THE WORKERS’ COMP SYSTEM: PAST AND PRESENT

Nobody goes to work thinking, “This is the day I get hurt on the job.” Unfortunately, for many employees in the state of Washington, the day does indeed arrive when something unexpected happens that – temporarily, at least – puts an end to your ability to earn a living. It could be an accident, exposure to hazardous materials, a repetitive stress injury, or something else. Regardless of the cause, when a work-related accident or illness prevents you from doing your job, you may find yourself wondering how you will replace your income and pay the costs of treatment.

The answers to all of these questions will likely center on two words: “Workers’ Compensation.”  In this article, we’ll introduce you to Washington’s system of Workers’ Compensation and, if you ever need to resort to it, what it can do for you.

What is Workers’ Compensation? Why does it exist?

Workers’ Compensation is a form of insurance for employers and, indirectly, for their employees. It works in the same way that any insurance policy does: if something happens that the insurance policy covers, then insurance benefits will at least partially cover the loss. Employers carry coverage for work-related injuries and illnesses through a Workers’ Compensation fund, which the state Department of Labor and Industries manages.

To understand why Workers’ Compensation exists, let’s go back to 1910: the year before Washington passed its Workers’ Compensation law. If you were hurt on the job that year, you had two fundamental choices: accept your situation and try to adapt as best you could on your own, or sue your employer for compensation. Unfortunately, however, in practical terms, it wasn’t much of a choice. If you filed a lawsuit against the employer based on negligence, Washington courts followed a legal theory that when you hired on with your employer you “assumed the risk” of possible on-the-job injury. Overcoming this presumption would make your lawsuit an uphill battle that very few people could overcome: only one in ten injured workers bothered to file a lawsuit against the employer, and of those only one in ten won an award.

Although this arrangement heavily favored employers, it wasn’t perfect for them. Defending against worker’s legal actions still burdened companies in terms of paying for court costs, attorney fees, and higher private insurance premiums, and every time a worker suffered an injury or died as the result of a work-related accident and came away with nothing it contributed to bad public relations for employers. Moreover, by 1910 Washington courts were starting to move away from the old assumption-of-risk idea – and that meant that not only were the odds of employees winning in court improving, but also the judgments they were winning were increasing in dollar amounts.

One of the driving reasons for the adoption of a Workers’ Compensation law in Washington is that it offers both employers and employees a better way to cope with on-the-job injuries and illnesses:

• Creating a collective system of state-sponsored insurance for employers helps to make their costs of insurance more predictable and easier to manage.
• Except for limited situations, such as intentionally wrongful conduct on the part of the employer or its management, Workers’ Compensation precludes the possibility of an injured employee lawsuit against the company.
• Workers’ Compensation encourages better relations between workers and their employers by creating a more reliable way for workers to recover from workplace accidents and injuries. It also clears the state’s court system of the need to handle worker-vs-employer litigation.

In short, Workers’ Compensation benefits employers, employees, and the judicial system alike.

Who is eligible for Workers’ Compensation?

If your employer has at least one employee – and chances are that if you are reading this because you were hurt in a work accident or are suffering from a work-related illness or disability, you are that employee – then unless a specific exception applies it must provide Workers’ Compensation coverage. Some of the exceptions include:

• Providing a self-insurance alternative to Workers’ Compensation. Washington is one of a handful of states that is “monopolistic” in its Workers’ Compensation insurance. This means that unlike in most states the Department of Labor and Industries (“DLI”) administers the Washington Workers’ Compensation insurance fund directly. But if your employer can show the satisfaction of the DLI that it can manage its own program to insure workers, then the company can remove itself from the state’s insurance program.
• Allowing some people to exclude themselves from Workers’ Compensation coverage (for example, officers of corporations, limited liability company managers, sole proprietors, and partners of partnerships).
• Some workers who fall outside of Workers’ Compensation coverage (for example, real estate agents and brokers, children under 18 who work on a family farm, barbers, or beauticians who rent booth space).

What kinds of injuries and illnesses does Workers’ Compensation cover?

What Workers’ Compensation insurance will cover depends largely on the seriousness and duration of the injury or illness. The first hurdle you must clear is that the injury or illness must happen in connection with your work. You will need to obtain the opinion of a medical professional to support you in this regard.

What benefits are available?

If your injury or illness qualifies for Workers’ Compensation, then the following benefits are available:

• Medical expense reimbursement. Medical expenses must be approved by the DLI as being reasonably connected with treatment for the work-related injury or illness, but as long as they fall in line with DLI-approved fee schedules then there is no dollar limit on their reimbursement.
• Compensation for lost wages. These depend on whether your disability – your inability to return to work – is temporary or permanent, and if it is permanent whether the disability is partial or total.
• If you temporarily cannot return to work, Workers’ Compensation will compensate for at least some of what you used to make on the job. This generally amounts to about two-thirds to three-quarters of your gross wages, but the actual amount is subject to adjustments based on factors like whether you have a spouse or partner and how many dependents you have, combined with how this calculated amount compares to the state’s annual calculation of the “average monthly wage.”
• If you return to work within 14 days, then your temporary disability benefits calculation starts on the fourth day of the disability. Otherwise, you are entitled to temporary disability compensation for as long as your doctor certifies that you are unable to return to work.
• Permanent partial disability benefits depend on the nature of the disability. The state has percentage-based compensation schedules for things like lost limbs or partial loss of vision or hearing. This calculation becomes more complex if the disability is not covered by a schedule, and is subject to maximum dollar limits.
• Permanent total disability benefits are calculated in a way similar to permanent partial disability benefits but are subject to considerations like offsets for Social Security benefits that you may receive. These benefits last for the rest of your life, and are referred to in Workers’ Compensation as “pensions.”
• Vocational benefits. In some cases, particularly if you suffer from a permanent partial disability, it may be possible to retrain you for another type of work. Vocational benefits do not always apply. Their availability to you will depend on whether the state offers it (or if the employer is self-insured, whether the employer offers it).
• Death benefits. Sometimes a workplace injury or illness is one the victim does not recover from; in 2015, for example, 70 Washington workers died from work injuries or illnesses. Workers’ Compensation provides survivor benefits for deceased workers, including burial expense benefits and death benefits. These are subject to some limitations, such as when the spouse of the deceased worker remarries or when the worker’s children reach either 18 or 23 (the latter limit being for full-time students).

What do you have to do to claim Workers’ Compensation benefits?

Workers’ Compensation benefits are not automatic. You must file a claim to begin the process, and this has its own specific requirements that you must satisfy such as claim filing deadlines, the requirement to notify your employer, and obtaining support from a medical professional about the work-related nature of the illness or injury and its effect on keeping you from returning to work. You can learn more about the claim filing process by going online to the Department of Labor and Industries website. Another good source of information is to consult with an attorney who practices in the area of Washington’s Workers’ Compensation law.

This article is the first of a series covering Workers’ Compensation, and only provides an overview of what it is and how it works. We will go into further detail about how the various steps in the process of making a claim in future articles.

Contact an Experienced Seattle Workers Compensation Attorney

You can file your own Workers’ Compensation claim; an attorney is not required. But it should be clear by now that not all such claims are equal. Serious injuries or claims arising from the actions of third parties, or complex situations involving later-developing injuries or illnesses can all affect which statutes of limitation apply to your case.

Having a Workers’ Compensation attorney as your advocate during the claim filing process is a good insurance policy against the possibility of you inadvertently missing a statute of the limitation-based cutoff date or failing to recognize other, complementary avenues for compensation. Contact us today to help you through this process.