All posts by Kit Case

New COVID-19 Portal for Frontline Workers

King County, WA has added a new COVID-19 portal for healthcare workers and first responders who need Coronavirus testing and are having difficulty obtaining the test. This portal, with speedy response time, will assist these workers in getting the care they need. It will also assist them in filing workers’ compensation claims.

Seattle and King County Public Health’s Notice:

Assistance for first responders and health care workers

If you are a first responder or a health care worker and are currently experiencing symptoms of COVID-19, and cannot access testing through your health care provider or occupational health, please fill out this online form for assistance. We will try to respond within 24 hours.

WA State Provides Workers’ Compensation Coverage

Seattle and King County Public Health’s new COVID-19 portal will help first responders and healthcare workers get the testing they need. This testing may result in a period of quarantine and medical treatment. A workers’ compensation claim may need to be filed if compensation for lost wages is needed.

Governor Inslee announced workers’ compensation coverage for quarantined health workers/first responders on March 5, 2020. The expanded coverage takes effect immediately and covers eligible workers already under quarantine.

“These health care workers and first responders are protecting our communities. They need to know that we have their backs. This is the right thing to do.”

– Governor Jay Inslee

The Department of Labor and Industries can pay time loss compensation to these workers during their period of quarantine. However, the Governor encouraged employers to keep these workers on their payroll to avoid the financial hit that comes with any worker’s receipt of time loss compensation under a claim.

Benefits Under a Claim

Workers’ compensation coverage can include medical testing, cover treatment expenses if a worker becomes ill or injured and provide time-loss payments for those who cannot work if they are sick or quarantined. A claim can also include benefits should death occur due to the virus.

Workers can file a workers’ compensation claim up to two years after being exposed to a disease at work.

Our suggestion to those that are diagnosed with COVID-19, and believe that they were exposed to the Coronavirus on the job, especially as a healthcare worker or first responder, is to file a claim with the Department of Labor and Industries.

How to File a Workers’ Compensation Claim

A claim can be:

  • Filed online
  • By phone: 1-877-561-FILE (3453)
  • Through your doctor’s office

As with any claim decision, the Department of Labor and Industries will issue an Order and Notice stating whether your claim is allowed or denied. You will have sixty (60) days within which to file a written protest or appeal if you disagree with the decision. A protest can be faxed, mailed or submitted to the Department online. If no protest or appeal is filed within 60 days from the date you received the order, the decision becomes final and binding on all parties.

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Contact Us for More Information

We hope this information about Seattle and King County Public Health’s new COVID-19 portal is helpful, to you or your friends and family members.

If you have any questions, either before filing a claim or if a claim should be denied, please feel free to contact our firm for assistance. We offer a free case analysis, and would be happy to discuss the circumstances you are facing with you.

DLI News: Telehealth Update

Washington State Department of Labor and Industries has issued a Telehealth Update. The changes are introduced, on a temporary basis, in response to the Coronavirus pandemic.

TeleSIMP and Telerehab Payment Policies Now Available 

Effective March 25, 2020, Labor and Industries (L&I) is temporarily allowing Structured Intensive Multidisciplinary Program (SIMP) services to be delivered as part of telehealth. This Telehealth Update is part of L&I’s Chronic Pain Management payment policy. This temporary TeleSIMP policy allows SIMP services to continue, while helping to slow the spread of coronavirus (COVID-19) outbreak by reducing in-person appointments. SIMP providers may use telehealth to deliver certain services for workers enrolled in their program. This policy isn’t intended to replace Chapter 34: Chronic Pain Management.

Effective March 20, 2020, L&I is also temporarily allowing the delivery of rehabilitation services using telehealth, called telerehab. Physical therapists, occupational therapists, and speech language pathologists may use telehealth to delivery services for established patients in outpatient settings.

L&I’s current payment policy and fee schedule already covers phone calls between providers and workers, see Chapter 10: Evaluation and Management Services for more details.

Both of these temporary policies will allow the use of the worker’s home as an origination site when they are receiving services. See L&I’s Temporary Telehealth Payment Policy for additional details. 

Updates and corrections are periodically posted on L&I’s Medical Aid Rules and Fee Schedules website. Both of these policies are available here.

Please note: a temporary telehealth policy is under consideration for brain injury rehabilitation services. If adopted, a future Telehealth Update will be issued.

Questions on the payment policies? Contact L&I at HPPM@lni.wa.gov

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DLI NEWS: TELEHEALTH VISITS

Cargill: Making Salt For a Living

As a scuba diver, I have had the pleasure of visiting Bonaire and seeing the Cargill Solar Salt Works operations. The sights and sounds of an industrial workplace caught my attention. It’s just another day at the salt mine!

Kit Case, Editor

Cargill is making salt in paradise on the island of Bonaire. A Dutch Caribbean island, Bonaire lies about 50 miles north of the Venezuelan coast. It is home to the Solar Salt Works of Bonaire.

Cargill has operated the Solar Salt Works on Bonaire since 1997, and employs roughly 40 workers. The site, on the flat south end of Bonaire, covers about 13% of the small island’s 115 square mile area.

Salt Production is a Modern Process

Abundant sunshine, an arid climate and near-constant trade winds make the process of making salt relatively fast. It takes two to three months from the time the seawater enters the salt flats until the salt crystals are ready for harvest.

Solar evaporation is a process that has been around for centuries. Salt water is collected in ponds and, as evaporation occurs, the level of salinity increases. Modern salt production involves the use of pumps to move the water closer to the harvesting site as the salinity levels rise. Once the salt is ready for harvest, heavy equipment is used to transfer the salt from the water to piles for drying. Once dry, the salt is again moved into large piles alongside the conveyor system that extends out along the salt pier. Ships arrive from ports near and far to load the brilliantly-white salt aboard.

My husband, both diver and photographer, captivated by the salt piles.

Like a mini-mountain range, the piles of harvested salt are a lovely site. Tourists pull off the road to snap photos. Scuba divers love diving on the salt pier whenever no ships are in port to load salt.

Salt Ponds are Wetlands

The salt ponds also contain habitat for flamingos and terns. Cargill has taken steps to set aside and protect these habitats, as well as providing community support for projects outside of the ponds.

Cargill partners Sea Turtle Conservation Bonaire to protect sea turtle nesting sites. It also works with STINAPA, which manages the Bonaire Marine Park, protecting the coral reef around the island to a depth of 200 feet, and the inland Washington Slagbaai National Park. 

Cargill’s solar salt works is a major employer, a tourist destination, and a community partner on the island of Bonaire. Read more about Cargill’s operations on Bonaire, here.

History of Salt Production on Bonaire

The story goes that the Spaniards began harvesting salt on Bonaire beginning in 1499. I’m sure the local Bonaireans were doing so long before that. The Spaniards did not initially inhabit the island, but used it as a hitching post on their trail of maritime commerce.

They harvested the mesquite forests for charcoal fuel, and left animals on the island. Goats were self-sufficient and hearty and were slaughtered, salted and used as meat provisions on the Spanish sailing vessels. Donkeys were brought as the heavy equipment of the time.

Later, as with many of the Caribbean islands, people from Africa were captured, enslaved, and brought to the island. They worked and lived in horrid conditions. Several of the slave quarter buildings remain on the island, some relatively intact and others mere ruins. Bonaire makes an effort to educate about the plight of the slaves that worked on the island. There are signs at each location that make it clear that whole families lived in the tiny slave huts by the sea.

Bonaire Marker
Modern dock next to historic range marker for guiding mariners safely to shore.

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DLI News: Telehealth Visits

Temporary Telehealth Visits Payment Policy 

To help support containment of the COVID-19 outbreak, the Department of Labor and Industries has issued a new temporary telehealth visits policy. This temporary telehealth policy allows medical providers to use the worker’s home as an origination site in some instances to treat injured workers. This policy is effective 3/9/2020, and expires 7/3/2020. This is an emerging situation, and this policy may be updated as needed.

L&I’s current payment policy and fee schedule already covers phone calls between providers and workers, and telehealth visits when provided at a medical origination site. Please see the DLI Fact Sheet for more details of the current policy: LI Telehealth Fact Sheet AUG 2019.pdf

The new temporary policy will stipulate the following: 

  1. In addition to providing telehealth services under the current payment policy, providers who can normally provide telehealth services using video remote technologies may now bill the following CPT© evaluation and management codes with home as an origination site: 
    1. 99211
    2. 99212
    3. 99213
  2. The documentation requirements will follow the Department payment policy established in Medical Aid Rules and Fee Schedules (MARFS) Chapter 10: Evaluation and Management Services. Under this temporary measure, providers will be required to include a note about the emergency situation (limiting exposure to COVID-19, in this case) that prompted this encounter, as well as noting that the originating site of the worker is home.
  3. Providers are encouraged to implement their clinic’s emergency response plan.

On July 3, 2020, the temporary L&I emergency telehealth policy is scheduled to end, unless the Department decides an extension is needed. This is an emerging situation, and this policy may be updated as needed.

Policy Does Not Provide Equipment to Workers

Additionally, the temporary policy will state that L&I will not provide the worker with or reimburse the worker for equipment. If a worker doesn’t have access to high-speed internet via computer or a camera phone with reliable connectivity, the provider must work with the worker to identify an alternative.

Instructions to Claims Managers re: Time Loss Payments

Claims Administration has decided to instruct claim managers not to automatically stop time loss benefits if the restrictions on an APF expire because the worker was unable to be seen in person due to COVID-19 precautions. Claim managers will be advised to assess each case and staff with their supervisor and/or ONC to decide how best to manage the claim during the period of the forthcoming temporary policy.

Questions on the payment policy after it’s published? Contact us at HPPM@Lni.wa.gov.  

If you have questions or concerns about your claim, feel free to contact our firm for assistance. We provide a free case analysis and would be happy to discuss your circumstances with you.

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CONTACT AN ATTORNEY EARLY IN YOUR CASE FOR THE BEST CHANCE AT A FAIR OUTCOME

DLI News: Coronavirus On The Job

Governor Jay Inslee and and L&I Director Joel Sacks issued a press release concerning the Department’s policy on workers’ compensation coverage related to exposures to Coronavirus on the job.

The primary news is for health care workers and first responders who are quarantined by a physician or public health officer.  Under the clarified policy, workers’ compensation benefits must be provided benefits to these workers during the time they’re quarantined after being exposed to COVID-19 on the job.  The policy also applies to others who may have accepted claims for exposure to COVID-19; for example, those who are not considered health care workers but are working in facilities with documented exposures or others whose claims may be approved.

As a reminder, answers to the following questions must be considered for workers who file claims and are not working in jobs or at facilities where exposure would be routinely expected:

Was there an increased risk or greater likelihood of exposure or contracting the disease due to the worker’s occupation (first responders or health care workers)?

If not for their job, would the worker have been exposed or contracted the condition?

Can the worker identify a specific source or event during their employment that resulted in exposure to COVID-19/Coronavirus on the job?

When exposure to or contraction of the disease is incidental to the workplace or common to all employment (for example, an office worker who may have been exposed through a fellow employee, or a waitress through a customer), the claim will likely be denied.

How to File, and What to Do if Your Claim is Denied

Our suggestion to those that are diagnosed with COVID-19, and believe that they were exposed to the Coronavirus on the job, especially as a healthcare worker or first responder, is to file a claim with the Department of Labor and Industries. A claim can be:

  • Filed online
  • By phone: 1-877-561-FILE (3453)
  • At your doctor’s office (if you complete the Report of Accident at your doctor’s office, the doctor files the form for you)

You can watch a DLI video that describes the process for filing a claim if you need more information about the process.

As with any claim decision, the Department of Labor and Industries will issue an Order and Notice stating that your claim was denied. You have sixty (60) days within which to file a written protest or appeal if you disagree with the decision. A protest can be faxed, mailed or submitted to the Department online. If no protest or appeal is filed within 60 days from the date you received the order, the decision becomes final and binding on all parties.

If you have questions or if your claim should be denied, please feel free to contact our firm for assistance. We offer a free case analysis, and would be happy to discuss the circumstances you are facing with you.

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National Ladder Safety Month

This March marks the fourth annual National Ladder Safety Month, promoted by the  American Ladder Institute (ALI). The ALI is a not-for-profit association dedicated to promoting safe ladder use. The ALI is comprised of members from the US and Canada who are ladder manufacturers and manufacturers of ladder components.

National Ladder Safety Month 2020 focuses on five key themes: 

  • February 23 – February 29: What is Ladder Safety?
  • March 1 – 7: Ladder Safety Training and Year Round Partners
  • March 8 – 14: Ladder Safety at Work
  • March 15 – 21: Ladder Safety at Home
  • March 22 – 28: Ladder Inspection and Disposal

Ladder incidents caused injuries to nearly 900 workers in Washington State in 2019. Improper ladder use ranked 8th among the state’s top 10 workplace safety and health violations for all industries.

Ladder Safety at Work

Common causes of workplace ladder-related incidents include:

  • Lack of ladder safety training.
  • The ladder used is in bad condition.
  • The ladder moves, falls over, or is set up improperly.
  • The worker slips on the rungs, overreaches, or carries objects while climbing the ladder.
  • The worker stands on the ladder’s top step.
Tips to Help Keep Workers Safe While Using Ladders

Plan for the job:

  • Use the right ladder for the job with the proper load capacity.
  • Inspect the ladder for defects and remove unsafe ladders from service.
  • Use a fiberglass ladder if there is any chance of contact with electricity.

Set your ladder carefully:

  • Set the ladder on a firm, level base, and angle it per the manufacturer’s guidance.
  • Don’t set the ladder near exit doors or near the path of pedestrian or vehicular traffic.
  • Make sure the ladder extends 3 feet above the landing.

Climb safely:

  • When climbing, use three points of contact — keep 1 hand and both feet or both hands and 1 foot in contact with the ladder at all times.
  • Never carry any load that could cause you to lose balance.
  • Never stand on the top step of a ladder.
  • Don’t pull, lean, stretch or make sudden moves on a ladder that could cause it to tip over.

For more information, including a list of trucking-specific training ladder safety training programs, take a look at the Keep Trucking Safe Blog. It is a health and safety blog for the trucking industry published by researchers at KeepTruckingSafe.org in coordination with the Washington state trucking industry.

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Physical Medicine Best Practices Project

The Physical Medicine Best Practices Project undertaken by the WA Department of Labor and Industries seeks to bring increased standardization of care and care reporting by physical and occupational therapists. The pilot project is a collaboration with community experts to implement best practices that ensure workers receive:

  • Effective physical and occupational therapy services.
  • Clinically meaningful improvement in function.
  • Focusing on return to work.

Learn more about the Physical Medicine Best Practices Project, including the stakeholders involved in the project, and watch the video, below, for an overview.

Understand How Your Providers Report to DLI

Under the Physical Medicine Best Practices Project, your physical or occupational therapist will report to your attending physician and your claims manager on a regular basis. Your therapist will use the Physical Medicine Progress Report form to document your treatment, progress, and functional ability levels. If you have an assigned vocational counselor, this report form may be used to clarify your physical abilities for purposes of documenting your ability to work. The form is currently used by your therapist on a voluntary basis, but it will be phased in and will become mandatory soon.

In addition to standardizing care and reporting, this project and, by extension, the reporting form, encourages your physical or occupational therapist to engage with you, the patient, and your doctor. Your therapist’s suggestions for evaluation by additional types of providers or for additional treatment services can be noted and shared using this form.

Best Practices Quick Reference Card

Although meant for medical providers, the Department’s Best Practices Quick Reference Card provides an injured worker with clear information about the intent of the Physical Medicine Best Practices Project. It shows the focus on patient engagement and increased communication, and outcome documentation and tracking.

Reviewing the quick reference card will give you a clear understanding of the goals and expectations for your progress in physical therapy.

KING 5 – Moratorium on Office Careers

Washington State’s Department of Labor and Industries has issued a moratorium on Office Careers retraining plans after KING 5 Investigations’ Susannah Frame reported on the company’s practices. Ms. Frame’s investigation reports, “School of Broken Promises,” have aired over the past few weeks. Links to all prior segments of Ms. Frame’s reporting are included, below.

Susannah Frame is the Chief Investigative Reporter and Specialty Reporting Coach at KING 5.  Ms. Frame’s investigation of Office Careers, an unaccredited training facility in Renton, WA, has finally drawn the attention of the Department of Labor and Industries.

Following a KING 5 investigation, Department of Labor and Industries officials said they will no longer approve requests to send injured workers to Office Careers.

Part 4: State orders halt on sending injured Washington workers to unaccredited online school

KING 5 Investigations by Susannah Frame | Aired March 3, 2020

Watch the Video

In the fourth segment of the series, “School of Broken Promises, Ms. Frame meets with an injured worker who completed a training plan at Office Careers. After 103 applications, she received 7 rejection letters, and not a single job offer.

Ms. Frame explains that, under Washington law, the Department of Labor and Industries is only supposed to utilize training facilities that demonstrate a minimum 50% placement rate – at least half of people retrained must go on to obtain jobs. Office Careers does not publish data on placement rates, yet they receive more funding from the Department of Labor and Industries than any other training facility in the state.

Ms. Frame interviewed David Johnson, owner of Office Careers. He continues to defend the practices of Office Careers instructors and the value of retraining received through their programs. He states that he has not received any complaints about it’s programs or practices.

DLI’s Moratorium on Office Careers Retraining Plans

Brian Wright received the following in an email from DLI today, March 3, 2020. We presume this is a public release.

Local media recently aired a series of investigative reports on Office Careers, a private vocational school. The allegations center on whether the school is adequately preparing students with the skills they need for employment.

L&I initiated an audit last year based on similar complaints. The audit is still in progress. Additionally, the Workforce Training and Education Coordinating Board (Workforce Board) opened an investigation into the school last week.

Effective immediately, L&I is instituting a moratorium on approving any new retraining plans for Office Careers. This will remain in effect pending the results of our audit and/or the Workforce Board investigation. We will announce any changes to this process.

Please share this message with your staff. Thank you for your partnership in helping workers heal and return to work.

Current, ongoing retraining plans are not addressed in this notice. Those plans, at this point, are allowed to continue.

Have Questions? Get Answers.

We have worked with many, many clients who successfully complete retraining programs and return to work in a new career. For many injured workers, quality vocational retraining programs bring the greatest, long-term benefit after an injury. Restoring earning capacity and/or finding satisfying work goes a long way towards making an injured whole after an accident.

If you, or a friend or family member, have any questions or concerns about a workers’ compensation claim, please feel free to contact our firm. We offer a free case analysis and are happy to discuss your questions and concerns with you. 

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KING 5 INVESTIGATION OF OFFICE CAREERS – Includes Parts 1 & 2 of the series, “School of Broken Promises.”

KING 5 – STATE LAUNCHING AN INVESTIGATION INTO OFFICE CAREERSPart 3 of the series, “School of Broken Promises.”

RETURN TO WORK – VOCATIONAL SERVICESInformation about the overall process.

KING 5 – State Launching an Investigation Into Office Careers

Washington State is launching an investigation into Office Careers after KING 5 Investigations’ Susannah Frame reported on the company’s practices. Ms. Frame’s investigation reports, “School of Broken Promises,” have aired over the past couple of weeks. Information reported prompted the State to look into the practices of Office Careers and it’s treatment of students.

Susannah Frame is the Chief Investigative Reporter and Specialty Reporting Coach at KING 5.  Ms. Frame’s investigation of Office Careers, an unaccredited training facility in Renton, WA, has drawn the attention of the Department of Labor and Industries and Workforce, which oversees retraining programs, including those for injured workers. Workforce is now launching an investigation into Office Careers.

Office Careers provides retraining to workers injured on the job, paid for by the Department of Labor and Industries (DLI). In a multi-part series, Ms. Frame laid out, in detail, what she found when she looked into the practices and results of Office Careers.

Washington state has paid millions of dollars to the uncredited, online school that aims to re-train injured workers for office jobs.

Susannah Frame, KING 5 Investigations
Part 3: Washington State Regulators Launch Investigation Into Office Careers

KING 5 Investigations by Susannah Frame | Aired February 25, 2020

Watch the Video

In the third segment of the series, Ms. Frame meets with Jim Parker, Chief Investigating Officer at WA State’s Workforce Board. Workforce is launching an investigation into Office Careers and it’s practices will determine if it has been involved in unfair business practices. Mr. Parker’s investigation will determine whether Office Careers maintains a license to provide retraining services in Washington State.

Ms. Frame also interviewed an injured worker who, after eleven months of training, says she fears becoming homeless as she faces losing her workers’ compensation benefits. Her retraining plan is scheduled to end next month, yet she says has gained no skills that would allow her to obtain an office job.

Ms. Frame notes that David Johnson, owner of Office Careers, disagrees with the information she has been reporting. He continues to defend the practices of Office Careers instructors and the value of retraining received through their programs.

What Should Happen When Retraining Ends

After completing a valid retraining program, an injured worker should have gained the skills and experience to re-enter the job market. The Department of Labor and Industries issues a determination that the injured worker is employable, based on the completion of the retraining plan. Time loss compensation benefits end with this determination of employability.

In most cases, the claim moves towards claim closure. However, sometimes claims can remain open for ongoing medical treatment, if indicated, even if the injured worker is back to work and time loss compensation benefits are no longer being paid.

Unemployment Benefits May Be Payable

Wage and hours worked data is used by the State of Washington’s Employment Security Department to determine eligibility for unemployment insurance compensation for all workers. Unemployment benefits are usually paid to a worker after a layoff. But, when a worker is injured on the job, their eligibility data is frozen while they are off of work.

If the injured worker was qualified to receive unemployment benefits on the date of their injury – and, if they were not off of work for 6+ years – unemployment benefits may be payable after time loss compensation ends.

In most cases, unemployment can be paid during the job search phase, while the injured worker is looking for physically-appropriate work or a job in their new field after retraining. Additional assistance can be provided by Worksource. This can include additional skill-building sessions, such as interview or resume writing classes. It can also include assistance with a job search, as well as the vast database of open jobs maintained by Worksource.

We have worked with many, many clients who successfully complete retraining programs and return to work in a new career. For many injured workers, quality vocational retraining programs bring the greatest, long-term benefit after an injury. Restoring earning capacity and/or finding satisfying work goes a long way towards making an injured whole after an accident.

Have Questions? Get Answers.

If you, or a friend or family member, have any questions or concerns about a workers’ compensation claim, please feel free to contact our firm. We offer a free case analysis and are happy to discuss your questions and concerns with you.

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KING 5 INVESTIGATION OF OFFICE CAREERSIncludes Parts 1 & 2 of the series, “School of Broken Promises.”

RETURN TO WORK – VOCATIONAL SERVICES

KING 5 Investigation of Office Careers

Susannah Frame is the Chief Investigative Reporter and Specialty Reporting Coach at KING 5.  Ms. Frame’s investigation of Office Careers, an unaccredited training facility in Renton, WA, is sobering.

Office Careers provides retraining to workers injured on the job, paid for by the Department of Labor and Industries (DLI). In a multi-part series, Ms. Frame lays out, in detail, what she found when she looked into the practices and results of Office Careers.

The Investigation

Some students do not finish the program or do not pass, but they are given certificates of completion anyway. Then their benefits are cut off.

Susannah Frame, KING 5 Investigations
Part 1 – School of Broken Promises
Watch the Video

KING 5 Investigations by Susannah Frame | Aired February 17, 2020

In this initial segment, Ms. Frame interviews an injured worker struggling with his training and worried about his future. She also interviews David Jordan, founder of Office Careers, and Katherine Mason, a Seattle attorney who represents injured workers.

Part 2: Training Program Not Effective, Say Workers

Watch the Video

KING 5 Investigations by Susannah Frame | Aired February 18, 2020

In the second segment of her investigative reporting, Susannah Frame interviews two injured workers who received certificates from Office Careers and were found to be employable on that basis. She also speaks with David Jordan, owner of Office Careers, who says the certificates are meant to reward students for trying, but it is up to employers to do their own evaluation of any candidate for hire. Claimant attorney Elizabeth LePley and DLI employee Rich Wilson, who oversees the worker retraining program, are also interviewed.

Our Experience with Office Careers

In our experience, injured workers with complex scenarios are offered retraining through Office Careers when other options are not readily available. This can be the result of limited skills or experience with computers, technology, or office work. Or, it may be that the worker’s level of education would hinder their ability to attend a college program. Language issues may also be present. Whatever the reason, Office Careers can be a tool for vocational counselors, and the State of Washington, to satisfy the requirements of showing that an injured worker is employable. Once found to be employable, the worker’s compensation is terminated.

Our firm has had many clients who participated in Office Careers retraining plans, some completing their program and some not. The most troubling cases involved aspects of an at-home training plan that seemed doomed to fail from the start.

Trust Your Instincts

I tell injured workers to trust their instincts. If things don’t feel right, they likely aren’t right.

Nobody is taught how the workers’ compensation works, they only learn after they’re injured. Getting advice along the way is wise. Most claimant attorneys, including our firm, offer free consultations.

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RETURN TO WORK – VOCATIONAL SERVICES