Common Questions and Misconceptions
About Industrial Insurance
Q If an injury isn’t reported to the supervisor or manager (owner) is it a valid claim?
A According to Washington state law a worker doesn’t have to report an accident to the employer for it to be a valid claim. When the worker completes the Report of Accident (ROA) form at a physician’s office, this is considered to be “notice” to the employer.
Q If nobody witnessed the accident is it a valid claim?
A If the attending physician agrees with the claimant and the claimant writes down a specific incident at a definite time and place in the course of employment, you have an acceptable claim. The burden of proof that the incident or exposure did not occur as reported is the employer’s responsibility.
Q Will the claim be rejected if it is filed after 60-days from the date of injury?
A No. A claim must be filed within one year from the date of the industrial injury or within two years from the date the worker has written notice from a physician that an occupational disease exists and that it is or was related to the worker’s employment.
Q Once a claim is closed, can there be further treatment or action on that injury?
A A claimant (injured worker) has seven years from the date of first closure to request that the claim be reopened for further treatment and benefits for a worsening of the condition. (The reopening period is ten years for eye injuries.)
Q When an injured worker returns to work full duty, does the claim automatically close?
A No. Typically a claim will remain open for another 60-days to insure that the worker is truly fixed and stable and can do the full duty work without further exacerbating his condition.
Q If a worker has a “pre-existing condition” then the employer is not liable?
A Not true. When you hire someone, you have just bought all bodily complaints. If the worker exacerbates his pre-existing condition working for you, your financial responsibility is limited to bringing him/her back to the pre-existing condition.
For example the person you just hired has a Category III back condition that has been previously fused. In the course of employment, if the worker blows out the disks above or below the previous condition, you will pay for the surgery to repair the injury and time loss benefits for this worker up to surgery. Time loss benefits will continue after surgery, and if the worker is found to be unable to return to the job of injury or any other type of work with you, you may pay for retraining and the time loss until claim closure.
Q Can I terminate a worker because he/she was injured on the job?
A NO! According to RCW 51.48.025, an injured worker cannot be terminated due to filing of an industrial injury. However, if an injured worker cannot perform his/her regular job duties and the job must be filled to accommodate your employment needs, you can fill the position.
Q Can I pay for the hospital/doctor visit and not claim it as an industrial injury?
A NO! According to RCW 51.28.025, all on the job injuries must be reported and recorded and a claim must be filed with the Department of Labor and Industries.