Washington State's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be obtained through a state fund. Waivers are not permitted.
Exemptions from coverage may apply to certain employees, including minors working on their parents' farms, domestic employees working for employers with fewer than two full-time employees, performers under contract, and casual laborers.
Medical Benefits are provided to employees entitled to workers' compensation benefits, including coverage for necessary medical care. Initial limits are placed on physical therapy and occupational therapy, subject to utilization review. Limits are also placed on epidural injections and facet joint injections.
After the initial office visit or emergency room visit, the employee may select the initial treating physician from a network established by the workers' compensation agency. The employee may petition the worker's compensation agency for a change of doctor, or may change physicians with the consent of the employer or workers' compensation insurer.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 3 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 14 days indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 60% of the worker's average pre-injury monthly wage, or 65% if the injured worker is married or is in a registered domestic partnership, with an additional 2% benefit per dependent (up to a maximum of 10%), subject to a cap. Benefits may continue for the duration of the temporary disability. Offsets may apply for Social Security benefits, and for money recovered through third party actions.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Washington PTD benefits, known in the state as pensions, are calculated in the same manner as TTD benefits, and may continue indefinitely. Benefits are adjusted periodically for inflation. each July 1st based on increase in 120% of the SAMW; cost of living adjustment frozen from 7/1/11–6/30/12 for one year only. Offsets may apply for Social Security and recovery from third parties.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In Washington PPD benefits are determined based on a statutory schedule and an assessment of the injured worker's impairment, and are based on an estimated loss of wage-earning capacity, an amount that is independent of the injured worker's actual earnings.
Temporary Partial Disability (TPD)
Although most states offer partial benefits to workers who are injured and able to return to work, but at a reduced wage or schedule that results in a loss of income, Washington State does not offer this type of benefit to injured workers.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, a payment equivalent to the average statewide monthly wage, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 62% of the worker's wage as of the date of injury, subject to a cap in amount. Benefits may continue for minors until the age of 18, the age of 23 if the dependent is a student, or indefinitely in the event of disability, subject to the cap. Spousal benefits end upon remarriage, at which time the spouse may receive a two year lump sum benefit.
Attorney fees are set by a statutory formula or by agreement of the parties. Fees are capped at 30% of the increase in benefits or award obtained by th lawyer.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Washington Department of Labor and Industries
Insurance Services Division
7273 Linderson Way, SW
Tumwater, WA 98501-5414
(360) 902-5800 or 1-800-547-8367