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Guide to Retirement

Plan now for Retirement

If you’re like most of us, you probably believe that retirement planning is something that you start thinking about when the end of your career is in sight. Nothing could be further from the truth. The secret to a successful retirement is getting started early: it’s never too early to start planning and saving for your retirement. 

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5. Workers’ Compensation

B. Using Your Benefits

Injured fire fighters are entitled to no-fault accident and disability coverage. This coverage, known as “workers’ compensation,” covers medical expenses and pays a portion of the wages you lose while you recover from a work-related injury, illness, or occupational disease. If you are injured at work, you will be covered by the City’s self-insured Workers’ Compensation program. You are covered as soon as you start work. 

Below, you’ll find a summary of your workers’ compensation benefits.

Healthcare Services

When your claim for a work-related injury or occupational disease is approved, the city will pay your medical bills while you recover.

Covered Healthcare Services and Costs

All healthcare provider, hospital, surgical, pharmacy, and other healthcare services necessary for treatment of your work-related injury or occupational disease are paid directly by the city. healthcare services are provided until your work-related injury has stabilized and reached a point where further recovery is not expected.

Other services may include but are not limited to, emergency ambulance service, special or home nursing care, dental repair, convalescent center care, glasses, hearing aids, crutches, braces, and prostheses. Workers receiving a prosthesis (an artificial limb, for example) also receive lifetime prosthesis maintenance, including replacements needed because of normal wear and tear of the prosthesis or related physical changes.

Choosing a Healthcare Provider

The first time you see a doctor, you may choose any healthcare provider who is qualified to treat your injury or disease. For ongoing care, you must be treated by a doctor in the L&I Medical Provider Network. You’ll find a list of network providers at www.lni.wa.gov/findadoc.

If you are receiving medical care out of state, your provider does not need to be in the network.

Qualified providers include medical, osteopathic, chiropractic, naturopathic, and podiatric physicians; dentists; optometrists; ophthalmologists; advanced registered nurse practitioners; and physician assistants.

Changing Providers Once Your Claim is Filed

You may change healthcare providers or ask for a consulting opinion from another provider if you feel you are not making progress with your current provider. However, to ensure proper payment of medical bills, you must get approval from the City of Seattle Workers’ Compensation Unit before changing providers or seeking another opinion.

Note: If you transfer care to a new provider or seek a consulting opinion, you still need to see a provider who is a part of the L&I Medical Provider Network. You’ll find a list of network providers at www.lni.wa.gov/findadoc.

Getting Your Medical Bills Paid

Healthcare providers should send their bills to the City of Seattle’s Workers’ Compensation Unit for payment.

Usually, you do not incur any out-of-pocket expenses. However, if your eligibility for benefits is in doubt, a provider may bill you. In that case, keep a copy of your invoice and receipt. If your claim is approved, the provider must reimburse you the amount you paid and seek payment from your employer or their representative.

Time-Loss Compensation

If you are unable to work as a result of your injury or occupational disease, you will be paid a portion of your regular wages tax-free.

  • If your marital status is single, 60% of your regular wages will come in the form of a check mailed to you from the City of Seattle Workers’ Compensation Unit.
  • If you are married, this adds 5%, and 2% is added for each dependent up to five, for a total maximum replacement of 75% of regular wages.
  • You will receive another benefit concurrently with the workers’ compensation benefits, which will get you to 80% of your regular wages, paid by the City from Ordinance Hours, which lasts for 2,376 hours of worked time.
  • After the Ordinance benefits drop, you’ll only receive your workers’ compensation portion (60% to 75% of your regular wages, depending on marital and dependent status).
  • Refer to the Department of Labor and Industries Claims Adjudication Guidelines for more information on this and other benefit calculations.

Qualifying for time-loss compensation

Your healthcare provider must notify the City that your condition is work-related and that you are unable to work. Your provider must also provide objective findings to support their certification.

How long must I be off work to qualify for time-loss compensation benefits?

These benefits are paid if you are unable to work for more than three days immediately following the date of your injury. Injured workers are not compensated for those first three days unless they are still unable to work on the fourteenth day (tenth day for members working an admin schedule) following the injury. (You may be eligible to receive time-loss benefits for the first three days if you returned to work, found you could not continue working, and then remained off work through the fourteenth day.)

It is important to note that the city will still take three shifts of sick leave (four if you have a debit day), but you will also be paid by Workers’ Compensation, meaning you are essentially being paid double for the first two weeks of your disability claim. If you want to, you can arrange to buy that sick leave back after you return to work.

When will I get my first benefit check?

The city must pay you within 14 days of being notified of your claim and receiving information that you have missed time from work due to an industrial injury.

How long will I receive time-loss compensation benefits?

You will receive time-loss payments twice a month or every two weeks as long as your healthcare provider verifies that your condition prevents your return to any work. You and your provider must keep the City informed of your progress. Without this information, your time-loss compensation check could be delayed or stopped.

Will I ever have to return time-loss compensation benefits?

If your claim is ultimately rejected because the city found that your injury or disease was not work-related or if new information shows your check should have been for a lower amount, you will be required to refund all or part of the money you received. Also, time-loss compensation must be refunded if it is later found that you were able to work or did work days for which you received benefits.

In most cases, the city has one year from the date of the incorrect payment to notify you that you must make repayment. If you are not notified within one year, you are not required to repay the overpayment. This time limit does not apply if your claim has been rejected.

How time-loss compensation is calculated

The amount of your time-loss benefit check is 60% to 75% of your total wages and certain benefits, depending on your family status and number of dependents you have when you are injured. These benefits cannot exceed specified limits and are based on a standard formula established by law.

Establishing your gross income

The following is taken into account to establish your gross income at the time of injury:

  • Your wages earned before taxes, including income from a second job.
  • The city’s contribution to your medical, dental, and vision benefits.
  • The reasonable value of room and board, housing, fuel, or similar considerations received from the city as part of your income.
  • Any bonus you received as a part of the contract of hire with the city at the time of injury.
  • Tips you reported to your employer for federal income tax purposes.

If you have established a history of overtime, those wages can be included in your calculation.

Possible effects of Social Security benefits

You should report to your employer any Social Security payments you receive as this can affect your workers’ compensation benefits.