Answers to common questions about Washington state industrial insurance benefits.
My employer is self-insured for workers' compensation. Am I entitled to the same coverage as an employee who works for a state fund employer?
Yes. All Washington workers are covered under the same industrial insurance law.
Who manages my workers' compensation claim?
Your employer may self administer industrial insurance claims, or contract with a third party administrator to manage the claims.
How do I obtain a copy of my claim file?
Send a written request to your employer or third-party administrator (TPA). You are entitled to one copy of your file and any updates. You may be charged for duplicate copies.
How is time-loss compensation calculated?
Time-loss rates can vary from 60 to 75 percent of your total wages up to a statutory limit. Your time-loss compensation rate is calculated based upon your total wages at the time of injury, your marital status and number of dependents. The self-insured employer or third-party administrator (TPA) must provide a copy of forms SIF-5 and SIF-5A to you on the date of the first time-loss payment. These forms contain the information used to calculate your benefits. Review them carefully.
Am I allowed to choose my health care provider?
Yes. Under Washington state industrial insurance law, you have the right to select your health care provider from within the Medical Provider Network. The provider you select must be qualified to treat your condition.
I was scheduled for an independent medical exam (IME). Do I have to attend?
Yes. The law allows the department or self insurer to arrange for an IME to resolve medical issues. (RCW 51.36.070). The exam should be scheduled at a location reasonably convenient for you. You will be reimbursed for your time and travel expenses to attend the examination. (RCW 51.32.110)
I received a bill from my health care provider for injury-related treatment. What do I do?
Contact your employer or third-party administrator immediately. All injury related medical bills should be sent directly to them for payment.