LABOR AND INDUSTRIES LAW: AN OVERVIEW
Claims made by workers injured in the course of employment in the State of Washington are administered by the Department of Labor & Industries. The benefits available to people injured on the job are commonly referred to as worker’s compensation. These benefits range from temporary, total disability (TTD) compensation or time-loss, to permanent partial compensation (PPD) and vocational retraining.
While most claims to the Department of Labor & Industries are handled at the administrative level and with a claims examiner, many of the decisions by the claims examiner are challenged for one reason or another. For example, these challenges could include objections to the amount of time-loss pay or denials of conditions that an injured worker says are attributable to an accident. On occasions the Department through its claims manager will deny claims altogether stating that there is insufficient evidence to prove that an accident occurred or that the accident did not occur on the job. There are many variations to the issues that arise in the administration of these claims. Many can be worked out at the Department level with the proper investigation. Many, however, require appeal to the Board of Industrial Insurance Appeals. The Board of Industrial Insurance Appeals is an independent body established by the State of Washington to review decisions that are in dispute at the administrative level. When referred to the Board of Industrial Insurance Appeals, the claim becomes adversarial in nature. It takes on all of the appearances of a typical law suit that one would bring before the courts in the State of Washington. The rules of evidence are followed as applied in the Superior Court as are the rules of civil procedure.
At the BIIA level formality is key. While a Claimant may represent him or herself in these proceedings, often the complexity and esoterica of the proceeding exceed the experience of the average lay person. Familiarity with the procedure and the substantive law in this area are crucial to a good outcome to a Labor & Industries claim that is appealed to the Board of Industrial Insurance Appeals.
CRITICAL THINGS TO REMEMBER IN THE ADMINISTRATION
OF YOUR LABOR & INDUSTRIES CLAIM:
- Scrupulously Observe All Deadlines.
If time limits are ignored in the Claimant’s compliance with the L&I rules, it can be fatal to a successful outcome. Irrespective of the merit of one’s claim, if deadlines are missed, the Department can correctly close a claim and ignore any further requests for benefits. Notices as to dates by which Notice of Protest or Appeals must be made are given in bold print on Department Orders. If Claimant receives such an order, attention should be paid to these deadline dates so as to not lose valuable benefits.
- Time-Loss Benefits May Not Be Drawn At The Same Time Unemployment Compensation Benefits Are Drawn.
Claimants who are without a job due to industrial injury are usually desperate for income. The State has an ongoing responsibility to promptly honor legitimate requests for time-loss benefits (TTD). Often the Department or self-insured employer will ignore a claimant’s request for TTD. Sanctions can be taken against self-insured employers who ignore a claimant’s request for time-loss benefits when such are properly claimed. However, claimants must not draw time-loss benefits at the same time they draw unemployment compensation benefits. These two claims are mutually exclusive. In the worker’s compensation arena, one must be totally, temporarily disabled so as to be unable to work and earn income at their job of injury. However, in an employment compensation claim, one must attest to his ability to work. The two positions are incompatible, and drawing benefits from both places will result in what is known as an overpayment that must be reimbursed to the Department out of any other benefits available to the claimant. A worker’s representation that he or she is able to work which is necessary for drawing employment compensation benefits would necessarily bear upon that same worker’s claim for industrial insurance benefits such as time-loss and vocational retraining.
- Attend All Noted Independent Medical Examinations.
The Department or the self-insured employer may request that their own physicians examine you. These examinations, called Independent Medical Examinations or IME’s are usually done by physicians who have no allegiance to the Claimant at all. While they are proper management tools for the orderly and fair administration of a claim, all too often these IME’s are ways for employers or for the Department to avoid responsibility for on-the-job injuries and the benefits accorded injured workers from such accidents.
At these examinations, while a worker should fully disclose all of the symptoms and consequences of the industrial accident, care should be taken not to exaggerate or overstate the extent of one’s condition. The examining physicians at IME’s are fast to note malingering and symptom magnification. Claims managers, both at the Department level and by self-insured employers, are fast to utilize such an opinion by their examining physicians to either deny claims or to limit the benefits available to the worker such as time-loss or permanent, partial disability awards. The claimant should know that these “independent” examinations are often not so. Employers tend to re-hire physicians who will defend their position finding workers to be able to work. Claimants should note that the “examination” will often include observation of claimant in the parking lot, entering the building, and in the waiting room.
- Be Sure Your Claim Is Made Within One Year’s Time.
The Department or the self-insured employer is responsible for injury accidents that are first reported within one year’s time of the accident itself. Obviously, the faster one reports a claim the easier it is to prove that claim happened. With the passage of time, evidence disappears and the fact that one had an injury can be forgotten. While it is often the case that an injured worker feels he or she might get over an injury sustained on the job and wait a while to report an injury, it is prudent to bring the fact of an accident to the attention of a supervisor or an employer as soon as it happens so that a record has been made. It is also prudent to seek medical attention and open an industrial claim if the employer does not have personnel to make a record of an accident report.
- Occupational Disease.
An alternative means by which L&I claims are started is by way of reporting an occupational disease or condition. These injuries are the kind that develop over time by workers who perform tasks that are unique to the job they do, such as repetitive motion injuries to the wrist. These claims must be made, with some exceptions, within one year of the last exposure to the injurious work place hazard, or the onset of the occupational disease. All claims must be presented on forms provided by the Department.
- Permanent Disability Awards.
In addition to time-loss benefits, injured workers who have suffered bodily impairment, or Permanent Partial Disability (PPD) are entitled to an award, or settlement, for the loss of bodily function. These determinations of PPD are made usually by Department or Employer doctors subject to the approval of your treating physician. Awards may be challenged if disputed, and the claimant may keep the original award while appealing its correctness to the Board of Industrial Insurance Appeals (BIIA).
Attorneys who handle industrial injury claims can help injured workers navigate the sometimes treacherous waters of the L&I claim’s process. Often the difference between a successful and an unacceptable outcome hinges upon knowledge of the applicable rules and being able to apply the law in the most effective way possible. Early consultation with an attorney when a claim is started can help one steer the course towards the proper administration of the claim so that the maximum benefits allowable under the Industrial Insurance Act are obtained.