It is no secret that workers' compensation laws in Washington are complex—even a seemingly straightforward claim can become complicated under closer examination. This article tackles some of the most common workers' compensation questions we're asked daily to help provide clarity and give covered employers some direction with claims management.

Will questioning a claim's validity get it denied?

No. It's true that Washington's Industrial Insurance Act and workers' compensation laws are considered relatively liberal and written to favor injured and ill workers. However, this doesn't mean employers can't dispute the validity of a workers' compensation claim. Employers have the right to question or dispute claims, including diagnosed conditions, work-relatedness, and even the insurance benefits the injured employee receives. 

To nullify the claim or any benefits, employers must prove the claim or coverage is invalid. This requirement of proof can be challenging for employers, which is why Archbright always recommends employer diligence in performing and documenting investigations into all workplace incidents, even if they don't seem to result in immediate injuries or illnesses. Maintaining clear and concise investigation reports can assist the state in determining whether a claim is allowed or denied. Furthermore, good documentation and recordkeeping of all workplace records, including employee training and any corrective action, can aid in future claims management. 

Does offering light-duty work to injured workers prevent time-loss payments?

Yes, if offered correctly. If a worker cannot return to their job of injury due to a work-related injury or illness, they may be eligible for time-loss benefits. Time-loss is a partial wage replacement paid out under their workers' compensation claim, which later impacts the employer's insurance rates. Employers can avoid the expense of time-loss by formally offering workers a modified position, often called light-duty, until they are released to full-duty by their healthcare provider. Light-duty has many benefits. It keeps employees working, which can aid in recovery, it helps them earn more money than time-loss payments, and it can improve workplace morale overall. Keeping an employee working in a light-duty capacity also helps the employer with production needs, keeps insurance costs lower, and employers can recuperate a portion of the employee's light-duty wages through the state's Stay-at-Work program. 

However, there are specific guidelines to satisfy when offering a formal light-duty job offer in Washington. Employers must make the job offer in writing, provide a position that falls within the worker's restrictions, and ensure the worker's attending healthcare provider approves the job description. Although employers can and should quickly identify light-duty work and verbally make an offer to get the employee back to work as soon as possible, the injured worker can refuse to return without their healthcare provider's approval and a formal job offer in place. If the worker refuses and there has been no formal job offer, the worker is eligible for time-loss benefits—even if they come back to work initially with just a verbal offer. For this reason, employers should follow the steps to formally offer a position to all workers with restrictions as soon as possible. If the employer follows the formal job offer steps and the healthcare provider has approved the description but the employee refuses, the worker should not be eligible for time-loss payments. 

Can previous injuries or pre-existing conditions be allowed on a claim?

Possibly. Sometimes, it's discovered that an injured worker has filed a claim for a specific body part for which they have a pre-existing condition or have previously injured. While most employers want to ensure their injured workers get the medical treatment they need, being financially responsible for what appears to be a non-work-related condition can be frustrating. 

Claims are typically denied if it's determined through an incident investigation or healthcare provider's medical findings that an injury or medical condition is unrelated to the workplace. However, a workplace incident could re-injure or aggravate a pre-existing condition. For example, suppose a worker injured their knee while skiing last year and had corrective knee surgery. This year, the worker slips and falls at work, re-injuring their knee and needing surgery again. In this scenario, a workers' compensation claim would likely be approved because the employee wouldn't need surgery again if it were not due to the fall at work. 
That said, insurance coverage for the claim may be reduced based on the knee condition before the re-injury. This is where having access to medical information is essential. Utilizing an experienced third-party claims administrator, such as Archbright, can help investigate medical findings to ensure that employers are only responsible for the re-aggravation and not the original non-work-related injury. 

Are employers required to allow injured workers to take time off to attend medical appointments?

Probably not. In most instances, injured workers should schedule medical and therapy appointments outside their work schedules once they have been released to full-duty by their healthcare provider or have been formally offered an approved light-duty job. This ensures they can continue to work their full schedule without missing time or pay. If, for some reason, the worker must make an appointment when they are scheduled to work, their claims manager will usually advise them to work with their employer to make up the missed time, as they will likely not be eligible for time-loss benefits under the claim. Workers who cannot make up the time may use any employer-provided sick or vacation time to fill in the gaps. 

However, workers could be eligible for time-loss benefits if their healthcare provider did not release them to full-duty or the employer did not formally offer them a medically-approved formal light-duty job offer. The worker may also be eligible for time-loss benefits if the Department of Labor & Industries (L&I), the state insurer, schedules a medical appointment for the worker. Examples of appointments that L&I might schedule include Independent Medical Exams and Functional Capacity Exams, both of which evaluate the worker's current medical state. If the worker is eligible for time-loss payments, Archbright recommends paying the worker 100% of their salary for the time missed to avoid adding time-loss to the claim, helping minimize claim costs. 

Can an employer pay an injured worker's medical bills instead of having the worker file a workers' compensation claim?

No. Washington laws are strict when dealing with this issue. Employers cannot pay for any costs related to the treatment or services rendered by a medical service provider for a work-related injury or medical condition. Although employers often have good intentions, L&I regards these kinds of payments as fraud. Some reasons why employers often want to cover costs out of pocket include:

• The worker has complications in filing their claim or getting it approved;
• The healthcare provider doesn't want to bill the insurer directly because of service fee discounts; 
• The healthcare provider failed to bill the insurer within one year of claim closure and is now requesting payment from the injured worker; or
• The employer wants to keep their insurance premium or industry incident rates low. 

In any of these situations, it is in the injured worker's best interest to work directly with L&I and the healthcare provider to determine if there is a way for these bills to be paid directly by L&I. Employers that try to pay bills, even with good intentions, will only complicate the matter and could be found liable for fraud.

Archbright can help!

When claims aren't managed effectively, the consequences can impact insurance rates and safety reputations for years. This article addressed only some of the questions we hear from employers about Washington workers' compensation, and employers will likely have more. Archbright offers third-party workers' compensation services to support employers, where our team of claims management professionals handles member claims from beginning to end. We help keep costs down while ensuring appropriate care for injured workers. To learn more, email info@Archbright.com.