Workers Compensation - Washington

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

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Work Injury and Workplace Accident Heroes: Nominate Workers That Saved Lives

A workplace can be dangerous. It can even be deadly. When disaster occurs, many workers respond heroically to help coworkers and others, and save lives. Nominations for work injury heroes are now open.

 

Coworkers rushing to save fellow employees in a construction work accident

I recently posted about the heroic efforts of several workers in a trench collapse at a wind farm near Rainier, Washington. The Department of Labor and Industries (L&I) cited and fined several employers for the incident.  Most importantly, we must remember that several construction workers risked their own lives. Those brave workers jumped into the trench to try and rescue their fellow workers.

 

Police officers heroes save lives after public shooting

Similarly, three police officers were recognized in the news and other media outlets for lifesaving efforts in Des Moines, Washington.  Very recently, on July 13, 2020 there was a shooting incident near a Metro stop in Kent, Washington, injuring six people.  An off-duty Des Moines K-9 police officer, Doug Weable, was in his patrol car. The police dispatcher flagged him down to help.  Immediately, the officer went to work using a shirt to apply a chest seal to 15-year-old victim.  In parallel, Officer Weable directed a bystander to move another 16-year-old victim onto his side to aid in his breathing.

 

Two other officers, Johnny Tyler and Shay LaMarsh responded to the scene and used advanced medical training to assist with other victims.  Luckily, these officers were trained in combat first aid alongside Army Rangers and Special Forces medics at Joint Base Lewis McChord near Lakewood, Washington.  Consequently, following their quick actions, the officers saved the lives of the shooting victims.  There’s no question that these officers acted heroically to save the life of others.

 

There are many work-injury heroes among us

While these officers received public credit, there are many workplace heroes that did not. For example, those fearless construction workers that helped after the trench collapse accident. However, that’s why every year, the Washington State Governor honors workplace heroes at the Governor’s Industrial Safety and Health Advisory Board  (GISHAB). This year, the Governor is presenting the awards at the virtual GISHAB conference occurring September 21-25, 2020.

 

Workplace hero nominations

If you know of live-saving incidents that occurred between June 1, 2019 and May 31, 2020, then you can nominate your fellow workers. All workers of a state-funded or self-insured employers are eligible for nomination.  Here, the most important nomination criterion is that a nominee performed hands-on aid. This is especially important for law enforcement officers, firefighters, and emergency medical technicians (EMT). To qualify for consideration, those and other similar professions must perform a lifesaving action beyond the call of duty.

 

This year, the deadline to nominate is July 31, 2020. Furthermore, the Governor will give out a humanitarian award to workers who tried to render lifesaving assistance to others, unsuccessfully. Workplace hero nominations can be submitted on the GISHAB website.  Finally, the registration for the Virtual Governor’s Industrial Safety & Health Conference  opens in August.

 

L&I Pension – Permanent Total Disability

An L&I pension is an important benefit after a serious work injury. For example, a catastrophic work injury or occupational disease can make work injury victims unemployable.  Here, unemployable means that the person is unable to “perform or obtain a gainful occupation with a reasonable degree of success and continuity”.  If medical treatment or vocational services cannot make the person employable, then the work injury claimant is permanently and totally disabled.  If you have an L&I claim or workers’ compensation claim, and you are permanently totally disabled, then you are entitled to “L&I pension” benefits under your claim.

 

L&I pension payments

When the Department of Labor and Industries (L&I) places a work injury claimant on L&I pension, then their L&I claim is closed. However, the injured worker receives L&I pension benefits for the rest of their life, so long as they remain unemployable.  L&I pays out pension benefits monthly, around the 15th of each month.  The amount depends on the worker’s salary and wages at the time of injury.  Furthermore, if the worker is married, then he or she can choose for their spouse to get survivor benefits. Simply put, “survivor benefits” means that if the work injury claimant passes then their spouse will receive the pension benefits. Under certain circumstances, this choice may also impact the monthly L&I pension amount.

 

Permanent total disability and L&I pension

There are many factors to consider when determining whether a work injury claimant is permanently and totally disabled.  These factors include the following considerations, among others:

1) The worker’s work pattern at the time of injury – part-time employment, full time, seasonal worker, and so on.

2) Whether the work-accident, injury, or work-related illness cause the permanent physical or mental limitations.

3) Were there any preexisting permanent (physical or mental) limitations?

 

 

4) The person’s wage-earning capacity.

5) The local labor market.

6) The worker’s strengths and weaknesses.

7) The work injury claimant’s age, education, training, and experience.

 

Based on these factors, L&I may consider the workplace injury claimant as permanently and totally disabled.  Even if a person is not physically or mentally helpless, they can still fall under the qualifications. However, we have to remember that an injured worker doesn’t have permanent total disability just because they cannot return to their former job. In fact, if the worker can perform or obtain any gainful work with success and continuity, then they are employable.

 

Employability: Are you employable?

The Department of Labor and Industries places great value on employability, for a variety of reasons.  From my perspective, there are some issues with how L&I views and evaluates employability. In my opinion, saying that someone is employable on paper is not the same as how things manifest themselves in the real world. Furthermore, it’s not uncommon for employability determinations to be based on erroneous or insufficient medical or vocational evidence.

 

Getting L&I pension help from an L&I attorney

As I see it, most people with a workers’ compensation claim recover from their injuries or illness and return to work. However, there are many individuals with L&I claims that need assistance to return to work.  Comparatively, only a small number of workplace injury claimants have permanent and total disability. If you have an L&I claim or a workers’ compensation claim, and the claim administrator is saying you are employable when you are not, then you should immediately speak with a workers’ compensation attorney.

L&I and Workers Compensation Claim Fraud

The Department of Labor and Industries (L&I) takes L&I claim fraud very seriously.  Under the Industrial Insurance Act, the letter of the law refers to fraud as “willful misrepresentation”.  Under the law (WAC 296-14-4121) it says:

“[I]t is willful misrepresentation for a person to obtain payments or other benefits in an amount greater than that to which he or she would have otherwise been entitled. Willful misrepresentation includes making a willful false statement or the willful misrepresentation, omission, or concealment of any material fact.”

In fact, if L&I finds willful misrepresentation, they can demand repayment and assess a 50% penalty.  If the willful misrepresentation is egregious, it can lead to criminal charges.

 

L&I claim fraud and scam

Recently, there was a story about a who pleaded guilty to a first-degree theft felony, in Renton, Washington. The man used his wife’s name and social security number to obtain work.  He worked in multiple delivery jobs as a driver while collecting L&I time-loss and pension benefits. To receive pension benefits means he contended that he was incapable of working on a permanent basis. Moreover, in addition to the criminal sentence, he must repay $340K in benefits. Ultimately, this is one of the largest L&I scams in history. This story received a lot of media coverage.

 

Receiving time-loss or pension benefits under a workers’ compensation claim

A work injury claimant may not be able to work while recovering from an industrial injury or occupational disease. Therefore, to support injured workers during their recovery, they should get time-loss compensation. Here, to be paid, the time-loss compensation must be “certified”.  Under a state-funded L&I claim, basic time-loss certification requires:

(1) Chart notes and forms from the attending provider, or the treating or consulting provider;

(2) An accompanying Activity Prescription Form (APF) from the examining provider; and

(3) A Work Status Form (WSF) completed by the workplace injury claimant.

 

Generally, L&I makes every injured worker complete a WSF approximately every 30 days.  If the work injury claimant fails to complete a WSF, then L&I might stop time-loss payments.  The WSF is the best tool that L&I employs to prove willful misrepresentation. Explicitly, the WSF specifically asks the work injury claimant if they are working.  It is not ambiguous. In fact, the bottom of the form must be signed by the injured worker, as shown in the image below. Signing serves as confirmation that the form contains truthful information.

L&I work status form

 

L&I claim fraud while on pension

If you receive pension payments because of your workplace injury, you must complete and file a form once a year. The name of this annual form is Declaration of Entitlement.  Remember, when completing this form, it must also be notarized. The form clearly asks whether the work injury claimant worked since submitting their last declaration. If the form is not complete within 30 days of its due date, L&I may suspend pension payment.

 

Final remarks

To summarize, dishonest people can hide work activity while collecting time-loss compensation or pension payments. Consequently, they are causing real and measurable damage to the workers’ compensation system. This behavior is unspeakable and is not tolerated. As L&I said in a recent announcement, this kind of willful misrepresentation is not a victimless crime.

 

Fraud in workers’ compensation claims and L&I claims hurts honest people trying to get better after a work injury. Recall, employees (and employers) pay L&I insurance premiums out of their pocket. They (and other stakeholders) are obvious victims. And, with that in mind, it’s important that victims of workplace accidents must be honest about their work status. That way, the system can continue to help those who really need help and assistance.

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