It’s fulfilling when you find a career that allows you to care for your family and keep your life running smoothly. If you’re injured on the job and can’t work, it can derail everything. Fortunately, Washington requires that employers pay your expenses when you’re hurt in the workplace. They must have mandatory Workers’ Compensation insurance to pay for your medical bills, medications, lost income, and other costs.
The system is beneficial for injured employees as it pays injury-related expenses without proving fault. To gain access to comp benefits you must follow the rules and time-sensitive guidelines. Failure to comply could jeopardize your benefits or force you to return to work before you’re fully healed.
The Workers’ Compensation Monopoly
The Workers’ Compensation system in Washington is similar to those in other states, with one exception. Washington is one of only a handful of US jurisdictions where the government holds a monopoly on compensation insurance. Only Washington, North Dakota, Wyoming, Ohio, and the US territories, Puerto Rico and U.S. Virgin Islands have government-run Workers’ Compensation plans. Everywhere else in the United States, multiple insurance carriers compete to sell compensation policies in an open insurance market. That matters because in the state’s workers’ compensation system one entity controls the insurance and claim process from beginning to end.
The system has inherent inequities and shortcomings. Independent Medical Examiners traditionally favor the employer and the Department of Labor and Industry. Employers misclassify employees, making them ineligible for coverage. Self-insured employers control access to benefits. When a case moves beyond a simple temporary medical condition, it becomes complicated and difficult to manage.
One-third of the employers in Washington self-insure for workers’ compensation benefits. If they meet the state’s financial requirements, they handle their own claims, pay the same benefits, and follow the same claim guidelines.
You Deserve Compensation for Your Work-Related Injuries
At Boohoff Law, we understand that the Workers’ Compensation system doesn’t always function the way it should. That’s why we’ve worked hard to help injured workers get the benefits they deserved. We’ve learned the system’s subtle issues and tedious requirements. We’ve helped our injured clients overcome the problems that prevented them from qualifying for Permanent Partial Disabilities, Pensions, or Structured Settlements. We’ve pursued every lead to recover damages from third-party defendants.
Workers’ Compensation claims don’t always have complex issues but sometimes the system works against you. When your claim stalls or L&I denies you the benefits to which you’re entitled, you need a legal advocate working to move your claim forward. Our lawyers have helped our clients get the benefits they deserved by relying on our experience and dedication.
Our Firm’s Workers’ Compensation Injury Results
Tatiana Boohoff has dedicated Boohoff law to injury cases only. Our lawyers have worked exclusively to recover damages for injured clients. We understand that workers ‘compensation is structured differently from other indemnification systems. Those differences have challenged us to help our clients get and keep the benefits they needed to support their families.
We’re proud of the accomplishments we’ve made on behalf of our injured clients. We keep our clients’ case details private but we invite you to view their comments on our Client Testimonials page.
Workers’ Compensation Claims
When you’re injured or sustain an occupational disease on the job, your employer must have coverage in place to reimburse you for the expenses you incur. When injured employees submit a claim, payment is contingent upon whether or not the claim is accepted. Washington companies don’t get to choose their insurance company. They can give their employees one of two coverage options.
- Washington State Department of Labor and Industries: L&I provides Workers’ Compensation coverage to two-thirds of the businesses in the state. An employer who chooses coverage through the state fund may deduct a portion of the premiums from their workers’ paychecks. These deductions cover premiums for the Medical Aid Fund and the Supplemental Pension Fund, which pays pension cost of living increases.
- L&I approved self-insured plan: To maintain self-insured status, a company must meet the state’s financial criteria. Once approved, self-insured businesses administer their workers’ compensation plans themselves or contract with a benefits administrator to do it. Self-insured companies are responsible for paying the same benefits as state-funded insurance. They must handle open and reopened cases. They must also pay benefits for previously submitted claims even after they give up their self-insured status.
When you’re injured on the job, you have a lot at stake. You rely on the system to pay your bills, wage losses, and other expenses. Unfortunately, the process doesn’t always work out that way it should.
Statistics from the Washington State Department of Labor and Industries show that 124,081 workers’ compensation claims were “allowed” during the state’s 2018 fiscal year. 29,749 of these allowed cases were handled by self-insured entities. An additional 28,324 injured employees experienced a different outcome.
- 5,845 claims were determined invalid.
- 1,212 claims were Not allowed.
- 21,267 claims were Rejected.
When the Department of L&I or a self-insured entity refuses to pay a claim, the injured employee has the right to have the claim reconsidered. An employee, his doctor, or his employer may protest an L&I decision within 60 days. If they’re protesting rejected vocational benefits, they have 15 days. Any of the interested parties may file the protest online or by mail. They may also file an appeal directly with the Board of Industrial Insurance Appeals.
Types of On-the-Job Injuries
Thousands of workplace injuries occur in Washington each year. They happen in offices, in factories, and in outdoor work environments. Employees in all occupations sustain workplace injuries and occupational diseases. Many occur as a result of conditions cited in the Occupational Safety and Health Administration top-10 list of standards violations. While employees can recover from some injuries, others cause a lifetime of problems and disabilities.
When L&I tracks injuries, they list categories of incidents, body parts involved, and injury descriptions. Below are some of the most frequent injuries from claims submitted across all industries.
- Traumatic injuries to muscles, tendons, ligaments, joints
- Intracranial injuries, including skull
- Nervous system and sense organ diseases
- Traumatic back injuries, including spine and spinal cord
- Digestive system diseases and disorders of the abdomen
- Traumatic injuries to bones and nerves
- Burns on face, hands, arms, multiple body parts
- Multiple traumatic injuries, including upper extremities
- Diseases to blood and blood-forming organs
- Respiratory system diseases
- Open wounds of multiple head locations
Who Is at Fault When an On-the-Job Injury Occurs?
In 1911, the Workers’ Compensation Act changed the idea of fault for workplace injuries. The Act, which is currently codified under Title 51 RCW, created Washington’s Industrial Insurance system. Even if an employer negligently contributes to the conditions which cause an employee’s injuries, comp benefits are the primary resource for medical bills, lost wages, and related expenses.
When considering the role an employer may have played in injuring an employee, fault is usually irrelevant. Employees turn their claims into the Department of Labor and Industries. If their employer is self-insured, they deal directly with their employer’s claims administrator or contracted representative. Workers’ Compensation coverage is often seen as the only resource for payment of costs due to workplace injuries, but there are a few exceptions.
When an employer causes an intentional injury, an employee may have a right to pursue damages based on provisions outlined in RCW §51.24.020. The injured employee may collect damages above those paid out by Workers’ Compensation.
Third Party Claims
If someone other than an employer caused or contributes to a workplace injury the employee may collect additional damages through a third party claim. This may be an option under these and other circumstances.
- A defective machine caused a workplace injury.
- Improperly labeled component chemicals caused a respiratory injury.
- A driver struck a delivery van while an employee was making a delivery.
- The property owner failed to deactivate the electricity on a job site causing an electrocution injury.
- A non-employee contractor dropped an object on a worker’s head
What Benefits and Damages Can an Injured Worker Recover?
When you’re injured or sustain an occupational disease on the job, your employer must have coverage in place to reimburse you for the expenses you incur. Payment of these benefits is contingent upon the claim being “accepted:”
- Medical benefits
- Vocational services
- Time loss compensation: You receive wage replacement benefits if your doctor certifies that you’re unable to work. You benefit totals 60 to 75 percent of your wages up to the current maximum. The first three days of lost time is considered a waiting period.
- Prescription medications: A schedule of drugs is approved for payment. L&I reimburses out-of-pocket costs.
- Travel reimbursement: Pays transportation costs when your physician is over 15 miles away.
- Property reimbursement: Replaces personal property lost or damaged during an accident at work.
- Permanent partial disability: PPD benefits are based on a doctor’s rating that you can work but you will have a permanent degree of disability.
- Pension: If a doctor certifies you for Permanent Total Disability you will receive a pension. PTD usually involves a catastrophic condition such as loss of use of both legs or both arms or lost vision.
- Structured settlement: You settle your claim with L&I by agreeing to a series of periodic cash payments instead of monthly time loss benefits.
Third Party Settlement
If your attorney makes a damage claim against a negligent third party, you may also recover general damages. General damages pay for subjective issues related to personal and lifestyle changes caused by your accident.
- Pain and suffering
- Loss of family relationships
- Emotional distress
- Permanent scars and disfigurement
- Loss of bodily functions
- Permanent limitations and disabilities
- Lifestyle changes
How Can an Employer Avoid Approving a Compensation Claim?
Sometimes an employer’s drive to avoid claim payments is tied to a desire to reduce business expenses. Workers compensation claim avoidance gives them an opportunity to do that. As the coverage is mandatory, it’s an unavoidable expense but business who improve their loss experience can reduce their premiums. When a company has a retrospective rating plan L&I Auditors review their claim experience every 12 months. If they’ve lowered their claim costs, they receive a premium refund and a lower rate.
As workers’ compensation rates are based on employee work hours and paid claims, reducing claims helps employers reduce costs. An employer can reduce their worker’s compensation costs in several ways.
- Employee misclassification: Non-employees aren’t entitled to workers’ compensation benefits and they aren’t rated in premium calculations. If an employer classifies workers as independent contractors, they avoid payroll and other taxes and won’t have to include the worker or his claims when L&I rates their policy. Misclassification is sometimes a mistake, but it’s also recognized as a ploy to reduce employer costs.
- Reject your claim: When an employer rejects your claim, it reduces the company’s loss ratio which often leads to insurance premium savings.
- Fail to turn in your claim: If an employer doesn’t turn in a claim for every workplace injury that occurs, it also improves loss ratios and insurance premiums.
How Do Third-Party Defendants Avoid Paying Claims?
Third parties use the same defenses negligent entities and insurance companies use when trying to avoid claim settlements.
- No negligence: If a defendant can convince a jury that they weren’t negligent and didn’t cause an injury, they won’t owe for the injured person’s damages.
- Contributory fault: Under Washington’s Contributory Fault Statute, RCW §4.22.005, an injured person can be partially responsible for their own injuries. Juries and insurance companies reduce damages based on a person’s negligence percentage.
- Damage mitigation: Defendants can reduce a plaintiff’s damages if they prove the worker exaggerated their injuries or that some or all of the damages may have occurred elsewhere.
- No defect: If a manufacturer of a defective machine proves there was no defect, they pay nothing.
At Boohoff Law, our attorneys have handled all aspects of Washington Workers’ Compensation claims. We’ve investigated our clients’ accidents and reviewed the evidence early during the life of each case. Thorough preparation has allowed us to handle appeals and successfully manage creative third-party defenses.
Boohoff Law Workers’ Compensation Attorneys
If you’ve been injured on the job or sustained an occupational disease you shouldn’t have to fight to get your benefits. At Boohoff Law, our attorneys have worked with many injured employees. We’ve helped them get the benefits to which they were entitled. Let us determine if we can help you. Contact Boohoff Law at (877) 999-9999 or complete our online contact form. We’ll schedule a consultation to review your case.