Are you familiar with the temporary total disability benefit in L&I claims in Washington State? Did you know that you can receive time-loss compensation while your workers’ compensation claim is open?
Time-loss compensation in an L&I claim
The Department of Labor and Industries (L&I) provides several benefits during the open and active phase of an L&I claim. The same benefits also apply under a self-insured employer claim. First, the most important benefit is medical treatment. Then, there are other benefits such as temporary total disability. The term time-loss compensation refers to L&I’s monetary benefit when a work injury claimant is temporary and totally disabled.
In order to receive the benefit, you must meet the legal definition of temporary total disability. Furthermore, you must provide the medical certification throughout your claim. More explicitly, the legal definition of temporal total disability is:
An injured worker is considered temporarily and totally disabled when they have an impairment of the mind or body. This leaves them unable to perform or obtain a gainful occupation with a reasonable degree of success and continuity.
In other words, it means losing the capacity to earn reasonable wage as a result of an industrial injury or occupational disease.
Time-loss benefit: What are the criteria?
When L&I considers if a work injury claimant has total disability, by law, they must consider the worker’s weaknesses and strengths. For example, they have to take into account the person’s age, education, training and experience. On top, they also have to factor in and review permanent loss of function. In doing so, they have to consider preexisting loss of function as well as new conditions as a result of the work injury or workplace illness.
A work injury claimant doesn’t qualify for temporary total disability just because they can’t return to their former job. If the work injury victim has the skills and abilities to work, and earn a reasonable wage, then they do not meet the criteria. However, having temporary total disability does not mean the work injury claimant is physically or mentally helpless.
Attending provider and activity prescription form
It is up to medical providers to decide if your bodily loss of function is a result of the workplace accident or work disease. Simply put, it’s a matter of medical opinion. Therefore, before L&I pays time-loss compensation benefits, there must be medical certification on file. Every time you visit your attending provider, L&I expects you to complete Activity Prescription Form. The form provides information to L&I regarding the nature and extent of the work injury claimant’s limitations. With it, L&I also expects to see the doctor’s report on chart note for each visit. Hence, we strongly recommended to see your attending physician every 30 days during the open and active phase of your L&I claim. This way, your doctor can update your treatment plan regularly. Moreover, your provider can submit to L&I all the relevant paperwork, including medical certification.
Recommendations and considerations
Sometimes, L&I declines to pay time-loss compensation benefits. It can even happen when medical certification is available on file. There are several reasons for denying benefits. Often, simple reasons include missing a check-mark on a checkbox in the activity prescription form. Other times, reasons can be more complex. For example, when L&I believes the reason for your loss of function does not relate to the workplace injury or the claim. Therefore, if L&I denies benefits despite medical certification, you should immediately consult with a workers’ compensation attorney.