Industrial Insurance
1.1 Coverage and Immunity
Industrial Insurance, also known as workers’ compensation, is designed to provide workers with coverage for injuries or illnesses arising out of the course of employment. Employers doing business in Washington may participate in the state program which is administered by the Washington Department of Labor & Industries, or, if large enough, may be eligible to self-insure. If the former, the business must register with the Department of Labor & Industries and must pay the appropriate quarterly premiums along with the premiums for workers’ mandatorily covered. The exact premium amounts depend on the nature of the business. RCW 51.32 et seq. and WAC 296-17 et seq. Employers electing to be covered under the state industrial insurance system may be eligible to join other companies in retrospective rating pools which may result in lower premiums and a significant savings. Otherwise future premium rates are set based on the company’s own history of accident rates and claims. One of the key benefits of the Industrial Insurance Act is that in exchange for paying premiums, the employer receives almost complete immunity from lawsuits by injured workers unless the employer intentionally injures the worker.
1.2 Scope of Coverage
Industrial Insurance only covers those injuries or illnesses arising out the course of employment; in other words, the employee must be acting at the employer’s direction or in furtherance of the employer’s business. Industrial Insurance coverage does not include traveling to or from work unless the employer provides the means of transportation, reimburses for transportation costs or receives some benefit as a result of the commute. If any of these are the case, the employee may have workers’ compensation coverage for any injuries occurring during their commute. A covered “industrial injury” is the result of a tangible work-related occurrence and generally excludes conditions developing gradually over time. However, covered occupational illnesses may develop over time as long as they arise proximately out of employment.
1.3 Claims
Covered employees file claims with the Department of Labor & Industry and copies are provided to their employers. Claims must be filed by the employee within one year of the workplace injury. Employers should carefully review the entire claim form and determine whether the employee accurately reported the pay rate, their marital status, dependents, how and where the accident occurred, and whether there were any similar prior injuries. In addition to questioning whether the alleged injury or illness occurred, the primary employer defense to a claim is the absence of work-relatedness for the injury or illness. Workers’ compensation claims forms are available in doctors’ offices and are generally filled out on the initial visit after a workplace injury. The claims are administered by the Department of Labor & Industries and are adjudicated by either the self-insured employer’s service company or the Department claims managers. Deadlines are critical and an employer typically has from 15 days to 60 days to object after it receives an order or letter from the Department regarding the alleged workplace injury. Failure to respond can foreclose the employer from challenging issues which may have a major impact on the outcome and costs of the claim as well as other, possibly related, litigation. When in doubt, protest in order to preserve employer rights.
If a workplace injury or illness is determined to be a temporary disability, the employee may be paid for the time they lose from work, which is commonly known as “time loss.” Employees with permanent disabilities are paid a pension and medical and surgical expenses are borne by the Department.
1.4 Appeal Rights
Employers and employees both have the right to appeal the determinations by the Department to an entity known as the “Board of Industrial Insurance Appeals.” The Board is a quasi-judicial agency which operates in the same manner as a court and applies the same rules of civil procedure and evidence. Witnesses are sworn in, exhibits may be submitted and, for the most part, testimony is taken live. Once an appeal has been filed and the matter assigned a case number, it is normally scheduled for mediation and, if the matter is not settled through mediation, the case will be assigned to a hearings judge. Hearings usually occur between 4 to 6 months after the initial scheduling conference. The affected employer, employee or the Department has a right of appeal from the Board’s Decision and Order to the Superior Court. The Superior Court “trial” is limited to the record developed before the Board of Industrial Insurance Appeals and, in the case of a jury trial, the record is literally read to the jury word-for-word. After the Superior Court trial, the matter is appealable to the Court of Appeals and, ultimately, the Washington Supreme Court, as any other Superior Court judgment.
1.5 Light Duty
Regardless of whether or not the employer chooses to agree or appeal the determination, the employer should consider creation of light duty work for the employee subject to recovery. The scope of the light duty work must be determined in conjunction with the claims manager from the Department as well as the treating physician. Light duty work may speed up the return of the employee and reduce the employer’s time loss. The Department strongly encourages the consideration of light duty by providing incentives, including 50% of the base wage and other reimbursements for employer costs in its so-called “Stay at Work” program.
1.6 Retaliation Protection
It is important for employers not to discriminate or retaliate against workers who file Industrial Insurance claims. There is an express state law providing a cause of action for employer retaliation. In addition, there is no “fault” under workers’ compensation law.
1.7 FMLA Overlap
Employers should also recognize and take advantage of the potential overlap of Industrial Insurance law and the Family Medical Leave Act (“FMLA”). The latter allows employees to take time off up to 12 weeks within any calendar year and return to work to the same or similar position. However, the 12-week period does not automatically begin to run when a worker suffers a workplace injury. Employers should notify the employee who is filing a workers’ compensation claim and taking time off, that this time off also counts toward any family medical leave benefit.
Industrial Insurance, also known as workers’ compensation, is designed to provide workers with coverage for injuries or illnesses arising out of the course of employment. Employers doing business in Washington may participate in the state program which is administered by the Washington Department of Labor & Industries, or, if large enough, may be eligible to self-insure. If the former, the business must register with the Department of Labor & Industries and must pay the appropriate quarterly premiums along with the premiums for workers’ mandatorily covered. The exact premium amounts depend on the nature of the business. RCW 51.32 et seq. and WAC 296-17 et seq. Employers electing to be covered under the state industrial insurance system may be eligible to join other companies in retrospective rating pools which may result in lower premiums and a significant savings. Otherwise future premium rates are set based on the company’s own history of accident rates and claims. One of the key benefits of the Industrial Insurance Act is that in exchange for paying premiums, the employer receives almost complete immunity from lawsuits by injured workers unless the employer intentionally injures the worker.
1.2 Scope of Coverage
Industrial Insurance only covers those injuries or illnesses arising out the course of employment; in other words, the employee must be acting at the employer’s direction or in furtherance of the employer’s business. Industrial Insurance coverage does not include traveling to or from work unless the employer provides the means of transportation, reimburses for transportation costs or receives some benefit as a result of the commute. If any of these are the case, the employee may have workers’ compensation coverage for any injuries occurring during their commute. A covered “industrial injury” is the result of a tangible work-related occurrence and generally excludes conditions developing gradually over time. However, covered occupational illnesses may develop over time as long as they arise proximately out of employment.
1.3 Claims
Covered employees file claims with the Department of Labor & Industry and copies are provided to their employers. Claims must be filed by the employee within one year of the workplace injury. Employers should carefully review the entire claim form and determine whether the employee accurately reported the pay rate, their marital status, dependents, how and where the accident occurred, and whether there were any similar prior injuries. In addition to questioning whether the alleged injury or illness occurred, the primary employer defense to a claim is the absence of work-relatedness for the injury or illness. Workers’ compensation claims forms are available in doctors’ offices and are generally filled out on the initial visit after a workplace injury. The claims are administered by the Department of Labor & Industries and are adjudicated by either the self-insured employer’s service company or the Department claims managers. Deadlines are critical and an employer typically has from 15 days to 60 days to object after it receives an order or letter from the Department regarding the alleged workplace injury. Failure to respond can foreclose the employer from challenging issues which may have a major impact on the outcome and costs of the claim as well as other, possibly related, litigation. When in doubt, protest in order to preserve employer rights.
If a workplace injury or illness is determined to be a temporary disability, the employee may be paid for the time they lose from work, which is commonly known as “time loss.” Employees with permanent disabilities are paid a pension and medical and surgical expenses are borne by the Department.
1.4 Appeal Rights
Employers and employees both have the right to appeal the determinations by the Department to an entity known as the “Board of Industrial Insurance Appeals.” The Board is a quasi-judicial agency which operates in the same manner as a court and applies the same rules of civil procedure and evidence. Witnesses are sworn in, exhibits may be submitted and, for the most part, testimony is taken live. Once an appeal has been filed and the matter assigned a case number, it is normally scheduled for mediation and, if the matter is not settled through mediation, the case will be assigned to a hearings judge. Hearings usually occur between 4 to 6 months after the initial scheduling conference. The affected employer, employee or the Department has a right of appeal from the Board’s Decision and Order to the Superior Court. The Superior Court “trial” is limited to the record developed before the Board of Industrial Insurance Appeals and, in the case of a jury trial, the record is literally read to the jury word-for-word. After the Superior Court trial, the matter is appealable to the Court of Appeals and, ultimately, the Washington Supreme Court, as any other Superior Court judgment.
1.5 Light Duty
Regardless of whether or not the employer chooses to agree or appeal the determination, the employer should consider creation of light duty work for the employee subject to recovery. The scope of the light duty work must be determined in conjunction with the claims manager from the Department as well as the treating physician. Light duty work may speed up the return of the employee and reduce the employer’s time loss. The Department strongly encourages the consideration of light duty by providing incentives, including 50% of the base wage and other reimbursements for employer costs in its so-called “Stay at Work” program.
1.6 Retaliation Protection
It is important for employers not to discriminate or retaliate against workers who file Industrial Insurance claims. There is an express state law providing a cause of action for employer retaliation. In addition, there is no “fault” under workers’ compensation law.
1.7 FMLA Overlap
Employers should also recognize and take advantage of the potential overlap of Industrial Insurance law and the Family Medical Leave Act (“FMLA”). The latter allows employees to take time off up to 12 weeks within any calendar year and return to work to the same or similar position. However, the 12-week period does not automatically begin to run when a worker suffers a workplace injury. Employers should notify the employee who is filing a workers’ compensation claim and taking time off, that this time off also counts toward any family medical leave benefit.