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Receiving coverage under Washington’s workers’ compensation plan

Being injured on the job is no picnic for Washington residents or their family members. Fortunately, the state’s workers’ compensation system gives workers the support they need to get back on their feet and back to work.

Coverage of health care services

When workers make a claim for a work-related injury or occupational disease, workers’ compensation will pay their medical bills while they recover. Workers’ compensation will be responsible for bills from all health-care providers, hospitals, surgical expenses and pharmacy bills, as well as all for other health-related services that are necessary for the treatment of work-related injuries or occupational diseases. All of the bills should be directly paid by workers’ compensation. Consequently, there should be no out-of-pocket expenses to the injured employees.

The coverage of medical benefits actually continues even if employees go back to work. Coverage of health care services lasts until the work-related injury has stabilized.

Time-loss compensation

If an employee is unable to attend work because of his or her injury, and a doctor certifies that he or she is unable to work, the Washington State Department of Labor & Industries or a self-insured employer may pay for a portion of your wages. Such wages are known as time-loss compensation.

Time-loss compensation will not cover all of the wages. For instance, the three days immediately following an injury are considered a waiting period and therefore, a worker will not be compensated for them.

Moreover, the compensation the employees receive will replace some, but not all, of the wages they were earning. According to the Washington State Department of Labor & Industries, the benefit is limited to 60 to 75 percent of the wages the employee was earning. This figure will depend on how many dependents the employee has.

The denial of insurance claims

If the Washington State Department of Labor & Industries denies an employee’s claim arising from a workplace injury, the employee has 60 days to file an appeal. If the claim is denied, the employee can file an appeal in writing with the Board of Industrial Insurance Appeals. The appeal must be sent within 60 days of receiving the claim denial.

Even if the appeal is also denied, the employee may have the option of bringing the case to a Washington State Superior Court. The problem with a workplace injury case in front of the Superior Court is that the Court only considers evidence provided during the initial appeal. Therefore, it is imperative to have a strong appeal before the Board of Industrial Insurance Appeals.

If you or your family member has been denied an industrial insurance claim based on a workplace injury or disability, contact an experienced workers’ compensation attorney who can discuss available options with you.