Workers' Compensation: Who Is Eligible in Washington State?

Have you been injured unexpectedly on the job? Are you now facing mounting medical bills and lost wages? Most people injured at work have never had to file a workers’ comp claim before. Navigating the workers' compensation system can be overwhelming, especially if you’re unsure whether you qualify. Lehmbecker Law's Seattle workers' comp attorneys understand the complexities of such claims and are here to help you get the benefits you need.

In this post, we'll break down the essential factors that determine qualification for workers' compensation benefits, empowering you to make informed decisions during this challenging time.

Who Determines Workers' Compensation Eligibility Rules in Washington State?

The Washington State Department of Labor & Industries (L&I) administers and enforces workers' compensation eligibility rules under the Washington State Industrial Insurance Act (Title 51 RCW). While the state legislature establishes the basic framework through laws, L&I creates specific regulations, processes claims, and determines eligibility.

The department works with employers, medical providers, and workers to implement these rules, ensuring the system protects both employees and businesses. L&I also has the authority to interpret and apply these rules in individual cases, though their decisions can be appealed through the Board of Industrial Insurance Appeals.

How to Qualify for Workers' Comp

If you’re injured on the job or come down with an illness after being exposed to chemicals at your place of employment, you may be eligible for workers’ compensation.

Workers’ compensation allows injured workers to receive weekly compensation and permanent impairment benefits, payment for medical treatment related to the injury or illness, and vocational rehabilitation.

Not everyone is eligible for workers’ comp, however. Eligibility depends on several factors, some of which might not apply in your situation.

To be eligible for workers’ compensation, you must meet the following requirements. Before we dive in, let's look at the brief overview:

1. Your Employer Must Have Workers' Compensation Insurance

In Washington State, all employers with at least one employee must have workers' compensation insurance (part-time employees are included).

If your employer in Washington State doesn't have workers' compensation insurance, you can still file a claim for benefits. You can file a claim with your employer or the state's Department of Labor and Industries (L&I). Employers who don't have workers' comp insurance can face penalties, including fines, stop-work orders, felony charges, civil penalties of up to $50,000, and daily fines of up to $250.

2. You Must Be Classified as an Employee

You must be an employee to qualify for workers’ compensation. That may sound obvious, but not everyone who works for a company is officially classified as an employee.

For instance, you aren't eligible for workers' comp if you work as an independent contractor, such as a freelancer or consultant, or you are a volunteer. In Washington, however, some organizations may choose to purchase workers' compensation coverage for volunteers, which only covers medical costs. Student volunteers may be eligible for medical aid-only coverage.

Sometimes, a company may misclassify an employee as an independent contractor when they should really be classified as an employee. If this happens, the employee may still be able to receive workers’ compensation.

3. Your Injury or Illness Must Happen While on the Clock

To receive compensation, your injury must happen while you are “on the job”.

You probably aren't eligible for workers' compensation if you get into a car accident while commuting to work, but if you are in the course of employment when you are in a motor vehicle accident, you will be covered. Washington State workers' compensation covers stress-related injuries that result from a single traumatic event. However, ongoing stress is not covered. First responders, though, such as firefighters, law enforcement officers, emergency medical technicians, and direct care registered nurses, may be able to claim workers' compensation for PTSD caused by accumulated psychological trauma.

In some situations, however, the connection may not be as clear-cut. For example, an employee who sustains an injury during a company retreat may be eligible for workers’ compensation, as may an employee who is on a business trip and is injured after hours. These cases are generally more challenging to determine and can be handled case-by-case.

A work-related injury or illness doesn’t ever have to be the employer’s fault, nor does it have to occur on company property. The injury is still covered even if it’s the employee’s fault, such as not paying attention where they’re walking and tripping over a step.

Types of injuries covered by workers’ comp include accident-related injuries, sickness caused by exposure, and occupational disease.

By contrast, stress-related injuries, self-inflicted injuries, injuries sustained due to drug or alcohol use, injuries caused by horseplay or fighting, and injuries sustained while committing a crime are ineligible for workers’ compensation.

4. You Must Meet the Mandatory Reporting and Filing Deadlines

Adhering to the required reporting and filing deadlines is crucial for ensuring timely access to benefits in the event of a workplace injury or illness. In Washington State, you must meet specific deadlines to initiate the claims process effectively.

First, the employee must report their work-related injury or illness to their employer promptly. While Washington law doesn't specify an exact timeframe for reporting, it's recommended that you inform your employer as soon as possible after the incident occurs. Delayed reporting could potentially impact the outcome of your claim.

After reporting the injury, the employee must file a workers' compensation claim with the Washington State Department of Labor & Industries (L&I) within one year of the date of injury or the date you became aware of its connection to your job. Failing to meet this deadline will result in the denial of your claim.

Work-related diseases must be reported within two years after receiving written notice from a doctor that the condition exists and is work-related. If you have a work-related disease, you must also file a claim for industrial insurance benefits. You complete the Washington State Fund Report of Industrial Injury or Occupational Disease. Someone else may do this for you if you cannot do so. However, it is your responsibility to make sure the claim is filed.

Special Workers' Comp Rules for Certain Workers

Even if you meet the standard eligibility requirements outlined previously, your eligibility for workers' compensation benefits in Washington State may come down to your employment category and specific exemptions delineated by state law. Here are some noteworthy exemptions and special rules that apply to certain groups of workers.

Domestic Workers

Like many other states, Washington doesn’t mandate workers' compensation coverage for employees working in private households, such as housekeepers or childcare providers. However, the application of this exemption may vary based on factors like employment status and the nature of work performed (Wash. Rev. Code § 51.12.020).

Agricultural and Farm Workers

While several states exempt agricultural and farm workers from workers' comp coverage, Washington has specific provisions regarding coverage for these employees, particularly concerning the size and nature of the farm.

Leased or Loaned Employees

If you're employed by a staffing agency and sustain an injury while working for another employer (referred to as the "special employer"), determining liability for workers' comp coverage can be complex. The allocation of responsibility between the agency and the special employer often hinges on state statutes and the circumstances surrounding the injury.

Casual or Seasonal Workers

Just like full-time and part-time employees, seasonal workers are eligible for Workers' Comp benefits in Washington for work-related injuries.

Undocumented Workers

In Washington State, even though the law doesn't specifically mention immigrant workers, it defines an employee broadly as anyone in the state working for an employer (Wash. Rev. Code § 51-08-185). Moreover, under the statutes Wash. Rev. Code. § 51-04-030-2 and 51-32-110, non-resident aliens are recognized as eligible for medical benefits and exams.

Reporting a work injury should not affect your immigration status. Washington state law protects all workers, regardless of immigration status. L&I does not ask about or report immigration status when processing claims. Federal law also prohibits employers from retaliating against workers who file L&I claims. Your personal information is kept confidential by L&I.

Workers’ Compensation Alternatives

Several alternative options are available for workers who sustain injuries on the job and either aren’t covered or are ineligible for workers’ compensation.

They include:

• Federal employees: Non-military federal employees have recourse through the Federal Employees' Compensation Act (FECA) for injuries sustained in the course of their employment.
• Mariners and seamen: Those employed in maritime roles can pursue claims under the Jones Act, also known as the Merchant Marine Act, if their injuries result from employer negligence.
• Traditional maritime occupations: Workers engaged in traditional maritime occupations, such as shipbuilders and longshore workers (excluding crew members), may find coverage under the Longshore and Harbor Workers' Compensation Act (LHWC).
• Railroad workers: Employees in the railroad industry are covered for workplace injuries under the Federal Employers Liability Act (FELA).
• Coal miners: Current and former coal miners suffering from mining-related injuries are entitled to benefits under the Black Lung Benefits Act (BLBA).

In rare situations, you may also be able to sue your employer to recover the funds needed to deal with your injuries or illness.

Get Professional Assistance Applying for Workers’ Comp Benefits

Workers' compensation is a vital resource for employees who suffer work-related injuries or illnesses. Understanding the eligibility requirements and resulting process can be complex, but with the right guidance, you can access the support you need to recover and move forward.

At Lehmbecker Law, we’re committed to advocating for the rights of injured workers in Washington State. If you or someone you know has been hurt on the job, don't hesitate to contact us for a free consultation. We're here to help you understand your rights and pursue the compensation you deserve.