Washington Workers Comp Claims: Eligibility, Filing and Appeals

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If you are injured while working in the State of Washington, or your employer has a place of business in Washington, you may be eligible for Washington workers’ compensation benefits. Washington’s benefits for injured workers are some of the highest in the country. Benefits may include payment of medical treatment, lost wages, compensation for partial permanent impairment, and/or a lifetime pension, depending on the circumstances of your particular case.

There are strict deadlines for reporting injuries, so make sure you report all injuries to your supervisor or human resources department promptly to ensure you obtain the maximum benefits you are eligible for.

State Fund vs. Self-Insured Employer

With limited exceptions, the Industrial Insurance Act governs all workers’ compensation claims in Washington. Most small employers purchase industrial insurance through the Washington Department of Labor and Industries (Department of Labor and Industries). Large employers, if they meet certain criteria, may choose to "self-insure." Regardless of whether your employer uses the state fund or is self-insured, your benefits should be the same. That being said, self-insured employers typically fight payment of benefits more than the Department of Labor and Industries fights on behalf of state fund employers.

Types of Industrial Claims

There are two types of covered claims in Washington: one, an “industrial injury,” and two, an “occupational disease.” An industrial injury is a sudden event, whereas an occupational disease is a condition that arises over time. For example, a low back injury that arises suddenly when a worker lifts a heavy box is an industrial injury. On the other hand, low back pain that develops and increases over time when a worker repeatedly lifts small boxes is an occupational disease. Occupational disease claims can also include exposure to chemicals or pathogens, and other conditions more commonly considered “diseases.”

The difference in these two types of claims comes in the medical evidence that the Washington Department of Labor and Industries will look for in determining whether to allow your claim. Your doctor can assist you in determining what type of claim you have and will prepare documentation to support your claim if you have an industrial (workers' comp) claim.

How to File a Washington Workers’ Compensation Claim

As soon as you are injured at work or become aware of a potential occupational disease, report this to your employer. Regardless of whether your employer believes your claim is legitimate, your employer will provide you with a form to complete. The employer is then required to send this form to the Department of Labor and Industries, thus beginning your claim process.

You should see a physician as soon as possible. If your primary care physician is not familiar with treating injured workers, or is not willing to do so, your physician may recommend you seek treatment with a different provider. It is in your best interest to seek treatment from a physician who regularly treats injured workers. These physicians have a required provider number from the Department of Labor and Industries, and know what information to provide to the Department/self-insured employer to substantiate your claim.

Once your employer has submitted the form to the Department of Labor and Industries, and your doctor has submitted the necessary forms and medical information regarding your condition, the Department or your employer, if self-insured, will issue an order allowing or denying your claim. If your claim is allowed, you will then begin receiving the workers’ compensation benefits you are eligible for. However, if your claim is denied, you'll need to appeal the denial.

Appealing a Washington Workers’ Compensation Denial

If the Department of Labor and Industries or the self-insured employer issues an order you do not agree with, you may appeal the decision. The order will include language regarding the deadlines required to file an appeal.

The first level of appeal will be with the Department of Labor and Industries. A different individual at the Department will review your case and the order you disagree with, and will decide whether the order was correct. If the Department affirms the order, the next level of appeal is to the Board of Industrial Insurance Appeals. The board will hold a hearing, much like a trial, and make a determination regarding the accuracy of the order. If you disagree with the initial board determination, you may appeal further to the three-member board panel. Appellate review beyond the board first goes to the Superior Courts of Washington State, then to the Court of Appeals, and potentially the Washington State Supreme Court.

You should strongly consider hiring a workers' comp attorney immediately after you receive an order you wish to appeal. The appeals process in Washington requires use of legal rules of procedure and evidence, and can be difficult for a non-lawyer to navigate. Lawyers representing injured workers almost always take the case on a contingent basis, meaning you will pay little or nothing unless the lawyer wins your case. If you win, the lawyer will be entitled to a small portion of the monetary value of the workers’ compensation benefits you receive.

Learn more about appealing a Washington worker's comp claim.

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LA-NOLO5:DRU.1.6.3.20141021.28794