WSLC program offers one-on-one assistance with workers’ compensation claims. Here are some examples.
SEATTLE (May 17, 2023) — The Washington State Labor Council, AFL-CIO has touted its Project HELP program on previous WSLC Wednesdays. This is the program that educates injured workers on how to navigate the state’s workers’ compensation system and offers workshops explaining this safety net for injured workers and their families.
The system is complex and requires a lot of forms to ensure that work injury claims are real and legitimate. Sometimes simple mistakes are made on those forms — not just by injured workers, but also by medical providers and others involved in the process. Project HELP can help resolve these problems and make sure this safety net is working as intended to protect working families.
That’s why the biggest part of Project HELP’s day-to-day work is providing individual one-on-one workers’ compensation claims guidance. The goal is to empower injured workers to become proactive in managing their claims. In the program’s most recent fiscal year, Project HELP Director Jessica Gallardo and Senior Claims Specialist Kathy Petruzzelli and Bilingual Claims Specialist Emmanuel Carrillo fielded a total of 1,670 claim inquiries.
Here are some recent examples of injured workers who got the assistance they needed when they contacted Project HELP.
Dude, Where’s My Claim?
A construction worker contacted Project HELP to request guidance with his workers’ compensation claim. He had completed the Report of Accident (ROA) in an emergency room 10 days prior and wanted Project HELP to check on his claim’s status since he had not heard back from the state Department of Labor and Industries.
After checking his claim file, Project HELP discovered the ROA was not submitted to L&I by the medical provider because they assumed — wrongly — that the claim would not be valid because it had been three months since the injury occurred. Project HELP advised the worker that injury claims can be filed up to one year after the date of the injury.
With assistance from the Project HELP liaison, the medical provider was notified that the ROA needed to be filed and per RCW 51.48.060 doctors who fail, neglect or refuse to file the report within five days of the date of treatment are subject to a civil penalty. After L&I received and reviewed the ROA, the claim manager determined the claim “met criteria for allowance” and the injured worker received his benefits.
An Erroneous Overpayment Order
If you miss work because of a work-related injury and your doctor certifies you are unable to work and your claim is allowed, L&I or your self-insured employer pays a portion of your lost wages. That’s called “time‑loss compensation” and it’s usually 60 to 75% of the gross wages you were earning when you were injured. It’s intended to keep you and your family afloat until you can return to work.
A worker who had received time-loss compensation reached out to Project HELP after receiving an “overpayment order” stating that he had continued to receive payments after the doctor had released him to return to his job without restrictions.
After a review of the claim file, Project HELP found an Activity Prescription Form (APF) where the medical provider marked a box releasing the worker to the job of injury without restrictions. But the provider also marked the box stating that the worker was released to light-duty, meaning that he could return but with shorter hours, less strenuous work and other such restrictions until he was fully healed and could return to normal full-time duties.
Additional research by Project HELP revealed a chart note from the doctor affirming the worker still had restrictions. L&I didn’t receive this chart note until after the overpayment order was issued. Project HELP provided the date L&I received the chart note to the worker for inclusion in his protest of the overpayment order. After review, the claim manager determined that the doctor provided objective medical evidence to support worker still had restrictions due to his work injury and therefore was entitled to the time-loss payments he had received.
The overpayment order was overturned.
If you or someone you know has been injured on the job or developed a medical condition from the performance of job duties, be proactive about making sure the workers’ compensation system works for you. Call 1-800-255-9752 (please leave a voicemail message) or contact Project HELP today!
WSLC Wednesdays is a feature of The Stand where different departments of the Washington State Labor Council, AFL-CIO describe their recent activities and the services they are providing to WSLC-affiliated unions.