If you are employed in Washington, you will be reassured that your employer must have workers’ compensation insurance to protect you in the event that an accident takes place while you are at work or carrying out duties concerned with your job. Workers’ compensation helps to pay for any medical expenses associated with a workplace injury or illness as well as replace part of any lost earnings. Not every claim is accepted by the state insurer. If a claim is denied, it doesn’t necessarily mean losing compensation as an appeal can challenge the decision and lead to a payment being made. It helps to have an experienced workers’ comp. attorney to assist with an appeal. Workers’ Comp. Law in Washington The Washington State Department of Labor & Industries (L & I) is the agency that oversees workers’ compensation arrangements in the state. It also handles most of the insurance itself, which makes Washington’s workers’ compensation claims and appeals different from most other states where typically a private insurance carrier is involved. In Washington, most employers must have workers’ comp. insurance, even if the employer only has a single part-time worker. The very few exceptions include domestic workers or people who do odd jobs such as gardening or repair work on an ad hoc basis in a private home. If you are injured or become ill at work you must first inform your employer as soon as possible, preferably in writing giving as much detail as possible. Immediately after an accident, your employer is required by law to ensure you have access to a doctor or are taken to hospital by ambulance if necessary. You submit a workers’ compensation claim to the L & I providing as much documentation such as medical reports and receipts. The L & I handles all insurance claims unless the employer has self-insured with a private insurer, something which is usually only available to very large, well established employers. The L & I will make a decision whether to make a payment or deny the claim as it is in which case an appeal may be made. Reasons for a Workers’ Comp. Claim Denial There are several reasons why the L & I may either deny your claim for compensation completely or reduce the compensation component requested without further information. The L & I will provide a reason or reasons why a denial of the claim has been made. Typical reasons for a denial include: not informing the employer or not providing sufficient details of what went wrong; making a claim too late; a claim that your injury or illness did not happen at work; a claim that you deliberately caused an accident to happen; a claim that you were drunk or had been taking drugs at work; a claim that you did not use the appropriate safety equipment. Any of these reasons can be challenged by filing an appeal, but if it gets to this stage you are advised to seek legal help. How the Workers’ Comp. Appeals Process Works in Washington The first stage in an appeal after a claim denial is a written protest to the L & I (assuming they are handling your employer’s insurance) giving details of why you think you are entitled to compensation and why the denial is not justified. This must be done within 60 days after the denial has been made. The L & I will respond to the protest with a decision to reverse or accept the original claim. If the decision is unfavorable you can then appeal to the Board of Industrial Insurance Appeals (BIIA). The BIIA may arrange a mediation meeting before organizing a formal hearing. Mediation may resolve the dispute which will mean the hearing will not be necessary. At the hearing, a judge will examine evidence and review the claim and reasons for the denial and then make a decision whether to change the original ruling. There are furthers steps that can be taken if the judge’s decision is still unfavorable. A request for a review to the BIIA can be made and if the review is still unfavorable, the final appeal stage is to the state’s Superior Court. Why You Should Hire a Worker’s Comp. Attorney The appeals process is very complicated as can be seen from the description above. If you fail to follow the established procedure or keep to the timeline required or fail to provide sufficient documentation then you risk losing the appeal prematurely. The best advice if you are contemplating an appeal is to contact an experienced workers’ comp. attorney first to discuss your case and how the attorney can best help you through the appeal.
