You may already be familiar with the existence of Workers’ Compensation in Washington and what its purpose is. But general knowledge will take you only so far when the time comes that you need to make use of Workers’ Compensation benefits after you are injured at work or suffer from a work-related illness. In this installment, we’ll take a closer look at what you will need to do to file a benefits claim.
Step one: does your injury qualify for Workers’ Compensation benefits?
Workers’ Compensation will cover almost any injury or illness you can think of, as long as it has some connection with your employment (we will call these injuries and illnesses “claim events” from here on). Claim events include soft tissue injuries like sprains and torn muscles, repetitive stress injuries, wounds suffered in accidents, respiratory afflictions, physical reactions to hazardous materials, and more.
Although most claim events will take place at the location where you work, that is not a requirement. If you are off-site but still performing your job responsibilities, such as driving to pick up office supplies, anything that happens to you while you are “on the clock” will still be a work-related claim event, including attending non-work company activities. Even some claim events that are not physical but mental in nature can become the basis for a Workers’ Compensation claim, as long as it is plausibly connected to your work environment.
There are some situations in which you can experience what would otherwise be a claim event, but it would not qualify for benefits. Some examples include:
- Misconduct or unauthorized activities. If you are doing something that you should not be doing at work, such as engaging in horseplay on the job site, being intoxicated at work or getting into a fight with a coworker, this may preclude claim eligibility. Similarly, if you are engaged in an activity that is outside of your work responsibilities and suffer a claim event, this can cast doubt on your ability to claim that it is work-related and might call your claim eligibility into doubt. In short, if what led to your injury or illness was something that could get you fired or was otherwise entirely personal in nature, it may not be a good candidate for a claim event.
- Pre-existing conditions. If you start employment with a bad back, your new employment status will not “bootstrap” such an existing condition into a claim event. The claim event must happen to you as a result of your work duties, and not be something you brought in with you. An exception to the pre-existing condition claim preclusion, however, can exist if the performance of your job aggravates that condition.
- Unforeseeable events. Even if you are at work, if your injury or illness happens because of something your employer cannot foresee or control, this may take it out of the scope of Workers’ Compensation (for example, being struck by lightning or being injured during an earthquake while at work). These types of situations are sometimes referred to as “act of God” events.
Another thing to consider when determining if your claim event qualifies for a benefits claim is whether a civil lawsuit would be more appropriate as the vehicle for your recovery. This can be the case if it was your employer’s deliberate acts that caused your injury or illness, or willful disregard for your safety at work. Another possibility is “third-party liability,” such as when a person who is not connected with your work injures you on the employer’s premises, or equipment you use to perform your duties is defective and causes you harm. In the former situation, a lawsuit may allow for a better recovery than workers’ compensation benefits would, and in the latter instance Workers’ Compensation does not apply to claims against third parties.
Step two: Reporting and filing your benefits claim
Before you file a Workers’ Compensation benefits claim with the Washington Department of Labor and Industries (DLI), the first thing you must do – after seeking immediate medical treatment if necessary – is to report the claim event to your employer, preferably in writing, either directly or through your immediate supervisor. This is a state law requirement, so failing to report can compromise your claim. Your employer has a legal duty to forward this notice to the DLI, which sets in motion that department’s assistance to you in the form of providing you with information to help you understand your rights under Workers’ Compensation.
Like so many causes of action for injury under Washington law, Workers’ Compensation claims are subject to time limits known as statutes of limitation. The time limit for injury-related claims is one year from the date on which it happened; for work-related illnesses, the time limit is two years from the date when a doctor, nurse or other health care practitioner informed you of the existence of the condition.
If your claim event involved a third party, personal injury claims in Washington are subject to a three-year statute of limitation.
If your employer attempts to persuade you not to report the claim event or takes action on its own to keep the DLI from finding out about it, that is “claim suppression” and is illegal. It is also against the law for your employer to discriminate against you or otherwise retaliate for your claim filing.
Running roughly parallel to your need to report the claim event is the advisability of seeing a doctor or other health care professional concerning your illness or injury. You will need to be able to support the existence and nature of your claim, and in many cases your doctor’s office will help you to provide the necessary documentation to the DLI (you can also report online or by telephone).
The exception to the requirement to file your benefits claim with the DLI is if your employer is self-insured (the employer will be able to tell you if this is the case). For a self-insured employer, you can file your benefits claim directly with the employer.
It is not a requirement to have an attorney help you to file your claim, although if third-party liability is an issue then this will involve a civil legal claim that you will probably want to have an attorney help you with.
What happens next?
Once you have timely filed your benefits claim, the DLI will assess whether you are eligible. If you encounter any problems during this period, such as a claim denial, that is not necessarily the end of the process. You can appeal an adverse decision, but before doing so you might want to consult with a law firm that practices in Washington Workers’ Compensation cases to ensure that nothing is overlooked and no avoidable mistakes are made which could affect the persuasiveness of that appeal. We will cover the claim appeal procedure in another post installment.