What follows are some commonly asked questions regarding workers’ compensation issues and general answers to those questions. Each situation is different. This is not intended to be a substitute for obtaining legal advice with respect to your specific situation.
Workers’ Compensation, or Industrial Insurance, is a system to provide basic benefits to people injured on the job. The goal of the law is to provide sure and certain benefits to reduce the physical and economic suffering of people injured on the job.
Compensation is provided for employees injured on the job regardless of who is at fault. In exchange for this no-fault coverage, employers are granted immunity from separate civil liability. However, if a third party’s negligence causes or contributes to your work-related injury or illness, you may have a separate civil action against that person or company. A third party is someone other than your employer or a co-worker.
Most employers in this state pay workers' compensation insurance premiums to the Department of Labor and Industries. If you are injured, the Department is responsible for approving your claim and paying benefits. Some employers are self-insured, which means they pay benefits directly and will manage your claim themselves or through a third-party administrator. The Department oversees the self-insured claims and may intervene to resolve disputes. You are entitled to the same benefits whether your employer is state funded or self-insured.
To receive workers’ compensation benefits, you must be a covered employee, acting in the course of employment, who has sustained an injury or occupational disease.
"A covered employee" — The law recognizes there are hazards in all jobs, so workers’ compensation coverage is almost always required. Generally, if you are an employee, not an independent contractor, then you will be covered. There are some categories of employees who are excluded from coverage. Where coverage is not mandatory, the employer can elect to provide coverage. You should check with your employer to make sure you are covered.
"Acting in the course of employment" — To be covered, you must be doing a task at the direction of your employer, or for your employer’s business, at the time you are hurt. For example, if you are injured on your way to work you will not be covered, but if you are injured while making a delivery for your employer you will be covered.
"Injury" — An injury is defined as a sudden and tangible event of a traumatic nature, which results in a physical condition. You must be able to identify an event or occurrence which resulted in your injury.
“Occupational Disease” — An occupational disease is not caused by a sudden identifiable traumatic event. An occupational disease is a physical state that arises naturally from the conditions of employment, as opposed to being caused by conditions that exist in everyday life. There must also be a causal relationship between your illness and your job. Hearing loss from exposure to harmful levels of occupational noise is an example of an occupational disease.
You are responsible for giving your employer notice of your injury or illness and you must file an Application for Benefits to open a claim.
You should notify your employer when you suffer an on-the-job injury or illness. Many employers, however, do not notify the Department of Labor and Industries of injuries to their workers. It is your responsibility to make sure that you file an application for benefits in a timely manner. You can get an application from your doctor’s office, from your employer or from the Department.
You have one (1) year from the date of your accident to file an application for benefits to open your claim. Applications for occupational disease claims must be filed within two (2) years of learning you have a work-related disease. The application has a section for you to complete and a portion for your doctor to fill out. The sooner you file the application for benefits, the sooner the Department will be able to provide benefits. Please remember your employer is not required to file an application of benefits for you, even where they have notice of your accident.
Many benefits are available. Numbers 1-8 are mandatory; number 9 is a discretionary benefit which the state or employer can choose to offer.
When a decision is made about your claim, either the Department or your self-insured employer will issue an Order. All Orders have specific information which explains your right to protest or appeal the decision if you do not agree. If you want to protest or appeal a decision, you must do it in writing within 60 days of receiving the Order. It is not enough to call your claims manager, although you may do that in addition to sending your written protest or appeal. If you do not file a written protest or appeal of an Order, the decision in that Order becomes final and binding and cannot be changed. You must carefully review each Order. If any of the information contained in a Department Order is incorrect or if you disagree with any decision contained in a Department Order you must file a written protest to protect your rights. A written protest is sent to the Department. See Resource List above. The Department will review your claim and issue a new Order.
If you still disagree with the new Order, you must file a written appeal with the Board of Industrial Insurance Appeals (see Resource List.) The BIIA is a separate state agency charged with resolving disputes that may develop in work-related injury claims. Information about the appeal process in general, or your rights, can be obtained by contacting the BIIA.
Your claim will be closed when your treatment is concluded, your medical condition is at maximum medical improvement and you are able to return to some type of employment. If your injury or disease has resulted in a permanent disability or impairment, you will receive a monetary permanent partial disability award at the time your claim is closed. No further medical bills will be paid by the Department or the self-insured employer after your claim is closed.
You will receive an Order from the Department notifying you that your claim has been closed.
You can apply to reopen the claim. Pick up an application to reopen your claim from your medical provider or from the Department. A claim will be reopened if medical evidence shows that your job-related condition has objectively worsened since the date of claim closure. You will be eligible for full benefits if your claim is reopened within seven years of when it was first closed.
Many work-related injury claims are processed with no difficulty and an attorney is not necessary. If your claim is allowed and time-loss compensation is paid promptly using correct wage information, you should focus on your medical treatment and follow your doctor’s recommendations about returning to work. However, if a dispute or conflict develops about your claim, consultation with an attorney may be helpful. If you believe your injury may have been caused by a third-party, it is also a good idea to speak with an attorney about your rights in a potential civil action.
An attorney may represent you while your claim is being managed by the Department or self-insured employer, or in proceeding before the BIIA. With a few exceptions, attorneys charge a percentage of the benefits they obtain on your behalf as an attorney’s fee. This “contingency fee” should be thoroughly explained to you before you hire an attorney. Do not be afraid to ask questions if there are things you don’t understand.
A lay representative rather than an attorney can also assist you with your claim. Many unions or trade organizations provide invaluable assistance to their members in resolving routine matters that may arise in the management of your claim.
Personal Injury is any physical or mental injury to a person that results from another person's careless or harmful act. Personal injury can occur in a wide variety of ways.
The following are some of the most common:
When personal injury strikes, there are a number of things you should and shouldn’t do to protect your rights. You want to be sure you are covered and compensated for all the damages, both personal and emotional, that you have suffered. Most importantly, you should follow these key rules:
We work with you on your case, we will contact the insurance companies and determine what coverage and benefits are available to you. This may also involve working with Medicare, L&I, DSHS and other agencies to be sure that you continue to receive appropriate payments. Once all available insurance coverages and other benefits have been determined, your attorney will then communicate with your health care providers and coordinate all benefits during the claims process.
Collision victims are entitled to recover monetary damages for all losses and expenses suffered from the collision. Depending upon the particular circumstances of your case, damages may include recovery for any of the following:
It is likely that your personal injury claim will reach a negotiated settlement, so a lawsuit is never filed.
If the case cannot be resolved, however, you have the option of filing a lawsuit and your attorney will explain the steps in the legal process. This is what happens when you file a lawsuit:
Your attorney will prepare a Complaint, a legal document that lays out your claims and secures it on the site.
The Defendant will have to file an Answer that says what portions of the Complaint, if any, the defendant admits to, what the Defendant contests, what defenses the Defendant may have, and whether the Defendant has claims against you or any other party. If the Defendant doesn't answer the Complaint, the court may enter a default judgment against the Defendant.
Your attorney will then exchange documents and other information about the issues relevant to the lawsuit, in a process called Discovery. Discovery can take three forms: written questions which must be answered under oath; document production; and Depositions, which are formally transcribed and sworn statements taken in front of a court reporter.
Sometimes, it is at this point that the case can be resolved in a pre-trial settlement. In that case, the settlement agreement resolves all issues and the court is either not involved or is involved only informally. If the parties do not reach an agreement the case will go to trial.
At trial, the attorneys for each side present evidence and arguments and the judge or jury decides the unresolved issues. Once the judge or jury has reached a decision, the judge will order that Judgment be entered for the side who wins.
A contingency fee is an industry standard fee that is applied to personal injury cases and is dependent upon the successful resolution of your case. A contingency fee is a percentage of the monetary recovery obtained by an attorney on a client's behalf and is only paid if and when an attorney is successful in obtaining monetary recovery, whether through settlement or litigation. The industry-standard contingency fee is about one-third of the awarded settlement. A contingency fee is the form of payment earned by an attorney when he or she states that "there is no fee unless we win your case."
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