The obvious answer to the question ‘When should you be receiving time loss?’ is, ‘When you cannot work because of your injury.’ But, as with most things in the workers compensation world, it is not always as easy as the obvious answer. Here are the steps to getting time loss payments.
First, there must be medical certification that you are unable to work because of your work related injury. At the beginning of your workers' compensation claim this should come from your attending medical provider. Go to a doctor as soon as you can, and have him or her fill out the ACTIVITY PRESCRIPTION FORM (APF). The certification will address your ability to return to work at your job of injury. Although the same information put on the form may be in the doctor’s records, the APF will get a faster response. You will not receive time loss for the day of injury, or the 3 days following the injury, unless you remain off work for 14 days.
You will also be required to sign a Worker Verification Form to certify you have not worked, and to let the Department of Labor & Industries know if you have applied for any public assistance. (Note – self-insured claims may not use this particular form) The Department may send you this form, or you can complete it on-line in the Claim and Account Center. You can mail it, fax it, or drop it off at a service location. If you have a workers' compensation attorney, your attorney will make sure you get one to complete when necessary.
Time loss can be paid even before the Department issues an order formally allowing your claim. If there is medical certification and worker verification, provisional time loss benefits should be paid pending the Department’s review of the claim and allowance or rejection of the claim. Of course, if the claim is ultimately rejected, these provisional benefits will need to be repaid. (In limited circumstance, the Director may waive repayment if recovery would be against equity or good conscience.)
As the workers' compensation claim progresses, your medical provider may be asked by your employer to release you to light duty or modified work of some type. The employer should provide a specific job description that allows your medical provider to assess whether you can perform the job. If your physician releases you to this work, you will not be entitled to time loss benefits. However, if this temporary light duty work pays less than your regular work, you may be entitled to Loss of Earning Power benefits to make up some of the wage loss. If this light duty work interferes with your recovery and your physician again certifies you are not able to work, your time loss should resume. Likewise, if the employer no longer has light duty work available, time loss should begin again.
If you leave your employment, and take another job with another employer, you may still be entitled to time loss if your physician subsequently indicates your injury interferes with your ability to work at either your job of injury or your new job. I had a worker call the other day who had changed employers several months after her injury. About a year later she had surgery for her work related injury. The claim was open and the surgery was approved treatment. She wanted to know if she should have received time loss while she was recovering from surgery and unable to work at her new job. Absolutely, yes! It does not matter that she was working for a different employer, she should have received time loss, and we will be following up on her claim to make sure she does.
If you move out of state you are still entitled to Washington time loss benefits. We have clients in a lot of different states, and several foreign countries. While medical treatment may be a challenge, there is nothing about a move, in and of itself, that limits the payment of time loss benefits. The challenge will be to find a doctor who will agree to fill out the paperwork to treat a Washington injured worker.
If your injury is serious and permanently prevents a return to work at your job of injury a vocational assessment will be conducted. You should receive time loss during this process. If the vocational assessment concludes you are employable, your time loss benefits will stop.
This is really only a very basic outline of when time loss should be paid. As a general rule, if you have an open Washington workers’ compensation claim, are not working because of your injury, and are not receiving time loss benefits, you should talk to an attorney about your specific circumstances. There may be some arguments to be made that benefits should be paid. It is always worth taking a look, and may result in the payment of significant back due benefits.
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