Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

Category: Time-Loss (Page 1 of 7)

What Happens If I Suffer a Work Injury While Working a Light-Duty Job?

If a worker has an L&I claim, then their employer might offer them light duty work. However, a light-duty job offer must be valid. Work injury claimants who refuse valid light duty work can no longer receive wage replacement benefits. These benefits include time loss compensation and loss of earning power benefits.


What is a valid light duty job offer?

There are many types of light-duty jobs. Yet, under the workers’ compensation claim system in Washington State, there are special considerations. More specifically, a light duty job offer is valid if it meets 5 criteria:

(1) The job must be with the employer of injury.

(2) The employer must send the job description (sometimes called job analysis) to the attending provider and the injured worker.

(3) The attending provider must approve the job.

(4) The employer has to provide a written job offer to the work injury claimant. The offer needs to include a reasonable start date.

(5) The employer must reinstate health care benefits at the same level as of the time of injury. One exception is when there’s a superseding agreement in place.


Workers’ concerns regarding light duty jobs

Some work injury claimants are nervous about doing light duty work. Personally, I regularly encounter 2 common concerns. First, there’s a fear of needing to perform work beyond the worker’s limitations. These limitations are set by the attending provider. Then, there’s a second concern – suffering another workplace injury while working light duty.


The first concern is easy to address. Employers cannot ask workers to do something that’s not in the job description. Remember, the attending provider approved the job description based on the worker’s limitations. Therefore, when this happens, the light duty job is no longer valid.


Suffering a work injury while working a light duty job

The second concern is not so simple. Unfortunately, in real life, work accidents do happen during light duty work. And then, when they do, they cause additional frustration and stress.


It’s important for workers to understand how to handle work injuries while working a light duty job. Here, there are different options and scenarios. One scenario pertains to temporary light duty jobs. The other applies to permanent light duty work. If you suffer a work injury while working a temporary or transitional light duty job, then you have coverage under your original L&I claim. However, for permanent jobs, you need to file a new workman’s comp claim.


Which conditions and benefits belong to what work injury?

Either way, the new work injury will likely complicate your claim. That’s because it’ll interrupt medical appointments and chart notes in the original claim. It also depends on the body area and the nature of the second injury. Many times, it can be hard to keep conditions and symptoms separate from the original injury.


In addition, it can be difficult to determine benefits. Do benefits apply under the original L&I claim? Or under the second work injury claim? Or both? Administratively, it can be very messy. Therefore, it’s important for workers and medical providers to be precise. In statements, in medical reports, and in all other documents.


Light-duty work injury can impact benefits

Another important point is the impact on financial benefits. Interestingly, your wage rate under the original claim and the new claim may not be the same. In the first case, the new work injury is under the original L&I claim. Here, the wage rate from the original claim applies. If the worker is receiving loss of earning power payments when the light duty injury occurs, then L&I will factor those benefits to wage rate calculations. Moreover, if the light duty injury means the worker can no longer work, then L&I will pay time loss compensation. Of course, as always, the worker must certify time loss with the attending provider.


The second case is when the light duty injury prompts a new claim. Here, L&I uses the wages of the light duty job to calculate benefits for the new claim. This holds true even when the light duty job pays less than the original job. When this happens, it’s incredibly frustrating for work injury claimants.


Some takeaways

To summarize, fear of re-injury at work isn’t a valid reason for declining a valid light duty job offer. Injuries that happen while working light are no fun! There are several ways to handle those injuries. They depend on whether the light duty work is temporary or permanent.


As always, the very best thing for workers and employers is to take all possible precautions. Do what you can to eliminate workplace injuries. However, if a light duty work injury occurs, then L&I is going to cover it. The coverage might be under the original claim or under a new workman’s comp claim.


Report of Accident (ROA) Form: How to File an L&I Claim

If you suffer an injury at work or develop an occupational disease, you need to file a claim right away. The best way to file an L&I claim is to see a doctor. There, you will fill out a Report of Accident (ROA) form. You must complete the ROA form to file the claim.


Filling the Report of Accident form

The Report of Accident form is long. It asks for a lot of information. Many workers rush when they complete the form. They end up giving inaccurate or incomplete information. This can cause a lot of problems and delays down the road. Therefore, it’s important to take your time. You must fill out the form completely and accurately.


The ROA form has 2 main sections. The first is Worker & Employer information. The second is for Health Care Provider information. Your doctor fills out the Health Care Provider section. You don’t need to worry about that part. However, you must fill all 43 boxes of the Worker and Employer section.


Sections in the ROA form

The first 9 boxes ask for basic information. For example, your full legal name, gender, and social security number. It also asks for your phone number, birth date, and home address. Also, you’ll need to provide your height, weight, and mailing address.


If you don’t have a social security number – it’s okay to leave it blank. Make sure your address and phone number are correct. This is how the Department of Labor and Industries (L&I) communicates with you. L&I will send you important documents and information over time. Hence, it’s critical to provide accurate contact details. If your contact info changes, you must notify L&I right away.


Answering questions about your family

Next, there are boxes 10 and 12. Box number 10 is small. Many work injury claimants overlook it. However, it’s a very important box because it asks about marital status. Are you married? Do you have a registered domestic partner? If so, then you can potentially receive higher time-loss compensation payments. To get a time-loss compensation increase, you must fill out box #10. You must also include the name of your spouse or domestic partner in box 12.


Box #11 and box #13 ask about dependent children. Usually, they refer to biological or legally dependent children. Kids must be under the age of 18 and living at home. Sometimes, L&I will consider children over 18 under certain requirements. If you have dependent children, you might be eligible to higher time-loss compensation. To get the increase, you must list all dependents on this form. Otherwise, L&I won’t take them into consideration when they calculate your payments. Box 13 asks for the full legal name of the children’s legal guardian (if it isn’t you).


Work injury details in the Report of Accident form

L&I asks you to describe the work accident or workplace illness in boxes 14 through 28. They use this information and the initial medical records to allow or reject your claim. It’s critical that you fill these boxes completely and accurately. Don’t guess anything. Especially not important dates. Look at your calendar and text messages if you have to. Go back and review your emails. Talk to friends and family members. It’s imperative that you enter the correct facts.


Employer and wage information

In boxes 29-39, L&I asks for your employer and salary info. L&I uses this data to calculate your wage replacement benefits and payments. Of course, L&I will verify the information with your employer. If you don’t fill boxes 29-39, it might cause delays with your payments.


Box 29 asks if your employer pays your healthcare benefits. If you get any healthcare coverage through your job, then you must check “Yes”. Even if it’s through union agreements or a partial health coverage. If your employer stops your healthcare coverage after your work injury, L&I still includes the value of the healthcare benefits when calculating your compensation rate.


Your employer info goes into boxes 30-34. L&I has to communicate with your employer. You must fill the employer info accurately because it reduces delays in claim processing. In box 35, list your job title at the time of injury. Boxes 36-39 ask for your rate of pay, hours per day, and days per week. They also want to know about all your sources of work income. For example, earnings from piecework, tips, overtime, commissions, and bonuses. Some workers have a complex pay schedule. In those cases, you must collect pay stubs for up to 12 months prior to the injury. Give them to L&I. It’ll help them calculate your wage rate. You can also do it later. In fact, you can send them paystubs after you file the initial ROA form.


Other details in the Report of Accident form

Some people work more than one job. If you suffer an injury at work, you must tell L&I about all your jobs. You’ll do it in box 40 and 41. They must consider all income sources to calculate your benefits. For instance, say you’re unable to perform all your jobs. In that case, L&I will compensate you for all your earnings from all jobs. Not just the job of injury. There are also other considerations with occupational disease claims. For example, L&I needs to know if there are work activities with other employers that contribute to your condition.


Finally, date your Report of Accident form and sign it in box #42. Then, after you sign it, return it to your medical provider. Your doctor will submit the Report of Accident to L&I.


What else should I do when filing a claim?

When you file your claim, there are other steps you must follow:

1. Look at the top right corner of the Report of Accident form. You’ll see your claim number. It’s pre-printed on the form. It begins with two letters with five numbers after. Next, take a picture or write down your claim number. Keep it safe. Sometimes, paperwork can get lost. Having your claim number is the easiest way to check the status of your L&I claim.

2. Give L&I access to your employment records. The Employment Securities Department (ESD) maintains your records. These records can help L&I calculate your wages and benefits.

3. Don’t hesitate to call L&I at the Injured Worker Hotline. In fact, you can call them any time you need help. The L&I Hotline number is 1-800-547-8367.


Attorneys cannot help until you file a claim

Most attorneys can’t help you until you file your claim. However, they can help after you file the L&I claim. For example, if you have issues with claim allowance or wage rate, then it’s important consult with an L&I attorney. L&I can calculate your wages in several ways. A workers’ compensation attorney can help determine if the calculation methods are appropriate. Or, if they used the method most beneficial to you. Attorneys can also help if L&I denies or rejects your claim.


L&I Claim Overpayment: They Overpaid Me and Want Money Back, Now What?

The Department of Labor and Industries (L&I) sometimes sends overpayment notices to work injury claimants. Receiving one of these letters can be very stressful. The purpose of the notice is to tell you that you’ve been overpaid. And yes, they want their money back.


The reality for injured workers

When work injury claimants are unable to work, their income is automatically slashed by 40%. Clearly, this creates significant financial strain and stress. After all, the cost of living is always on the rise. Consequently, many workers have no choice. They live from check to check. In reality, many workers use wage replacement benefits in their entirety to pay for housing, food, and family care. Very often, injured workers must dip into their savings to make ends meet.


L&I claim overpayment

It feels like L&I is so stingy with paying benefits that overpayments can’t possibly happen. However, overpayments are very common. Most times, when overpayments occur, it’s not the fault of work injury claimants.


Overpayments can occur for many reasons. For example, because of clerical errors or identity mix-ups. They can also happen due to wrong data or adjudicator errors. One case is when L&I computes the wage rate incorrectly. Another is when L&I pays benefits even after the injured worker is released to work. Furthermore, there are instances where L&I reverses claim closure and must recoup a previous PPD award. That said, I’ve seen many cases where L&I tries to collect an incorrect overpayment. Therefore, it’s always important to double check everything. You must take steps and check if the L&I repayment demand is correct.


Repaying L&I overpayments and the law

Under RCW 51.32.240, L&I has the right to make a claim for repayment or recoupment of an overpayment. However, they only have one year form making of the overpayment to ask for money back. If L&I doesn’t make the claim within one year, then they waive their right to  recoup funds.


The one-year limitation doesn’t apply if there are issues of willful misrepresentation. More explicitly, willful misrepresentation is when a person obtains payments or other benefits under the Industrial Insurance Act after knowingly giving a false statement or misrepresentation. It also includes cases where people omit or conceal facts intentionally to receive benefits they shouldn’t get. Willful misrepresentation does happen. Yet, in my experience, L&I sometimes incorrectly accuses workers of willful misrepresentation. This is very common in cases of innocent mistakes.


L&I overpayment after willful misrepresentation

If an overpayment occurs due to willful misrepresentation, then L&I has three years. Here, the timer starts ticking when L&I discovers the willful misrepresentation. Then, they can also demand repayment plus 50% penalty. However, there are examples when L&I doesn’t claim the repayment within 3 years. In such cases, L&I automatically waives the right for repayments.


L&I claim repayment – summary

To conclude, overpayments in L&I claims are more common than you think. L&I has one year to make a claim to recoup overpayments. Although, if there’s been willful misrepresentation, then L&I has three years to make the overpayment claim.


Regardless, L&I sometimes makes mistakes when it comes to assessing overpayments. These mistakes happen because of miscalculations or timing issues. They can also occur when L&I incorrectly blames workers of willful misrepresentation. If you feel that L&I is incorrect, it’s always a good idea to consult with an experienced attorney right away.

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