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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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6. Long-Term Disability

D. Your Legal Rights and Responsibilities

Disputing a Decision About Your Disability Claim

Every decision about a claim requires the use of judgment, and you may not always agree. If you believe a decision made by the City is wrong, first contact your City of Seattle Workers’ Compensation Unit claim analyst. If you are unable to resolve the issue, you may ask for help from the Department of Labor & Industries.

You can write a letter to:

Department of Labor & Industries Self-Insurance Section
P.O. Box 44892
Olympia, WA 98504-4892

Or, report your dispute online at www.Lni.wa.gov/SIClaimProblems

Requesting a Penalty If Benefits are Delayed

If there is an extended delay in the payment of your benefits, such as your time-loss compensation or medical bills, you can ask L&I to decide if the City should pay a penalty. These penalties are not automatic; L&I may discover legitimate reasons for the delay. However, if L&I does approve a penalty, it will be payable to you: $500 or 25% of your delayed benefit, whichever is greater.

To request a penalty, write a letter to L&I explaining your reasons, attach any supporting documents, and mail your letter to the address above.

Protesting or Appealing a Legal Order and Notice

Formal decisions about your claim will be communicated to you in a legal document called an Order and Notice. If you disagree with a decision in an Order and Notice:

  • Protest to the Department of Labor & Industries: Within 60 days of receiving the Order and Notice with which you disagree, you must send a written protest to L&I or submit a protest online. (See mailing and web addresses above.) For some vocational decisions, you may have a shorter timeframe to reply: be sure to review the timeframes in the document you’ve received. Explain in detail why you think the decision is unfair and supply any additional information you think may help them in their evaluation.

    They will review your claim and send you an Order and Notice in response to your protest.
  • Appeal to the Board after Protest to Labor & Industries: If you disagree with the Order and Notice sent in response to your protest, you may appeal in writing to the Board of Industrial Insurance Appeals. You must send your appeal to the Board within 60 days of receiving this Order and Notice.

    You can write a letter to:

    Board of Industrial Insurance Appeals
    2430 Chandler Ct. SW
    P.O Box 42401
    Olympia, WA 98504-2401

    Or, submit your appeal online at www.BIIA.wa.gov

    The Board’s phone number is 360.753.6823 ог 1-800-442-0447 (in-state toll-free line).

    The Board, which is independent of L&I, conducts hearings on claim issues that cannot otherwise be settled to the satisfaction of you, your employer, or the department. The Board issues a written decision about your case after personal arguments and testimony have been taken. This decision may be appealed to a Washington State Superior Court. For more detailed information, ask the Board for its pamphlet, Your Right to be Heard.
  • Pay During Appeal: If you have appealed an L&I order that awarded benefits to you, in most cases, the City must continue paying benefits during the appeal. Payment must continue until the Board of Industrial Insurance Appeals formally allows the City to stop payment during the appeal or makes a decision on the appeal.
  • If the Board of Industrial Insurance Appeals decides that the benefits should not have been awarded to you, you may have to repay them. If you want to stop the payment of benefits to you during the appeal, send a written request or email to the city’s Workers’ Compensation Unit (WCU), the state L&I division, and the Board of Industrial Insurance Appeals (BIIA).
  • If you have questions about what benefits should be paid during the appeal, please contact your City of Seattle WCU claims analyst.

If You Need Legal Assistance

You are not required to have an attorney to protest any L&I decision. However, you may want an attorney’s advice before appealing an L&I decision to the Board of Industrial Insurance Appeals.

Attorney fees are limited by law to a maximum of 30 percent of any increased benefit you receive as a result of your protest. Attorney fees for a Structured Settlement Agreement are limited to 15 percent of the settlement amount. Because this maximum fee may not always be reasonable, either L&I or the Board will set a reasonable fee for your attorney’s services upon request.

To request a fee review from L&l, write to:

Director of Labor & Industries
P.O. Box 44001
Olympia, WA 98504-4001

To request a fee review from the Board, write to:

Board of Industrial Insurance Appeals
2430 Chandler Ct. SW
P.O. Box 42401
Olympia, WA 98504-2401

Reopening a Claim

You may apply at any time to reopen your claim. If objective medical evidence shows the condition caused by your injury or disease has worsened and requires additional healthcare attention, your claim may be reopened. In most cases, we will decide whether to reopen your claim within 90 days of receiving your application.

If your claim is reopened, any benefits will be payable beginning 60 days prior to L&I’s receipt of your reopening application. If more than seven years have passed since the date your claim was first closed (or ten years for an eye injury), you may not be eligible for time-loss compensation or permanent partial disability benefits. However, you will still be eligible to receive medical benefits.

The application form to reopen your claim is available through your healthcare provider’s office: “Application to Reopen Claim Due to Worsening Condition.” If your provider doesn’t have the form, you can request one by contacting an L&I office. You’ll find telephone numbers for these offices at the end of this booklet.

Complete the reopening application form and promptly mail it to:

L&I Self-Insurance Section
P.O. Box 44892
Olympia, WA 98504-4892

When to Reopen a Claim, When to File a New Claim

In most cases, it’s better to open a new claim when you have a new injury rather than reopen an existing claim.

If you’ve injured a body part that you previously injured, but the injury occurred from a new event, you should file a new claim.

The difference between filing a new claim versus reopening an old claim is that you are compensated based on the wage you were earning on the date of injury. Cost of living adjustments are included, but those adjustments rarely keep up with Local 27 negotiated wage and step increases.

If you’re unsure how to proceed, consult an attorney.

Rights Cannot Be Waived

An injured worker may not waive his or her rights under the Workers’ Compensation Act.

Protection from Employer Discrimination

If you believe your employer has discriminated against you because you filed a claim or expressed an intent to file, you can submit a discrimination complaint by writing to:

L&I Investigations
P.O. Box 44277
Olympia, WA 98504-4277

You must act within 90 days of the incident.

Requesting Copies of Files

The City or the City’s representative maintains a complete copy of your claim file. You can request a copy of the file. You must submit your request in writing. The City or the City’s representative has 15 days from the day they receive your written request to provide a copy to you. The first copy will be provided free of charge to you or your representative.

To request new or updated material, you must submit another written request. All new material not previously provided also will be provided free of charge. However, the City is entitled to charge a fee for copying any materials already provided.

You may review the information that L&I has in your claim file by using the online Claim & Account Center at www.lni.wa.gov/claims/for-workers/ check-the-status-of-my-claim.

Consequences of Knowingly Giving False Information

Any person claiming benefits under the Workers’ Compensation Act who knowingly gives false information relating to a claim of $500 or more will be guilty of a Class C felony. When the claim involves less than $500, a person knowingly giving false information will be guilty of a gross misdemeanor.

When Injuries Are Caused By a Third Party

In Washington, you cannot sue your employer or coworkers when a work-related injury or disease occurs. However, you can sue another company or individual if they are responsible. An example might be a company that manufactured a defective product that caused your injury. Such an individual or company is called a third party.

In these cases, you may choose to initiate legal action yourself to recover damages. If so, you may wish to consult an attorney. Or, you may have the City initiate action on your behalf. In either case, the City may recover its claims costs from the settlement.

Your injury may increase the City’s insurance costs. For this reason, the City may decide to take legal action even if you don’t.

Initiating third-party legal action will not jeopardize your right to workers’ compensation benefits. You’ll receive all the benefits for which you qualify, regardless of the outcome.

If you believe a third party may have been responsible for your injury or occupational disease, contact the Department’s City of Seattle Human Resources Representative.