Frequently Asked Questions (FAQ)

Video Transcript:

Ultimately every claim comes to a close. A claim is closed when your medical condition is likely to not benefit from any treatment that is considered to be necessary and proper.

Necessary and proper treatment is that treatment which is considered to be either curative, rehabilitative, or diagnostic. Once your medical provider determines that you are not likely to benefit from such treatment or it is determined by a group of examiners for either the Department of Labor & Industries or a self-insured employer, then your claim may be closed.

The closure of your claim does not necessarily mean that you are back to where you were before you first opened your claim. It simply means that there has been a determination that you are not likely to benefit from further necessary and proper medical care. At this point, it will be determined whether or not you are entitled to an award for either permanent partial disability or perhaps even pension benefits.

Q: Because of an injury to my shoulder, I have been receiving time loss compensation from the Department of Labor and Industries for over a year. I had reconstructive surgery for the shoulder, but was still unable to return to work.

A: By statute, if an individual was “voluntarily retired” and “is no longer attached to the work force”, he is not entitled to benefits paid by the Department of Labor and Industries. If you can establish though that your decision to stop working, or your decision to apply for any type of retirement benefits, was due at least in part to the effects of the industrially related disability, you have not “voluntarily retired”. The Department’s interpretation of these situations is often difficult to deal with. Learn more about workers’ compensation claims.

Q: I injured my back while lifting at work and was unable to continue working. After treating with a chiropractor, my back has improved. My employer has offered me a part-time, light duty position. However, because it is light duty, it does not pay much. Will my time loss benefits stop if I take the part-time job?

A: Time loss is only payable when a worker is “off work” due to an industrial injury and continues to receive treatment for his industrially related condition or is participating in vocational services. However, there are other benefits that you may not be aware of. There is a benefit called “Loss of Earning Power” or LEP. These benefits are paid once a month instead of twice a month like your time loss. They are calculated after you submit to the Department your pay stubs for the entire month. Learn more about workers’ compensation claims.

Q: I was recently hurt on the job and have filed a claim with the Department of Labor and Industries. I am still awaiting their letter to tell me whether or not the claim is going to be allowed. Currently, I am not able to work. What should I do now? What if I am approved for time loss benefits, but the benefits I receive are a lot less than what I was making at the time I was injured?

A: If an industrial injury or occupational disease prevents you from returning to any work for which you are qualified, you should be entitled to what is called “time loss” benefits. Certification as to whether or not you are able to return to work is usually provided by your attending physician. Time loss benefits represent a percentage of your wages at the time of injury. Wages at the time of injury are generally calculated by taking an hourly wage multiplied by the number of hours typically worked per day. The percentage is determined by whether you are single, married, or how many children you have. It can vary between sixty and seventy-five percent. Learn more about workers’ compensation claims.

Q: I have been receiving time loss benefits for ten years. Last month the Department reduced my benefits because my oldest son turned 18. Can they do that?

A: The short answer is yes, they can. However, it is important to know whether or not your son, although 18, is still attending school full-time. If your son has not yet graduated, or has gone from high school to college and is attending college full time, you can have that reduced benefit reinstated. A dependent child who continues to be enrolled in school full-time can still qualify you for their assigned percentage (2% of wages at the time of injury) until they reach the age of 21. A statement from the registrar of the college or school he is attending confirming enrollment should be sufficient. If you have any further questions, feel free to call an attorney who handles worker’s compensation claims.

Q: Are time loss benefits under the Industrial Insurance Act/Worker’s Compensation Act different for seasonal workers versus non-seasonal workers?

A: Yes. In brief, seasonal workers have their time loss paid based on their average monthly earnings over a 12-month period before the industrial injury. Non-seasonal workers have their time loss benefits paid based on their rate of pay at the time of injury, regardless of their earnings history. However, if the Department of Labor and Industries labels you as a seasonal worker, you should not accept that classification without having it reviewed by an attorney. Current Department policy conflicts tremendously with the current status of court decisions on what constitutes seasonal versus non-seasonal or full-time work. For example, the Department often labels a farm worker who is employed nine to ten months out of the year as seasonal, while a construction worker employed nine to ten months out of the year will be labeled as non-seasonal, the latter receiving a greater time loss rate merely because of the way the Department treats farm workers as a whole. Be aware that the number of months worked in a year may not be indicative of whether a worker is seasonal or non-seasonal. There are many other facts that need to be considered, so you should always consult a person experienced in this area to review your time loss rate after the Department has made its final determination as to your time loss rate. Learn more about workers’ compensation claims.

Q: Will my worker’s compensation benefits be stopped if I have an attorney make a claim against the person who injured me while I was on the job?

A: No. You may receive worker’s compensation benefits while seeking a recovery from the non-employee, who is often referred to as a third party. This will not stop, delay or otherwise interfere with your current receipt of L&I benefits. When the third party claim is settled or a judgment is obtained, you may experience an interruption or stoppage of your benefits if the third party recovery is greater than the costs, the attorney fees, the 25% of the balance paid to you regardless of the amount of the recovery, and the L&I lien. However, in those cases where you are left with funds above and beyond all claims against your recovery and above the first 25% paid to you, you merely substitute those funds recovered from the third party for your L&I benefits. If the surplus funds (funds paid to you after the 25% and after payment of all litigation expenses and the Department lien) are consumed at a rate similar to the L&I benefits, then when those funds are exhausted, you will again receive L&I benefits unless the third party recovery is greater than those benefits paid by the state.

Q: If I bring a lawsuit against another party who injured me while I was in the course of employment, what, if anything, is owed to the Department of Labor and Industries as a result of benefits paid by the Department?

A: The Department of Labor and Industries is entitled by law to be reimbursed for all benefits paid to any injured worker when that injured worker obtains a recovery from a third party or non-employee who is responsible for the on-the-job injury. However, the law does provide an incentive to the injured worker to pursue litigation which would result in reimbursement to the Department of Labor Industries. That is, even in cases where the injured worker was at fault with a resulting deficiency recovery or a recovery less than the amount of money paid out by the Department of Labor and Industries, the injured worker is assured a percentage of that recovery. The bottom line is that the statue or law concerning what is labeled as third party recovery is written to assure some recovery by the injured worker, despite the lien or interest by the Department of Labor and Industries, as long as there is a party at fault other than the employer or co-worker employed by the injured worker’s employer. Learn more about workers’ compensation claims.

Q: When a person sustains an injury by falling in a retail store, how long does that person have to file a claim against the business? Does the time limit start to run when the medical treatment has been completed, or as soon as the accident happens?

A: When dealing with issues of fault arising out of acts of negligence, the time limit for commencing a law suit extends for three years from the date of the accident in Washington State. There is a shorter time limit when the incident producing injury is an intentional act. When the person who has sustained the injury is a minor, the three year statute of limitations does not begin to run until that person reaches the age of 18, and would expire on their 21st birthday. Often, when dealing with incidents of negligence in a retail establishment, it is extremely important to determine the detailed condition that led up to the injury. It is important to be able to contact and interview eye witnesses and to be able to go and inspect the premises before the conditions may be changed. Such investigative efforts often require the assistance of an attorney. Learn more about workers’ compensation claims.

Q: I injured my knee at work. The Department of Labor and Industries paid for my treatment for three years. I then moved to Pennsylvania and continued treatment, but paid for it myself. I have now moved back to Washington, but have never heard anything else from the Department regarding my claim. Recently, my knee has begun swelling and popping when I walk. Can I ask the Department of Labor and Industries to pay for any further treatment of my knee injury?

A: If you never received any written notice of claim closure from the Department of Labor and Industries, all you have to do is see a doctor and if they recommend further treatment, the Department should have to pay for that continued treatment. If the Department, while you were in Pennsylvania, attempted to close the claim but you never received any written notice of that closure, the claim is still “open”. The Department of Labor and Industries has the obligation to “communicate” the order to the injured worker. Learn more about workers’ compensation claims.

Q: I have a previous knee injury claim for an on-the-job injury which was closed several years ago. My knee has become stiff due to arthritis that has developed. My doctor indicates that there is not much that can be done in the way of treatment. What should I do?

A: Even though your doctor is not currently recommending further medical treatment, if your industrially related knee condition has worsened objectively, you should be entitled to have your claim reopened and have a re-evaluation of the permanent partial disability decision made. As the law now stands, an individual has seven years from the date that the claim is first “finally closed” to reopen the claim. If you wait beyond seven years from the first final closure of your claim, you may lose the right to reopen the claim. Learn more about workers’ compensation claims.

Q: My claim was closed, but my doctor discovered that I am developing arthritis in my left hip. Can I reopen my Labor and Industries claim even though the left hip was not originally injured?

A: It is not uncommon for injuries in one part of the body to leave an individual with permanent disability such that it changes the way they walk, the way they reach, the way they stand, etc. The way we physically compensate for a permanent injury or disability sometimes causes us to overuse other parts of our body. Under the Worker’s Compensation system, if compensation for permanent impairment of one part of the body leads to the development of symptoms in other parts of the body, you should have a right to reopen the claim for the new condition. It is largely a medical question as to what brought about the arthritis in your left hip. If your doctor believes that it is related to the change in gait, stance or weight bearing, then you should file a reopening application. Learn more about what to do if the reopening application is denied.