Get What You Deserve A Worker's Guide to Workers Compensation From The Law Office of Robert M. Keefe Copyright Robert M. Keefe 2010 Pg. 1
General Information, Not Legal Advice Information contained in the following guide provides a general overview of individual rights and employer responsibilities. In the state of Washington, the provisions of RCW Ch. 51, the Industrial Insurance Act govern these rights and responsibilities. All information below is general and not intended as a substitute for legal representation. Anyone who needs legal advice should contact an attorney for answers to specific questions. Consulting with an attorney may provide immediate benefits. Because each situation is unique, attorneys evaluate claims on a case-by-case basis. Attorneys may offer a free initial consultation although many do not. Individual case evaluation is vital to determine the steps necessary to preserve a claim following an unreasonable denial of benefits. Robert M. Keefe is an attorney who is well known in the Seattle and Western Washington area. His practice includes representing injured workers during all phases of filing claims, collecting benefits and resolving disputes. Keefe provides the information appearing below as a public service. Get a free consultation on the specifics of your case by contacting Rob Keefe at (206) 325-3333 or rkeefelaw@msn.com.. Copyright Robert M. Keefe 2010 Pg. 2
Contents Preface.5 Understanding Worker Compensation 6 Five Essential Steps for Collecting Benefits...... 8 1. File an Accident Report....8 2. Obtain Medical Care Quickly... 8 3. Avoid Confrontations, Arguments and Disputes About Fault..9 4. Keep Medical Appointments and Follow a Physician s Advice.10 5. Start a File to Organize and Retain Records... 11 Additional Questions and Information.....12 Copyright Robert M. Keefe 2010 Pg. 3
Summary Things to Do After an Accident 1. File an accident report. The state of Washington s worker compensation laws protect injured employees. Specific provisions forbid employers from terminating an employee for filing an accident report. File an accident report as soon as possible. In most cases, failure to report an accident within one year of injury will result in claim denial. 2. Obtain medical care quickly. All serious workplace injuries deserve medical attention. When in doubt about the seriousness of an accident, report incidents and request medical help immediately. Allow doctors to assess the nature of injuries and recommend a course of treatment. In addition, ask your doctor about the time required for recovery when you may return to work. 3. Avoid confrontations, arguments and disputes about fault. Filing a worker compensation claim should not be confrontational. Focus on your doctor s orders, recovery, and complying with procedural requirements. If disputes arise, consider retaining professional help to avoid compromising your employer/employee relationship. 4. Keep medical appointments and follow a physician s advice. The opinion of a trained medical professional is the best proof of an injury and recovery. Follow your doctor s advice to avoid unnecessary delays. Ask questions freely. Take medications as prescribed. Keep all follow-up appointments. 5. Start a file to organize and retain records. After filing an accident report, keep all documents and records in a safe place. In addition, keep notes detailing dates and topics of conversations. Your file should include all documents received including medical records, an accident report, official forms and personal notes. Include your claim number and the date of your accident in all correspondence. Frequently, legal advice is not necessary when suffering minor injuries. In cases involving serious injuries or unreasonable disputes, an attorney s help may help you get quick access to medical treatment, and navigate a bewildering claims process. Copyright Robert M. Keefe 2010 Pg. 4
Preface Industrial accidents and illnesses are not pleasant. An employee s livelihood is at stake, employer s lose productivity at least temporarily, and the claim process may be intimidating. Many injured workers have similar questions when encountering the worker compensation system the first time. Is my job at risk? What happens if I was negligent and caused the accident myself? Will my employer treat me fairly? How can I pay my bills while off work? How long can I receive medical treatment? What happens if I have permanent disability? All employees in the state of Washington have legal rights. All employers have legal responsibilities. A basic understanding of these rights and responsibilities makes the process of collecting benefits easier and prevents unnecessary confusion. In addition, employers who violate their legal responsibilities may incur fines. In cases involving knowing or intentional employer misconduct, fines can be severe and result in additional legal action. This guide to worker compensation benefits provides basic answers to common questions and identifies proven ways to avoid costly mistakes. The guide does not provide legal advice. The purpose of the guide is to point out general employee rights while a claim is pending. Resolving legal disputes may quickly become complex. When encountering unfair treatment or a denial of benefits which often must be appealed within 60 days, consider asking an attorney for help. Any attorney you consider should be well versed in worker compensation laws. The best worker compensation attorneys have a high level of experience negotiating with the Department of Labor and Industries or insurance companies and resolving disputes voluntarily. Copyright Robert M. Keefe 2010 Pg. 5
Understanding Worker Compensation In the state of Washington, worker compensation rights are similar to a policy of insurance under which an injured worker is entitled to medical treatment and lost wages and other benefits. The fact that an injury occurs is enough for an employee to file a claim. Common legal theories of negligence, fault and causation are not relevant. Workers compensation is a no fault system. Worker compensation claims are common throughout the United States. In 2008, injured or ill workers reported approximately 3.7 million accidents. Approximately 1.1 million employees lost work due to an on the job accident and illness. Workplace falls and traffic accidents caused 1,630 fatalities. Nationwide, considering all causes of accidents, approximately 5,100 people lost their lives due to workplace injuries. In the state of Washington, a worker compensation insurance policy may cover most or all out of an employee s out of pocket costs. Benefits paid to an injured worker typically include the following items: Lost wages Medical expenses Prescription drugs Prosthetics Permanent disability payments Additional job training As a general rule, all employers must provide employees with worker compensation coverage. The law does however create a few exceptions. These exceptions apply in a relatively small number of situations. Why Traditional Fault and Negligence Do Not Matter In a typical automobile accident case, a plaintiff must first prove fault as a condition of recovering damages. In most automobile cases, fault depends on establishing negligence or the breach of a legal duty. Worker compensation claims function differently. In a worker compensation claim, injury alone entitles an employee to compensation without proving an employer acted negligently. An injury entitles an employee to benefits. This lower no-fault standard of liability is not a gift. Employees also give up the right to collect damages for pain, suffering and mental anguish. Occasionally, a few employers may not understand their legal obligation to provide workers compensation coverage to an employee. Anyone who encounters difficulty receiving coverage should seek professional assistance. The state of Washington, through the Department of Labor and Industries, and private attorneys may help. A delay filing a Copyright Robert M. Keefe 2010 Pg. 6
claim or seeking and receiving medical treatment may compromise an employee s health and unnecessarily complicate the claim process. Copyright Robert M. Keefe 2010 Pg. 7
Five Essential Steps for Collecting Benefits An injured employee must comply with an established claim process provided by the state of Washington. The goal of all state worker compensation regulations is to create a fair and orderly claim process that provides notice to all parties involved. In addition, employees may reduce the likelihood of encountering problems by adopting a common sense approach for dealing with injuries. 1. File an Accident Report Employers typically have written procedures for reporting accidents. Industrial Insurance policies frequently require companies to provide a claim form to an injured employee after receiving notice that an accident occurred. In practice, if written procedures or accident reporting forms are not available, consider writing a brief report yourself to give to your employer and the Department of Labor and Industries. When employers do supply written procedures and forms, follow all guidelines precisely. Employees who do not provide actual notice of an injury, usually within one year of the date of the injury, may lose all worker compensation benefits. The Law Protects Employees State regulations encourage employee health and safety. To insure against retaliation, state law prohibits employers to seek revenge when an employee files a report of illness or injury. Filing a report cannot be the sole reason an employer fires an employee, cuts wages, or refuses to offer a promotion. If an employer refuses to accept an accident report, contact the Department of Labor and Industries or a private attorney and request assistance. The agency s official websites provides useful tips and explains an approved procedure to preserve benefits. The website is located at www.lni.wa.gov. Filing a claim for a minor injury may prevent a future denial of benefits. Illnesses, infections and tissue injuries that progress slowly may place employees at risk over time. A failure to file a report within applicable deadlines may invalidate an otherwise worthy claim when the full extent of injuries becomes apparent. 2. Obtain Medical Care Quickly Consider medical attention your first priority. Quality care may prevent unnecessary scarring, infections and other unnecessary complications after a minor injury. State law requires employers to provide first-aid kits onsite to provide immediate relief. When injuries become more serious, do not hesitate to ask for help at the nearest emergency room or medical clinic. Copyright Robert M. Keefe 2010 Pg. 8
Full Service Medical Care Upon initial examination, a doctor should immediately assess all injuries and determine the best course of treatment. After treating injuries, a doctor should explain injuries, the likelihood of a full recovery, potential risks, and answer patient questions. In addition, when a worker compensation claim is involved, a medical provider may offer to help you file a claim and provide future updates to interested parties. Over time, a doctor should also assess disability, if any, that may result from an accident. Finally, a doctor should determine when treatment is complete. An injured employee can choose a personal treating physician. However, restrictions apply. To be acceptable, a physician must: Hold a valid license issued by state authorities Possess professional skills necessary to treat injuries Retain a state license to provide care in one of nine approved categories Maintain facilities within a reasonable distance of an employee s residence The nine approved practice categories include doctors, nurses, nurse practitioners, podiatrists, chiropractors and dentists. Categories of approved doctors include specialists in medicine, surgery, naturopathy and osteopathic medicine. In addition, when justified by circumstances, employees may choose doctors who practice outside these approved categories when satisfying additional requirements. Changing physicians requires approval of a state case manager. Company Doctor Visits Employers, their insurance companies, or the Department of Labor and Industries may request an examination by a doctor of their choice. The employee is obligated to attend these exams, and may be accompanied by an observer. An employer or insurance company may request to observe examinations conducted by your personal physician. In the state of Washington, you may deny these requests without adverse repercussions. 3. Avoid Confrontations, Arguments and Disputes About Fault The concept of no-fault liability eliminates the necessity of proving someone did something wrong. When an employee suffers an injury while working, employers are responsible for providing a full complement of benefits. Nevertheless, a few legal defenses and exceptions may release an employer from liability. Employers are not responsible for injuries caused by alcohol or drug abuse. Self-inflicted harm is not compensable. Occasionally, employers claim the injury was caused by a third party or did not occur in Copyright Robert M. Keefe 2010 Pg. 9
the course of employment. These types of disputes may result in the denial of worker compensation benefits. Consider discussing all claim denials with an attorney. If a third party is responsible, an employee may receive both worker compensation benefits and pursue a traditional lawsuit for damages. Alternatively, if a third party is not legally responsible, an employee may still receive worker compensation benefits if an injury resulted from job related activities. When dealing with a dispute, always be courteous and avoid confrontations. Avoid discussing your claim with your employer. Claim mangers, attorneys and insurance company personnel resolve disputes daily. These professional are best equipped to resolve disputes by agreement without becoming personally involved. 4. Keep Medical Appointments and Follow a Physician s Advice Only a physician may properly determine when an employee may return to work. Returning to full-duty and regular pay status is a goal that may unduly influence employers and employees. The best practice is to allow your physician leeway when deciding when you may begin working again. The state of Washington designed compensation benefits to allow full medical recoveries. An early return, against a doctor s advice, may expose an employee to re-injury and lost benefits. Keep all medical appointments. Repeated failure to attend appointments reflects poorly on employees and claims. Insurance companies and claim managers may eventually deny a claim when an employee abandons medical treatment. Consider following a few guidelines while under a doctor s care: Attend all appointments if possible, including examinations, treatments and therapy sessions Follow your physician s orders and the advice of all medical care providers to the greatest extent possible Fill all prescriptions and take medications as directed Let your physician know if you experience problems, unexpected pain or adverse side effects from medications Always discuss medical issues openly, honestly and courteously with medical providers Limited Duties and Work Restrictions A doctor may permit you to return to work before reaching a point of full recovery. Common work restrictions include limits on lifting, bending and stooping. In addition, a doctor may limit time standing, driving or climbing. Regardless of the restrictions imposed by a doctor, follow all orders precisely. A doctor should provide restrictions in writing for the benefit of employees and employers. Copyright Robert M. Keefe 2010 Pg. 10
Occasionally, an employee may feel unduly pressured to perform restricted tasks. Nevertheless, do not violate a physician s order. Employers cannot legally penalize an employee for following work restrictions established by a treating physician. 5. Start a File to Organize and Retain Records As a general rule, request copies of all documents and forms and keep them safe. You may need copies of individual items when discussing a claim with any interested party. The Department of Labor and Industries, employers, insurance companies and medical provides may request copies occasionally. Keep all records and documents organized for easy retrieval. The initial report of an accident is a primary document. It should show the date and manner an employee first reported an accident or illness. Medical records and receipts prove a patient s course of treatment. Letters and correspondence may also be helpful. In addition, be sure all records indicate your claim number and the date of the accident. If a record does not contain that information, you may include them yourself. Copyright Robert M. Keefe 2010 Pg. 11
Additional Questions and Information Filing a claim and receiving benefits should not intimidate employees. The state of Washington provides each employee with undeniable rights. Collecting these rights may however require dealing with unexpected problems, injury relapses, and the denial of benefits. In addition, claimants frequently have questions about the following potential issues. What if my employer s worker compensation insurance lapsed for non-payment? Will I receive lifetime benefits if I am disabled? What is the best way to overturn the denial of a claim? Can my claim be reopened after it is closed? How do I calculate the amount of compensation I deserve? Does the state of Washington provide death benefits to family members? Does the location of an accident matter? The purpose of this guide is to provide a general summary of rights, responsibilities and common issues that arise during the claim process. Nevertheless, numerous additional legal issues also arise and quickly become complex. Anyone who experiences difficulty initiating a claim or receiving benefits should seek competent professional advice. The assistance of an attorney early in the process may preserve rights and insure receipt of all compensation deserved. The Law Office of Robert M. Keefe welcomes all questions and inquiries about worker rights. Call him free of charge anytime at (206) 325-3333 or email him at rekeefelaw@msn.com. Copyright Robert M. Keefe 2010 Pg. 12