Category: Time-Loss (Page 5 of 7)

time-loss compensation in washington state

Time-Loss Compensation: Minimum and Maximum Amounts Under an L&I Workers’ Compensation Claim

Previously, I posted articles about temporary total disability and how to calculate time-loss compensation wages. In short, we consider people with work injury that are unable to work as temporarily and totally disabled. Work injury claimants that fall under this criterion should receive time-loss compensation benefits based on their wages at the time of their workplace injury. Wages can be salary or hourly rate and include things like bonuses, housing and meals. They should also include healthcare, commissions and tips. L&I, or a third-party administrator in case of self-insured employer claims, pays time-loss compensation every 14 days. However, to receive time-loss compensation benefits, you must certify that you are unable to work. Furthermore, the reason for which you are unable to work must be related to your L&I claim.

Time-Loss Percentages

The amount of money that you will get under your time-loss compensation benefits depends on several factors. If you are single with no dependents, then you should receive 60% of your wages as time-loss compensation payments. If you were married at the time of your work injury, you should get an additional 5%. Moreover, people with dependents can receive an extra 2% per dependent child up to a maximum of 10%. In summary, work injury claimants can expect to receive anywhere from 60% to 75% of their wages prior to their work accident.

Minimum and Maximum Time-Loss Compensation Amounts

It’s important to know that the Department of Labor and Industries (L&I) established minimum and maximum time-loss compensation payments. The minimum time-loss rate for a workplace injury that occurred on or after July 2, 2008 is 15% of the Washington State’s Average monthly wage. For example, for dates of injury (or occupational disease manifestation) between July 1, 2018 and June 30, 2019, 15% of the average monthly wage is $773.59.

Similarly, L&I time-loss compensation maximum rates depend on the date of injury or manifestation. Currently, the maximum rate is set at 120% of Washington State’s average wage. As an example, if you were hurt at work between July 2019 and now, then 120% equates to $6,530.10 per month or $217.67 per day.

Washington State and L&I

People frequently ask me: “What is the value of my workers’ compensation claim”?. The answer is always the same. For Washington State work injury claimants, the value of your workers’ compensation claim depends on several factors. And, it is unique to your claim.

I know it can be hard for work injury claimants to make ends meet. Many are receiving 40% less of what they were getting before the injury. Considering that many have families that they need to support, this can be even more difficult. However, we are lucky to live in Washington State where injured workers have rights. And it’s that L&I is taking marital status and depends into consideration when they calculate time-loss compensation benefits.

Workers’ Compensation Claim Errors and Misconceptions

/ L&I attorney / 8 Comments

Workers’ compensation is a vital program for the safety and health of our workforce in Washington State. It is relatively straight forward, and the Industrial Insurance Act governs the Workers’ Compensation system. However, in my experience, most people don’t really know how the system works.

Understanding workers’ compensation claims and L&I claims

Here are seven of the most common misconceptions about workers’ compensation claims.

Medical provider – Work injury claimants must see the doctor that the employer or L&I chooses

If you had an injury at work, you can see any provider that you choose. It doesn’t have to be the provider that the Department of Labor and Industries (L&I) or the employer say you should see. If the provider is a member of the Medical Provider Network or MPN. There are thousands of providers in the MPN. In fact, there is a good chance your primary care provider is a member of the MPN. Here is more information about the MPN and finding a doctor for your L&I claim.

L&I claim settlement – Injured workers get workers’ compensation claim settlement at the end of the claim

Technically, this is not true. People with work injury may or may not receive an L&I claim settlement at the end of their claim. Many work injury claimants receive what is called a Permanent Partial Disability or PPD award at the end of their claim. The award is based on the PPD rating. However, this isn’t a settlement and there is no guarantee that you will receive this award.

Employment – A PPD award will impact future employment

Some individuals with a work injury claim have concerns about PPD and PPD ratings. They think that rating means branding or labeling them as “disabled”. In turn, many believe it will impact their chances to find work in the future. This isn’t necessarily true. As an injured worker, the most important thing is for you to not exceed your permanent limitations in any future employment. Additionally, you don’t have to disclose your PPD award when seeking employment in the future.

Job of injury – The employer must hold your job or cannot terminate you

Employers cannot to retaliate when someone files a workers’ compensation claim. However, they are not obligated to keep a person’s job while they are off work due to a work injury or occupational disease.

Attorney fees – L&I covers the cost of a workers’ compensation attorney

Unfortunately, this is not accurate. Workers’ compensation attorneys work on a contingent fee basis. By law, fees are taken as a percentage of the monetary award that a work injury claimant receives under their L&I claim. There is one exception where a judge may award attorney fees.

Filing lawsuit against employer – You can sue L&I, the employer, or the claim manager for wrongdoing

This is false. As frustrating as workers’ compensation claims can be, there is no legal option for suing L&I, employers, or third-party administrators. In other words, it doesn’t matter how L&I, or your employer handle your claim. You cannot sue them for it.

Maximum medical improvement means L&I will close your claim

When some work injury claimants reach maximum medical improvement or MMI, their claims can close. However, this isn’t always true because some claims can remain open even after treatment is complete. Remember, if you reach maximum medical improvement and you are unable to return to work, you may still be eligible for vocational training services. Finally, vocational retraining can take up to two years.

How to Increase Your L&I Claim Time Loss Compensation or Loss of Earning Power Benefits

/ L&I attorney / 4 Comments

Did you know that you can apply for a change of circumstance to increase your wage rate under your workers’ compensation claim in Washington State? When you do, they have to redo your L&I time loss calculation. The same applies with loss of earning payments. In short, if you’re getting time-loss compensation from L&I, or Loss of Earning Power checks, it can help increase your payments.

Calculating wages for L&I time-loss and wage benefits in your claim

People that have a workers’ compensation claim for a work injury typically receive L&I claim benefits such as time-loss compensation benefits (TLC) or loss of earning power benefits (LEP). This fact applies to people with an L&I claim that are administered by the Department of Labor and Industries (L&I). And, it also holds true for people that have a workers’ compensation claim with a self-insured employer, which is administered by a third-party administrator (TPA). In short, we refer to these benefits as wage replacement benefits, because they compensate the work injury claimant for lost wages while he or she are trying to recover from their workplace injury.

The entity that administers the claim (L&I or the TPA) must be able to determine the appropriate monthly wages. This is required in order to pay the correct amount for wage replacement benefits. According to RCW 51.08.178, monthly wages includes the injured worker’s hourly rate (or salary) at their normal work pattern at the time of injury. It must also include board, housing, fuel or other consideration of a similar nature. For example:
1) Bonuses received in the preceding 12 months;
2) The value of employer-paid healthcare benefits if the employer stopped paying for healthcare insurance coverage; and
3) Tips reported to the employer for federal income tax purposes.

How to protest or appeal a wage order?

The Industrial Insurance Act mandates L&I claim administrators to compute wages in a “fair and reasonable” manner. Here, when the claim administrator determines the wages, L&I usually issues a written L&I order decision called “wage order”. The order outlines the wage rate computation. Like other L&I orders, the wage order becomes final and binding after 60 days. However, just like other orders, you can protest or appeal it.

If you are an injured worker and you received a wage order, it is very important to review it carefully for accuracy. If it’s not correct, you must send a written protest or appeal and file it in time. Again, you must send your protest within 60 days to have L&I correct the wage computation. Once the wage under your L&I claim becomes final, the wage order cannot be changed even if it is wrong. Finally, it’s important to note that the only exception to this rule is when there’s a “change of circumstance”.

What is change of circumstance under a workers’ compensation claim?

Under RCW 51.28.040, injured workers can apply for change of circumstance after a wage order has become final and binding. One of the most common events that constitutes a valid change of circumstance is when an employer stops providing healthcare benefits.

Often, employers will continue healthcare insurance coverage for work injury claimants after opening an L&I claim. While the employer pays your healthcare coverage, it is not appropriate to include the value of healthcare benefits in the wage rate computation. However, when the employer stops paying, then a change of circumstance occurs. Therefore, if your employer stopped paying for healthcare coverage, you should file for change of circumstance. Consequently, L&I will include the value of your healthcare insurance in your wage rate calculation.

L&I time-loss calculation: Legal notes and personal experiences

In general, if the facts of your L&I claim warrant an adjustment or increase, it will apply to benefits paid up to 60 days prior to when the application for change of circumstance was filed. An inaccuracy in the original computation does not constitute a valid change of circumstance. There must be some material change that occurred after the fact.

Most workplace injury claimants I talk to are not aware that they can file a change of circumstance. Sadly, it is very common for me to discover that injured workers weren’t paid years of increased benefits because they didn’t apply for change of circumstance when the change originally occurred. Filing an application for change of circumstance is relatively easy. All you need to do is send a written request to your L&I claim manager asking for an adjustment. In this letter, you should explain the change that occurred and provide the relevant details.