of your industrial injury or occupational disease, you will receive a permanent partial disability award (PPD). The level of impairment is determined by a doctor—either your attending physician or an IME doctor. The level of medical impairment then translates into a monetary amount, which is set by statute and increases yearly. So, for example, if you broke your wrist and your doctor determined that you have a 5% impairment of your arm, and your injury occurred in June 2014, you would receive a PPD award of $5,833.40.

What if my doctor thinks my PPD rating should be higher? Can I do anything about that?

Yes, you can protest or appeal the PPD rating and try to get a higher one.

What is a workers’ comp pension?

L&I will award you a pension if you are Totally and Permanently Disabled as a result of your industrial injury or injuries. Once you are placed on a pension, you will continue to receive your time-loss benefits for the rest of your life as long as you do not return to work. Generally speaking, you will not be entitled to ongoing medical treatment once you’re placed on the pension, but there are exceptions to that.

My doctor says I’m totally disabled. Why can’t L&I just go ahead and put me on a pension? Why do I have to deal with the vocational counselor?

There is a specific sequence of steps that L&I must take to determine if you’re eligible for a pension. You must be at maximum medical improvement, and there must be a vocational determination that you cannot currently work and that vocational retraining would not likely help you to become employable. If you are still receiving curative treatment, a pension is premature. If there has not been a vocational determination, a pension is premature. While your doctor’s input will certainly be helpful, L&I will not simply place you on a pension at your doctor’s request.

L&I closed my claim and my doctor thinks I still need treatment. What can I do?

You can protest or appeal the order closing your claim. You must do this within 60 days of the day you received the closing order. You can submit protests to L&I online, or you can file an appeal to the Board of Industrial Insurance Appeals.

I was fired after filing a worker’s comp claim. What should I do?

It’s important to distinguish between whether you were fired for filing a claim or let go because you are no longer physically able to perform the job you were doing. If it’s because you filed a workers’ comp claim, you should contact L&I and report it. You should do this right away, because you must file a claim within 30 days of the termination.

If your employment has been terminated because you’ve been unable to work, you may have recourse under the Family & Medical Leave Act (FMLA) or state and federal anti-discrimination statutes.

Does your firm handle FMLA claims and disability-discrimination claims?

Yes.

My workplace accident occurred because my employer (or my coworker) was negligent. Can I sue her?

No. Your only legal recourse is to file a workers’ compensation claim. The only remedies available to you are those provided by Washington’s workers’ compensation program.

What if my workplace accident was caused by someone who doesn’t work at my company? Can I sue that person?

Yes. If your accident was caused by a third party (i.e., someone other than your employer or coworker), you can bring a personal-injury claim against them.

Does your firm handle third-party claims?

Yes.

If I get money from the third-party claim, do I have to pay any of it back to L&I?

Yes. If L&I or the self-insured employer has paid benefits on your workers’ comp claim, then they are entitled to receive a portion of the proceeds from the third-party claim. However, the amount you have to repay is often negotiable, and having an attorney represent you on the third-party claim can help maximize the amount you get to keep.

Can I be on Social Security Disability and workers’ comp at the same time?

Yes, this is quite common. If you have been unable to work for a year (or think that you will be unable to work for a year), you should go ahead and apply for Social Security Disability. Those claims can take a long time to be approved, so there’s no reason to delay.

I can’t pay an attorney an hourly fee to represent me on my workers’ comp claim. Would you still represent me?

Yes, if we think your case has merit, we can represent you on a contingency-fee basis.

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