Category Archives: Workers Compensation

Medical Bills After an On-The-Job Injury – Do I Have to Pay Them? (PART 2)

Last week we shared a post about dealing with medical bills after an on-the-job injury. Our quick answer was that you most likely do not have to pay these bills, depending on your specific circumstances, which we discussed. So, let’s say that you don’t actually have to pay these bills, but you’ve already paid some of them. Here are a few more questions and answers.

What About Everything I Have Already Paid? Can I Be Reimbursed??

Question: My private insurance has covered the cost of my medical care while my workers’ compensation claim was in dispute. I have been making payments to my doctor’s office, too, for co-pay and other charges. Can I be reimbursed? What about my prescription costs?

Answer: Yes, you can be reimbursed for your expenses!

You can be reimbursed for medical expenses, prescription costs, travel expenses (when appropriate) and other costs once your workers’ compensation claim has been approved. In Washington State, though, the Department of Labor and Industries will only make payment to medical providers directly for services rendered, so you cannot receive direct reimbursement for payments to your doctor, physical therapist, chiropractor, etc… These providers will need to submit bills for services under the allowed claim, receive payment for those services, and then issue refunds to you and your private insurance carrier for payments previously made. This can be a difficult process, though, as the medical providers have already been paid, often at a higher rate than what is allowed under a workers’ compensation claim, so they often would prefer to not go to the hassle of rebilling for services they have already been paid for and then make refunds to you and/or your insurance carrier in excess of the workers’ compensation payments.

Prescription costs are easier to have reimbursed. If you have receipts, you can submit a Statement for Pharmacy Services form to request reimbursement. If you do not have your receipts, you can submit this form with a printout from your pharmacy of all filled prescriptions related to the claim. The printout and the form must be signed by the pharmacist to certify that you have paid for the claimed prescriptions. Reimbursement for pharmacy expenses will be paid to you directly.

Similarly, travel expenses can be claimed under certain circumstances. If the travel was at the request of the Department of Labor and Industries, or if travel greater than 30 miles round-trip was needed to see the closest appropriate medical provider, then you can request reimbursement of mileage at the State’s rate and some extra expenses, such as ferry fares, parking charges or meal expenses. The Travel Reimbursement Request form must be submitted using the appropriate code for the type of expense incurred and receipts must be provided to support the reimbursement request. As with pharmacy reimbursements, travel reimbursements are paid to you directly.

Overpayment Of Unemployment Due To Payment of Workers’ Compensation Benefits – NOW WHAT?!?

Injured workers transition from time loss compensation under their workers’ compensation claim to unemployment compensation when they are released to return to work but do not have a job available to them. In many cases, disputes arise as to whether the release to work and termination of workers’ compensation payments is appropriate. Often, the worker tries to find physically-appropriate work while collecting unemployment compensation during the dispute process but, once their attorney secures payment of back benefits under the workers’ compensation claim, an overpayment of unemployment benefits has occurred due to the overlap between the two systems. When this happens, workers should:

  1. Notify the unemployment insurance system that they are continuing to seek payment from the workers’ compensation system, but that they are involved in an appropriate job search during the dispute process.
  2. Immediately share with the workers’ compensation attorney any notices or orders received from the unemployment insurance system. These are usually NOT mailed to the attorney of record in a workers’ compensation claim and the notices often have limited time periods within to file a protest or request for reconsideration of the determination.
  3. Hold in savings from the workers’ compensation payment the claimed unemployment overpayment amount during the dispute process until a final overpayment notice has been issued, or have the workers’ compensation attorney hold this amount in their trust account. If this is not possible, be prepared to enter into a repayment agreement with the unemployment insurance system once a final overpayment figure has been determined.
  4. Seek assistance from the workers’ compensation attorney to document all attorney fees and costs paid as part of the effort to obtain back benefits under the workers’ compensation claim. Submit this documentation to the unemployment insurance system and request a reduction in the claimed overpayment to take these attorney fees and costs into account.
  5. Continue to send any notices or orders to the workers’ compensation attorney.
  6. Once the overpayment has been repaid, check to see if the receipt of workers’ compensation back benefits changes your tax obligations. In many states, workers’ compensation payments are not taxable income, but unemployment benefits are taxable. If there is a significant payment of back benefits under the workers’ compensation claim, it may be worthwhile to file an amended tax return with the IRS to document the lower taxable income figure.

Can I Move To Another State If I Have A Workers’ Comp Claim?

Question: Can I move to another state even though I have a workers’ compensation claim in Washington State?

Answer: Absolutely!

Many claimants move to other states during the course of their workers’ compensation claims. Here are the top five things to consider when moving to another state:

  1. Tell your workers’ compensation attorney that you are moving, and update your contact information such as telephone number and address. Discuss any changes that may occur in your specific case after your move – changes in claim procedures or benefits, vocational retraining options, etc..
  2. Find a doctor in your new state that handles workers’ compensation claims from Washington. The Department of Labor and Industries offers a searchable list of providers in the United States, Mexico, Canada and other countries. Be sure to ask whether the doctor provides treatment to injured workers when making your appointment.
  3. As there is often confusion at the initial stages of treatment as to why a patient is seeing the doctor, be sure to tell your doctor that you have relocated and that you have an open, ongoing workers’ compensation claim from Washington State for which you need continuing treatment.
  4. Have your Notice of Decision authorizing your claim for medical treatment handy! This is how the doctor knows that he or she is allowed to treat you for your work-related injury. If you do not have a copy of that Notice of Decision or have lost it, ask your workers’ compensation attorney to send you a copy ASAP.
  5. Be proactive. This is your workers’ compensation claim: you have a right to your medical records. Ask for them after each visit! Give your workers’ compensation attorney the doctor’s contact information, including telephone number, fax number, and address. Get in touch with your workers’ compensation attorney if the doctor is having any difficulty getting your medical treatment paid for under your claim.

Workers’ Compensation: Are We Our Brother’s Keeper? Should We Be?

For over 100 years, the Workers’ Compensation system has protected workers in Washington State.

Just over 100 years ago, Washington State put into place our workers’ compensation system, providing the structure under which workers and businesses across the entire state pay into a fund to provide medical care, wage replacement, vocational retraining, total disability and death benefits to those workers injured, disabled or killed in the course of their employment. In exchange for their participation, businesses are provided immunity from lawsuit, even in cases of negligence. Workers are covered, even if they are at fault, if they are injured on the job.

“The common law system governing the remedy of workers against employers for injuries received in employment is inconsistent with modern industrial conditions. In practice it proves to be economically unwise and unfair. Its administration has produced the result that little of the cost of the employer has reached the worker and that little only at large expense to the public. The remedy of the worker has been uncertain, slow and inadequate. Injuries in such works, formerly occasional, have become frequent and inevitable. The welfare of the state depends upon its industries, and even more upon the welfare of its wage worker. The state of Washington, therefore, exercising herein its police and sovereign power, declares that all phases of the premises are withdrawn from private controversy, and sure and certain relief for workers, injured in their work, and their families and dependents is hereby provided regardless of questions of fault and to the exclusion of every other remedy, proceeding or compensation, except as otherwise provided in this title; and to that end all civil actions and civil causes of action for such personal injuries and all jurisdiction of the courts of the state over such causes are hereby abolished, except as in this title provided.” – RCW 51.04.010

The system has evolved over the decades to address changes in the workplace and in the economy. A balance has been sought between encouraging businesses to locate here, remaining profitable while maintaining safe workplaces, and providing the care and assistance to those workers injured or disabled on the job to reach a maximum level of medical improvement and return to gainful employment in a physically-appropriate job.

The majority of injury claims are handled by the Washington State Department of Labor and Industries, a state agency with no profit motive that is assigned the task to carefully administer the provisions of the program, directed by statute to be construed “to the benefit of the injured worker.”

Claimants, employers and providers are all parties to each claim, with the ability to protest or dispute an unfavorable determination made by the Department. If any party remains aggrieved, an appeal to the State’s Board of Industrial Insurance Appeals or beyond can be pursued. This system is not perfect, but it has worked well for many decades, allowing Washington to boast of relatively high benefit levels but as one of the lowest-cost systems in the country.

Shared Burden Versus Individual Cost Accounting

Washington is one of very few states where workers share the cost of the industrial insurance system, paying 50% of the medical aid premiums through payroll deduction. Premiums are set by risk class so that higher-risk jobs are charged higher premiums than the proverbial desk job. Everyone pays something into the system.

We all share the cost of caring for our injured brethren, be they male or female. The benefit reaped by those not injured is that their co-workers, family members, neighbors – their fellow citizens – who have the misfortune of becoming injured or disabled, have some income and medical care during their recovery. Some measure of belt-tightening may be required, but families of injured workers do not become instantly destitute.

Over the past thirty years or so, there has been a shift in thinking about the shared burdens, not just in Washington but across the country and within our national psyche. We don’t want to take care of others anymore. When a bridge is needed in Seattle, those in Yakima don’t want to pay for it, even though our entire highway system supports tourism and commerce throughout the state. So, we have an insufficient tolling system in place based on the concept that only those citizens that drive on the bridge should have to pay for it. This same attitude has now infected our industrial insurance system.

Should the overall citizenship be responsible for caring for it’s injured members? To what extent? For more in this issue, check back later this week with part 2 of this series. 

 

An Ad Campaign That Warms the Heart

General Electric is running a series of advertisements that portray their employees, working in several industries, celebrating the impact of their work on our communities as well as on individuals.

In one spot, workers who build jet engines explain the precision of their work and are shown watching a plane take off using a set of engines they built, with smiles on every face.

In another, workers in a plant that builds medical scanning machines are visited by a bus load of cancer survivors whose treatment included scans by the devices. In a third spot, workers who build engine turbines are toasted at their local watering hole because, without them, there wouldn’t be cold beer (Bud, specifically).

It’s more than just television, it’s Social Networking

General Electric has launched a website which encourages individuals to participate in its “Celebrate and Power What Works” campaign. Visitors are able to upload photos and vote on their favorites, hooking into Facebook and entering to win prizes. For every action taken on the site – – upload or like a photo, or like GE on Facebook – – GE will donate $1 towards a non-profit group supporting workers, with a new non-profit recipient each week, giving up to $10,000 to each group. Past groups that benefited from this campaign include: Veterans Green Jobs, College for Every Student, Hire Heroes USA, and the Network for Teaching Entrepreneurship. In order to participate, you have to log in using your Facebook or Twitter account, so I skipped this step.

The message: real workers make an impact on all of our lives every day.

The company’s primary message, of course, is that General Electric has an impact on our lives every day, that GE is a leader in technology on multiple fronts. But, every time I see the ads, I am more focused on the pride on the workers’ faces and the message that the work they do matters. Everyone wants their work to matter but, in many cases, blue-collar workers are portrayed in an unflattering manner.
If our manufacturing economy is to prosper, we need to respect and appreciate the workers in that sector. Young people need to be shown that skilled labor is a valued and important facet of the workforce. GE has accomplished this in their latest ad campaign and created a way for individuals, in their own small way, to take action that matters, too.

Kit Case, Causey Wright's Paralegal & Media Manager

Annual Rate Adjustment: WA Workers’ Compensation

Time Loss rates go up, but permanent impairment awards go down…

Workers’ compensation benefits to increase, decrease effective July 1.

Workers currently receiving Washington workers’ compensation wage-replacement or pension benefits will receive a 1.9 percent cost-of-living increase effective Thursday, July 1. State law requires that benefits be recalculated each year to reflect the change in the state’s average wage from the previous calendar year. The recalculation of benefits is based on the average annual wage of all workers in Washington. That wage, calculated by the Employment Security Department, rose to $47,153 in 2009, an increase of 1.9 percent from 2008.

The amount the Department of Labor and Industries or self-insured employers pay for permanent partial disability (PPD) awards for new injuries that occur on or after July 1 is decreasing by .67 percent. This decrease is based on the change in the Consumer Price Index. PPD awards go to workers who have lost a body part or suffered a permanent, disabling injury.