FREQUENTLY ASKED QUESTIONS
THE INFORMATION CONTAINED ON THIS PAGE IS INTENDED AS GENERAL EDUCATION. IT DOES NOT CREATE AN ATTORNEY-CLIENT RELATIONSHIP, IS NOT PRIVILEGED OR CONFIDENTIAL AND IS NOT CASE-SPECIFIC LEGAL GUIDANCE. AS ALWAYS, PLEASE CONSULT AN ATTORNEY IF YOU ARE FACING A SPECIFIC LEGAL ISSUE AND NEED REPRESENTATION.
Why am I not receiving time loss benefits?
To be eligible for time loss benefits while you are receiving treatment for your injury or deemed unable to work because of your work injury, you must submit medical certification from your attending physician documenting your restrictions and the objective findings warranting restrictions.
How is my time loss rate calculated?
Your time loss rate is set as a percentage of your time of injury wages. If you are single with no dependents, you will receive 60% of your wages. If you are married with no dependents, you will receive 65% of your wages. Each dependent, up to a limit, will add 2% to your time loss rate (or be sent to the custodial parent, if you don't have custody of your dependents). Time loss compensation benefits are typically not taxable. Your time of injury wage is usually set by a formal order. If you disagree with the amount listed in such order, it is imperative that you timely protest/appeal such decision as it directly impacts your time loss rate.
How do I protest/appeal a decision that I believe is incorrect?
Most formal decisions and orders contain protest/appeal language and must be filed within 60 days of the date you receive the formal order. Some decisions have shorter timelines. Protests and appeals must be filed in writing. A phone call to your claims manager will not suffice.
Can I draw workers' compensation benefits and social security at the same time?
Yes. Your total combined monthly entitlement will be determined by your highest year's earnings and the type and amount of your social security benefits.
Can I sue my employer for being a cause of or contributing to the injury?
Not usually. You may have a cause of action against your employer if you can prove your employer knew or should have known that serious injury or death was likely to occur as a result of the work activity or exposure. This is a very high standard and is often difficult to prove. You should consult a personal injury attorney if you want to know more. I do not handle such lawsuits.
Can I file a third party claim?
Yes. If your work injury is the result of a third-party's negligence, you can file a personal injury claim against that party. You will want to discuss this with a personal injury attorney as I do not handle third-party claims. If you do recover against a third-party for a work-related injury or illness, there is typically a recovery amount due and owing to the self-insured employer and/or Department.
How do I find a doctor to handle my claim?
L&I provides a list of approved providers by geographic area on its website. This list is not always up-to-date, so you will want to call listed providers and verify that they still accept workers' compensation patients.
Can I move out of state while my claim is open?
Yes. You will need to find an attending physician to take over your care. Out-of-state physicians must still agree to abide by the Washington L&I fee schedule, which can sometimes be difficult to find.
How do I change my doctor?
File a change of attending physician form with the self-insured employer or Department, depending on which company or agency is handling your claim.
Do I file a new claim if I re-injure the same body part covered under a prior claim?
It depends. Often, if your condition worsens without a new, traumatic injury, you will want to apply to reopen your original claim. If, however, you have a new, traumatic injury, you will want to file a new claim. Often, I advise workers to file both a reopening application and a new injury application. This is a complex area of the Industrial Insurance Act and you will want to meet with an attorney to discuss your case specifics.
How do I apply to reopen my claim?
You can file to reopen using L&I's formal application to reopen. You can also submit a written request for reopening, with a doctor's chart note outlining your worsened condition and the objective findings warranting reopening. If L&I denies your reopening, you will want to speak with any attorney about filing a protest/appeal.
How long will an appeal to the Board take?
I typically advise that the appeal process is 10-14 months from the date of filing the appeal until you receive a written decision. This timeline can shorten or lengthen depending on case specifics.
Am I entitled to a permanent partial disability award?
What do all these letters stand for anyway? A permanent partial disability (PPD) award is a monetary award paid out once your claim is ready to close, i.e. you are at maximum medical improvement and you have either returned to work or been found employable. This award is meant to represent your loss of physical functioning as a result of the work-related injury or illness. You do not receive a PPD award if you are placed on pension.
Can I cash my PPD check if I do not agree with my rating and/or claim closure?
Yes. You can cash a PPD check even if you plan to protest/appeal the decision. If the order is reversed and a lower PPD amount awarded, you may have an overpayment.
What happens if my doctor does not release me back to work?
If you are able to return to your job of injury following medical treatment, a vocational counselor will be assigned to your claim to determine if you are employable based on skills you have obtained from other employment or hobby activities. If all transferable skills jobs are also ruled out by your doctor, then you may be entitled to either retraining services or a lifetime pension. You should consult an attorney if you have questions about your permanent disability status.