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Workers' Compensation Benefits
 

Workers in Washington State who are injured on the job or who suffer an occupational disease have the right to receive workers' compensation for their injury or illness.  Under the Washington State Workers' Compensation System, workers can receive payment for medical expenses, partial compensation for wages lost while they recover, and payments for partial or total disabilities.  Other benefits such as vocational counseling or transitional work opportunities also may be available.

 

If a worker is hurt on the job or has an occupational disease, s/he should seek medical attention right away.  The injured worker should also notify his/her employer.  If the employer is self-insured then the worker should fill out a "self-insured accident report" form.  Injured workers should see a doctor and let the doctor know that s/he was hurt at work.  In order to receive benefits, injured workers generally must apply for them within one year of injury or within 2 years from discovery of an occupational disease, but it is important to apply as soon as possible.

 

 

How do I file a claim for workers' compensation? 

 

State Claims (not self-insured)

 

Forms for filing a claim for workers' compensation are usually available at hospitals, clinics or doctors' offices.  Workers must make sure that a claim is filed.  Be careful to include all dependents when filing a claim because the number of dependents indicated on the claim form determines time loss benefits. Claim forms may be obtained at local Department of Labor and Industries field offices. To determine the location of the Department of Labor and Industries service location near you click here or call 1-800-354-5423.

 

 

Self-insured Claims

 

If the employer is self-insured then the worker should get an accident report form from the employer and be sure that the injured worker's doctor completes the "Physician's Initial Report" portion of the accident report form.  Make sure that this form is submitted to the employer or their service company. When injured on the job, workers have many rights including:

 

Choosing your Doctor: Injured workers have a right to choose any doctor who is qualified to treat the injury or disease and who is convenient.  Injured workers also have the right to change doctors, but must get approval before changing doctors or seeking another opinion.  Injured workers may request a change of doctor by contacting their claims manager.

 

Medical Care:  Workers' compensation covers the cost of all doctor, hospital, surgery or other medical services necessary for the treatment of the injury or disease.  Usually, there are no out-of-pocket expenses to the injured worker. However, if eligibility has not been decided, a medical provider may send a bill to the injured worker.  If so, keep a copy and send one to the Department of Labor and Industries. The bill will be paid if the claim is approved.

 

Time Loss Benefits: Time loss benefits are generally paid when a doctor says that an injured worker is unable to work for more than 3 days.  Injured workers receive time loss payments about twice a month as long as the doctor says the worker cannot return to any work.  Time loss benefits do not fully replace wages lost due to injury or accident.  Instead, injured workers will receive a percentage of lost wages based on marital status and family size.

 

Light Duty: Under Washington State law, while an injured worker qualifies for time loss benefits, the employer has the option of offering light duty to the injured worker- but only if, in the doctor's opinion, the injured worker is capable of performing the light duty specifically described by the employer.  If the worker believes that the light duty work is making the injury worse, s/he should immediately contact their doctor.  If the doctor believes that the work is making the injury worse the worker may be returned to time loss benefits.  To do so, notify your claim manager that you are no longer able to perform light duty work.   If only part-time light duty work is available then the worker may still be entitled to additional time loss benefits.

 

Permanent Partial Disabilities: If the injury or disease causes a permanent partial disability, the injured worker will be paid a fixed amount of money.  The amount that the injured worker receives is established by law and depends on the particular disability.

 

Freedom from Retaliation: Injured workers have protection under the law to exercise all of their rights under the Workers' Compensation laws without suffering retaliation or discrimination by their employer.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Unemployment Benefits
 

The State of Washington provides compensation to certain workers who become unemployed by no fault of their own. Generally speaking, workers must have 680 hours of covered employment in a given base year in order to meet the initial eligibility requirements. The reason why employment ended is crucial in determining ultimate eligibility. Generally, employees are entitled to benefits when their employment ends for reasons not attributable to their fault, whereas they are not eligible for benefits if they lose their job because of misconduct (such as chronic absenteeism, intentional violation of workplace rules, resignation without good cause, etc.). Once qualified, the employee's benefit amount is based upon his or her average weekly wage.

 

Unemployment benefits are administered by the Employment Security Department. Oftentimes the Department is not able to immediately verify a worker's eligibility for benefits and therefore begins to make payments on a provisional basis. If it later finds that employment ended because of misconduct, the employee must repay all benefits received plus interest.

 

 

May I appeal a denial of unemployment benefits?

 

After your initial interview with the Claims Telecenter, you will receive a written notice by mail that will allow or deny you unemployment benefits.  If you have been denied benefits, you have a right to appeal. If you have been allowed benefits, your former employer has the same right to appeal.  If either you or your employer appeals, you will have a hearing with an administrative law judge.  

 

 

How do I file an appeal?

 

You have thirty days from the date on the decision to send in an appeal.  If you write a letter, state:  "I want to appeal the denial of unemployment benefits because I disagree with the decision.  I want a hearing, and I want a copy of my file."  Include your name and address and your employer's name and address. Send the form or the letter to the address on the notice or fax it to the Telecenter using the number provided on the written decision that denied you benefits.  Make sure you keep a copy of what you send.  If you need help with your appeal, the Unemployment Law Project may be able to help you.  Their phone number is (206) 441-9178 or (888) 441-9178.

 

 

Should I continue to file for unemployment benefits while I appeal?

 

If you decide you are going to appeal the decision, you should continue to file your claims.  If you win at your hearing, you will receive benefits for each of the weeks for which you filed.  If you lose at your hearing, and you had been receiving benefits before the hearing, the Employment Security Department will try to get these benefits back from you.

 

You must keep a record of all the places you have looked for work.  If you have not been doing this, start now.  Also, write down all the prior contacts you can remember.  Contact at least three different potential employers each week, using work search methods that are customary in your line of work. These contacts can include calling or going to the personnel office of a potential employer to see if there are any jobs available, or filling out and returning a job application.  You will need to be able to tell the judge at the hearing about your efforts to get work.  If you were offered a job and didn't take it, you will have to prove to the judge that the job was not suitable for you.

 

 

What happens next?

 

After you have sent in your Notice of Appeal, you will receive a notice of the date and time of your hearing. Your hearing may be by telephone or in person.  If you cannot come to the hearing on that date, you must call the Office of Administrative Hearings.  The number to call can be found in the Notice of Hearing.  The Office of Administrative Hearings has offices in Seattle, Olympia, Vancouver, Yakima and Spokane.  Make sure you call the right office.

 

Your Notice of Appeal will also state whether the hearing will be in person or by telephone.  If you are scheduled for a telephone hearing and you feel you would be at a disadvantage if the hearing were not in person, you should call the administrative law judge and ask for a change.  For example, if you and your employer are saying two different things about what happened, it may be better to have a judge listen to you in person.  If you are scheduled for an in-person hearing and you have a condition that would make it difficult for you to attend the hearing in person, you should also call the judge.  The judge will listen to your reasons for wanting to change the way the hearing is conducted and decide whether to agree to the change.

 

 

How should I prepare for the hearing?

 

The Legislature passed a new law that affects those claims that have a Benefit Year Ending (BYE) of January 1, 2005 or later. Generally, you will not receive benefits if the judge decides that you quit your job without a good reason, known as "good cause."  If you were fired, you will not receive benefits if you did something on the job that the judge thinks is "misconduct."  We will describe below what is good cause and what is misconduct.  If you quit, think about how you would show that it was for good cause.  If you were fired, think about how you would show that it was not because of misconduct.  Write down what you want to tell the judge about good cause or misconduct and bring these notes to your hearing.  

 

IF YOU QUIT YOUR JOB:  RCW 50.20.050(2) is where the new law on quits can be found.  If you quit your job with good cause, you are eligible for unemployment benefits.  The burden is on you to prove good cause.  Under the new law, you show good cause if you can show that you quit for one or more of the following reasons:

  1.   acceptance of other work (bona fide offer of bona fide work)
  2.  
      your illness or disability, or the illness, disability or death of someone in your immediate family
  3.   relocation of your spouse due to a mandatory military transfer
  4.   your protection or the protection of a member of your immediate family from domestic violence or stalking
  5.   reduction of your usual income by at least 25 percent
  6.   reduction of your usual hours of at least 25 percent
  7.   a change in your worksite that caused a problem with commuting
  8.   a deterioration of worksite safety
  9.   the existence of illegal activities in the worksite
  10.   a change in your usual work which violated your religious convictions or sincere moral beliefs

 

You also need to show that before you actually quit, you tried to solve the problems you were having at your job.  For example, if you talked with your supervisor and asked him for a different job or a different shift, you should tell the judge that.  If you did not do this, you need to explain why you felt it would have been completely useless to try to change things that way. There are some situations where the judge may find that you most likely did not have good cause to quit.  For example, if you quit because you were no longer satisfied with the work, or the reduction in hours and pay were a result of something you had control over, or the new job offer was a sham, or you knew of the worksite safety issues before taking the job, but took the job anyway, the judge might find that you have not shown good cause.

 

IF YOU WERE FIRED FROM YOUR JOB:  RCW 50.04.294 is where the new law on misconduct can be found.  Generally, you are eligible for unemployment benefits if you were discharged or fired from your job, unless the employer can show that something you did was misconduct.  Whether something is misconduct or not is up to the judge to determine.  The judge will listen to your employer's story and your version before he/she will decide.  The employer has the burden to prove that you were fired or suspended for misconduct or gross misconduct.

The new law describes misconduct as including, but not limited to:

  1. willful or wanton disregard of the interests of the employer or a fellow employee
  2.  
    deliberate violations or disregard of standards of behavior the employer has the right to expect of you
  3. carelessness or negligence that causes or would likely cause serious bodily harm to the employer or a fellow employee
  4. carelessness or negligence of such degree or recurrence to show an intentional or substantial disregard of the employer's interest

 

Examples of misconduct or willful or wanton disregard of the employer's interests include, but are not limited to: insubordination, repeated and inexcusable tardiness after warnings, dishonesty related to employment, repeated and inexcusable absences, deliberate and illegal acts, deliberate acts that provoke violence or a violation of the law or collective bargaining agreement, violation of reasonable company rules, and violations of the law while acting within the scope of employment.

 

The new law describes gross misconduct as a criminal act in connection with your work for which you have been convicted in a criminal court, or conduct connected with your work that demonstrates a flagrant and wanton disregard of the interests of your employer or a fellow employee. The new law also describes what is not misconduct.  Misconduct does not include inefficiency, unsatisfactory conduct, or failure or perform well as the result of inability or incapacity; inadvertence or ordinary negligence in isolated instances, or good faith errors in judgment or discretion.

 

At the Hearing Your Employer Will Try To Show that:

1)   you were warned about something you were doing that was against company policy and you did not make efforts to stop what you were doing.  For example, if the company manual said you have to lock up a tool cabinet at the end of your shift, and you continued to leave it unlocked after repeated warnings from your supervisor, that might be misconduct.

2)   you did not do something your boss asked you to do, which was reasonable and part of your job.  For example, if you worked as a janitor and your boss asked you to mop the floor and you refused to do it, that might be misconduct.

 

At the Hearing You Should Try To Explain that:

1)    You were fired because your employer thought your work wasn't good enough, but you had tried your best to do it right.  For example, if you made several mistakes while operating the cash register, but did not mean to make those mistakes, it would probably not be misconduct.

2)    You didn't know what you were doing was wrong because no one had told you or warned you about it.    For example, if you were not warned by your supervisor that you should lock the tool cabinet, and you didn't know it was a rule, it would probably not be misconduct.

3)    You refused to do a dangerous job after you told your employer about the danger.  For example, if your employer wanted you to work on a machine without safety glasses and you told him or her that you refused to do it because you thought it was too dangerous, it would probably not be misconduct.

4)    You were fired for reasons that were not related to how you do your job.  One example is if your employer fired you because you got a traffic ticket and driving is not part of your job.  Getting a traffic ticket would probably not be misconduct because it has nothing to do with your job.

 

Look at Your Unemployment File

When you file an appeal, you have a right to a copy of everything in your unemployment file. If you will be having an in-person hearing, you should call the Office of Administrative Hearings number that is listed in the Notice of Appeal Filed or Notice of Hearing and ask for a copy of your file if you have not already received your file from the Claims Telecenter.  If your hearing is by telephone, you will receive copies of the documents in the mail.  Look at these documents carefully.  If there are no statements from your employer in the file, talk to someone at the Office of Administrative Hearings and tell them you want everything in the file, including the statements of other people. Look closely at your employer's statement and see if you think it is true.  If it is not true, think of ways you can show it is wrong.  Also, look closely at any written statements that are attributed to you.  These statements may be inaccurate.  Make sure you tell the judge if you disagree with anything in the file.

 

Consider Looking at Your Employer's Records

Your employer is required by law to keep records showing the hours you worked each day and each week and the reason you left your job.  You can also have access to letters of warning and other records of discipline.  If you wish to receive copies of any of these records, ask the Administrative Law Judge at the Office of Administrative Hearings well before the hearing.

 

Consider Using Documents or Witnesses to Support Your Case

If a co-worker saw or heard what you or your employer did or said, you could ask the worker to be a witness at your hearing.  A witness who is unable to attend the hearing can telephone in.  It is your responsibility to make sure your witness comes to the hearing or is at the phone at the right time. If you cannot get someone whom you are sure will help your case to agree to come to the hearing, you may ask the judge to subpoena that person.  A subpoena legally requires a person to come to the hearing.  If a witness needs an excuse to be out of work during the hearing, or is fearful of being punished for volunteering to testify, it may also be helpful to subpoena that person. You may want to tell the witness in advance that you will be sending a subpoena.

 

Documents That You Could Submit

You are allowed to submit documents to the administrative law judge to help to prove your claim.  Some things that may be helpful include:

  1. your medical records;
  2. a letter from your doctor or mental health care professional;
  3. an affidavit or sworn state­ment from someone who saw what you or your employer did or said if that person cannot be present at the hearing in person or by phone;
  4. any other document that you think would support what you are saying happened.

 

Prior to an in-person or telephone hearing, you will be mailed documents that will be used at the hearing.  If you want to submit additional documents, you should mail or fax copies to the judge and to your former employer (or to any other parties listed on the Notice of Hearing) before the hearing.  The address and any fax numbers are listed on your hearing notice. The judge may also require that you submit documents before an in-person hearing.  Make sure that you read all the information sent to you from the Office of Administrative Hearings.