Washington Workers Comp Claims: Eligibility, Filing and Appeals

The Washington Workers Compensation is fully funded by the state and there are no private carriers allowed for employers, but they can self-insure or work within groups of employers to provide coverage. In addition all employers must carry workers compensation in the state, with no waivers or exceptions for small businesses, agriculture or domestic workers as long as they are working for at least 40 hours per week. There were 25,870 state fund claims and 15,111 self-injured claims processed in Washington through the Workers Compensation program in 2008.

Work Related Injuries

Any work related injury is typically covered by Workers Compensation provided the employee was not impaired by alcohol or drugs at the time of the accident. Some occupational diseases may also be included within the program coverage. In general permanent and total disability has to be certified by a doctor and often includes the use of one or more limbs or loss of vision.

Filing a Workers Compensation Claim

The first step is to report the accident to the employer. All claims have to be filed within one year of the date of the injury. This information will be contained on the Report of Industrial Injury or Occupational Disease for the state fund or the Self-Insurer Accident Report for those companies that are self-insured. Your doctor  will provide information that outlines work restrictions and this will also be required at the time of filing or as requested.

Washington Workers Comp Claim Denials

Workers Compensation claims can be denied if the doctor fails to provide information or does not support the information provided by the employee making the claim. The employer can also appeal the decision which could lead to a claim denial if the appeal is upheld. Typically most cases are denied because of lack of documentation or inaccurate completion of the paperwork.

Appealing a Compensation Denial

To appeal a decision by the insurance provider, the employee must file an appeal with the Board of Industrial Insurance Appeals. These appeals and protests of the decision have to be received by the Department of Labor and Industry in Washington no later than 60 days after the decision has been rendered or the decision is considered to be final.

Washington Workers Compensation Payments

As with most states, Washington Workers Compensation benefits are paid as a percentage of the employees wage that can range between 60 and 75 percent. Other benefits may be paid on a fixed sum per month, typically these are benefits for permanent disability only. Benefits of total permanent disability will continue for life with a minimum amount of $185 plus additional benefits for dependents. Documentation must be provided as required based on the type of benefit being received.

Since there are different forms of appeals and legal options available in many types of workers compensation cases it is always recommended to seek legal counsel. This is particularly true if filing an appeal or if considering a third party lawsuit in cases of negligence.

Washington Workers Compensation Office Locations

Washington Department of Labor and Industries
PO Box 44850
Olympia, WA 98504-4850