What is a Pension in L&I Claims or Self-insured Employer Claims?
Sometimes injured workers suffer such significant permanent impacts from their industrial injuries and illnesses that they are incapable of returning to work. Under the Industrial Insurance Act, this is called Total Permanent Disability or TPD. The definition of TPD is nearly identical to the definition for Temporary Total Disability (TTD). The difference between the two terms has to do with the length of time the state of total disability is expected to continue. If an injured worker has reached Maximum Medical Improvement (MMI) and remains totally disabled, it is likely that the total disability is permanent because it is not going to improve in the foreseeable future.
Total Disability in workers’ compensation claims
In Washington State, total disability is considered an impairment of mind or body that renders a worker unable to perform or obtain a gainful occupation with a reasonable degree of success and continuity. It is the loss of all reasonable wage-earning capacity. An injured worker is totally disabled if unable to perform or obtain regular gainful employment as a result of an industrial injury or occupational disease. However, a determination of total disability should take into consideration the following factors:
1) The individual worker’s weaknesses and strengths;
2) The person’s age;
3) Level of education;
4) Training and experience
5) Permanent loss of function which pre-existed the industrial injury or occupational disease; and
6) Any permanent loss of function that was proximately caused by the industrial injury or occupational disease.
An injured worker is not totally disabled solely because of inability to return to the worker’s former occupation. At the same time, total disability does not mean that the injured worker is physically or mentally helpless. Total disability is permanent when it is reasonably probable to continue for the foreseeable future.
Benefits and the Law
Under the Industrial Insurance Act, the injured workers who are totally and permanent disabled receive a benefit called “pension”. Pension benefits are appropriate if the injured worker has been medically (and in some cases vocationally) certified as being incapable of gainful employment, at least in part, because of industrially related causes, or if the injured worker lost the use of both legs, both arms, an arm and a leg, or vision. If an injured worker is totally permanently disabled, pension benefits are paid to the injured worker for the remainder of their lifetime (so long as they are not working).
If applicable, at the time the injured worker is placed on a pension, they may also be given several options related to survivors benefits. The option section can impact the actual monthly pension amount received. The value of the monthly pension benefits must be determined on a case by case basis because it is highly fact dependent. However, as a general rule, pension benefits are paid on a monthly basis on the 15th of the month and are a percentage of the injured worker’s wages at the time of injury or illness. For a single person with no dependents, that percentage is 60%.
Additional conditions and recommendations
It is important to know that workers must reach maximum medical improvement before they can be found totally and permanently disabled. Once placed on pension benefits, additional treatment for claim related conditions will not be covered without pre authorization pursuant to RCW 51.36.010(4). It is typically up to the treatment provider to request that a treatment order be added to the pension claim if they feel it is needed. To do so, they must submit a written request and get approval from L&I or the self-insurer before providing treatment. Costs for treatment received before getting approval will be denied.
Pension benefits are an increasingly difficult benefit to secure. If you are an injured worker with significant limitations as a result of your industrial injury or illness having difficulty reentering the workforce, you should consult with an experienced workers’ compensation attorney before your claim closes.