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 workers’ compensation benefits. Washington workers’ comp benefits for injured workers are some of the highest in the country. Benefits may include payment of medical treatment, lost wages, compensation for permanent partial impairment, and a lifetime pension, depending on the nature of your injury.
With limited exceptions, the Industrial Insurance Act governs all workers’ compensation claims in Washington. Most employers have workers’ comp coverage through the Washington Department of Labor and Industries. The other option is to self-insure, which is only available to large employers that meet certain financial criteria. While the available benefits are the same either way, self-insured employers typically fight claims more than employers that are insured through the Department of Labor and Industries.
As soon as you are injured at work or become aware of a potential occupational disease, report it to your employer immediately. Your employer should provide you with the proper form to complete. If your employer is insured with the Department of Labor and Industries, you can also file your claim online. You must make sure that your claim is filed within the following deadlines:
You should get medical treatment as soon as possible. For your first visit, you can see your primary care physician or another doctor of your choosing. However, after that, you must treat with a doctor within the Department of Labor and Industries’ network.
Once your employer has submitted your claim form to the Department of Labor and Industries, and your doctor has submitted the necessary forms regarding your condition, your claim will be reviewed. If your employer is insured through the state, the Department will decide whether to accept or deny your claim. If your employer is self-insured, it will make that decision itself.
Like other states, Washington workers’ compensation covers medical bills and pays temporary and permanent disability benefits.
Employees who need time off work while recovering from their injuries can receive temporary total disability benefits. These benefits are between 60% and 75% of your average monthly wage before your injury, based on whether you have a spouse or dependent children. However, you cannot receive more than a monthly maximum set by law. As of July 1, 2016, the maximum monthly benefit is $5,627.29.
If you’re able to work in a part-time or light-duty position, but you’re earning less than you usually do, you can remove temporary partial disability benefits. These benefits are 80% of the difference in your wages.
If your injury causes a permanent and total disability, you will be eligible for a life pension. This means you will receive benefits at your temporary total disability rate for the rest of your life. However, only the most serious impairments qualify as a permanent and total disability—such as the loss of both hands, arms, feet, legs, or eyes.
If you are only partially disabled, you can receive a scheduled award. Washington has a schedule of losses, which lists certain body parts or bodily systems and provides a corresponding dollar award. For example, the award for the total loss of a leg at the ankle is $83,683.80 (as of July 1, 2016).
If your workers’ compensation claim is denied, you may appeal the decision. The first level of appeal is filing a protest with the Department of Labor and Industries. The second level is filing an appeal with the Board of Industrial Insurance Appeals. If your employer is self-insured, you must start with the protest first. If your employer is insured through the state, you may choose to skip the protest and go directly to the Board appeal.
There is no particular form for a Protest and Request for Reconsideration; instead, simply write a letter to the adjudicator listed on your claim denial and list the reasons why you disagree with the decision. Alternatively, you can file your protest online using the Department’s Claim and Account Center system. You must file your protest within 60 days of the denial; otherwise the decision becomes final.
A different individual at the Department will review and reconsider your claim. Within approximately 60 days, the Department will issue another order either affirming the decision or changing it. If you disagree with the new order, you will need to appeal to the Board of Industrial Insurance Appeals.
The next level of appeal is to the Board of Industrial Insurance Appeals. You may file your appeal in person, by mail, by fax, or by using the Board’s online filing system. The Department’s order will include the deadline for filing your appeal, which is usually 60 days.
The first event that will happen after you file an appeal with the board is typically a mediation conference before a workers’ compensation judge. This is an opportunity for you and your employer to try to resolve the dispute informally. If you are unable to come to an agreement, the judge will send the matter on to a different judge for a hearing.
Hearings at the board are much like a trial in regular court. Both you and the employer will present evidence, primarily through documents and witness testimony. The judge will then issue a Proposed Decision and Order.
If you disagree with the Proposed Decision and Order, you may file a Petition for Review within 20 days. This is a legal document that must state the reasons you believe the Proposed Decision and Order is inaccurate and the evidence you think supports your position. A three-member board panel in Olympia will then decide whether to accept your Petition and review your case. If the panel grants review, it will look over the record and issue a final decision.
If the panel rules against you, you may appeal to the Washington superior court in the county where you live by filing a Notice of Appeal within 30 days. The superior court must presume that the decision of the panel is correct. For that reason, it is rare for the superior court to overturn a decision by the panel.
If you lose at superior court, you may appeal to the Washington State Court of Appeals. Similar to the superior court, however, the court of appeals rarely overturns decisions. The last avenue of appeal is to the Washington State Supreme Court. However, the Supreme Court rarely accepts review of a workers’ compensation appeal.
Appealing beyond the Department of Labor and Industries requires legal expertise and skill—not only to file the appeal, but also to effectively argue the case. The earlier you obtain an attorney, the better the attorney will be able to gather evidence to support your case. (For more information, see Do I Need a Lawyer to Get Workers’ Compensation Benefits?)
Attorneys typically represent injured workers in their appeals on a contingent basis. This means that you will pay little or nothing unless you win on appeal. If you win, your attorney will take up to 30% of your award.