Workers Compensation - Washington

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

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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

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.

Retrospective Ratings and legal conflicts in L&I workers’ compensation claims

Lately I encounter more and more conflict in L&I claims. What I mean by conflict, in the context of this article, is disagreement over work injuries that results in litigation. I attribute the increase in L&I claim conflicts to the Retrospective Ratings program.

 

What is Retrospective Rating program?

According to The Department of Labor and Industries (L&I) the Retrospective Rating program is a safety incentive for employers to reduce the amount of workplace injuries.  Additionally, employers can earn a partial refund of their workers’ compensation premiums. Refunds are available whenever claim costs are lower than expected. L&I calculates employer premiums either 10 months after the coverage period ends, or retrospectively for that 12-month period.

 

L&I created this program to promote workplace safety and lower work injury and accidents. However, it is entirely inconsistent with what workers’ compensation is all about. Workers’ compensation, by definition and by law, is there to provide relief for people with a work injury, without questions of fault or negligence. Instead, the Retrospective Rating program only weakens the most basic principles of workers’ compensation. Furthermore, it created a new set of conflicts in workers’ compensation claims.

 

Retrospective employers and retrospective groups

Under Retrospective Ratings, employers and employer groups hire legal representatives to prevent work injury claims just to keep work injury claim costs low. I recently see an increase in client calls from people with work injury dealing with employers that are forcing them into litigation. In turn, work injury claimants must hire a workers’ compensation attorney and legal representation and mount expensive legal battles just to get their workers’ compensation claim allowed. There is nothing here that increases work safety or reduces work injury occurrences.

 

Employers taking advantage of retrospective groups

One retrospective group advertises that they secured over $600 million in premium refunds for its 1000 employers. Another group has a picture of a work injury claimant on the beach as their cover photo. Others advertise that they assist employers in reducing the number of L&I claim incidents and costs. While some groups appropriately focus on helping employers achieve safe work environments, others could not care less about this objective.

 

While employers are enjoying things like ~$600 million in premium refunds, victims of a work injury are suffering. These days, L&I will reject a claim because the retrospective ratings employer or group convinces them to do so. It can cost work injury claimants $2500-$5000 just for expert medical testimony to prove the decision is wrong. Most people that suffer an injury on the job cannot afford this, and the Department rejects their L&I claim. They are often left on their own to try and obtain treatment and recover from their occupational disease or industrial injury.

 

Summary

The Retrospective Rating program missed its mark. Rather than incentivizing employers to have safer workplaces, it encourages them to engage in sanctions and L&I claim suppression.  From my perspective, with programs like the Retrospective Raring program, L&I is failing in its duty to provide sure and certain relief to work injury victims.

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