What is time loss?
Time loss is partial wage replacement for an L&I claim. It is money paid every two weeks while you are not working because of a job injury.
Who gets time loss?
To get time loss you need all of the following:
- an open L&I claim
- certification by your doctor that you are unable to work
- because of a medical condition which is causally related to your injury or occupational disease
What can I do while on time loss?
You can go about your daily activities within the limits and restrictions outlined by your doctor. You should be receiving medical treatment and attending medical appointments while on time loss. Use this time to focus on your recovery.
The time loss rules. What should I not do while on time loss?
- Do not work while on time loss
- Do not perform activities that look like work, especially in your front yard where you are in full view of L&I investigators
- Do not post anything on social media which in any way contradicts what you are saying to L&I and your doctor. L&I investigators read the social media posts of injured workers every day. They will charge you with fraud if you collect time loss and brag abour your activities that look like work
- Do not miss your medical appointments
- Do not engage in sports or other activities which are inconsistent with your medical restrictions. Follow your doctor’s advice about activity
Who pays the time loss?
The Department of Labor and Industries makes the time loss payment to injured workers on State Fund Claims.
If you work for a Self Insured employer, your employer pays your time loss. The self insured employer may have a Third Party Administrator (TPA) as their claims managers and issue time loss payments through that TPA.
How long do claims managers have to start paying time loss?
The first time-loss compensation payment must be mailed within 14 calendar days.
The 14-day clock begins the day after the receipt of either the Report of Industrial Injury form or the worker’s application for benefits, or
The 14-day clock begins to run the day after the department receives either contention or certification from your doctor that time-loss compensation benefits are payable.
What if the self insurer or L&I won’t pay time loss or pays time loss late?
Self insured employers can be penalized for late or for missing time loss payments. You can request penalty from the Self Insured Section of the Department of Labor and Industries. The law assesses a penalty of the greater of $500 or 25% of the amount due. Payment is to the injured worker.
For claims managed by the Department of Labor and Industries there is no penalty however you can request to speak to the unit supervisor and ask them to intervene.
How do I get paid penalty money for late time loss payments?
You can request a penalty on a self insured claim by writing to the Self Insured Section of the Department of Labor and Industries. The director of L&I is required to issue an order within 30 days of your request.
Who do I complain to if my time loss rate is not correct?
Contact your claims manager to advise that your time loss rate is not correct. If an order has been issued setting your time loss rate, you must properly submit a timely WRITTEN protest or appeal that order. Provide the claims manager with your pay information if your employer is not responding to requests for wage information.
What is provisional time loss?
Time loss paid while the claim is under investigation is provisional time loss. It is different in character then time loss. Provisional time loss comes with strings attached. If your L&I claim is later denied with a final order you must pay back all the provisional time loss you received. L&I does not always initiate provisional time loss while they are waiting to make a decision on allowing or denying your claim. They do have to pay it, so if you deserve it and want it, then request that L&I pay provisional time loss.
What does the law say about time loss?
Are time loss orders important?
- Pay attention to all L&I orders, including time loss orders
- An order is a legal communication from L&I. Your benefits are affected by these orders. Pay attention to when you get the order. Look at the amount of time you have to protest. This information is written at the bottom of the order.
- If an order is unfavorable then protest or appeal in writing, or get a lawyer to do it for you, and do it before it’s too late.
- The first time loss order you receive is the most important, because it sets your wage rate which determines your time loss rate. Be sure you pay attention to the L&I order setting your wage rate. This may be the most important order on your claim. Make no mistake about this: the wage rate set in that order, once it becomes final, is the wage rate you will have for the life of your claim. If it isn’t right, then do something about it. Protest the order in writing . You can protest in writing first, and get them the evidence later. Insist the claims manager get it right. Continue to protest or appeal as necessary. If L&I doesn’t get it right, then get a lawyer, before it’s too late.
Why does time loss end?
L&I time loss gets cut off for a number of reasons:
- Return to work
- Vocational services end and the injured worker is found employable
- Doctor fails to certify time loss
- Employer offers a job within the medical restrictions
- IME doctor or the attending physician says worker can return to work
- Self Insured makes a mistake, or is unreasonable
- L&I makes a mistake
What to do when time loss ends before it should?
- Disagree with any decision you think is wrong. Do it on time. See How to Disagree with an L&I Decision
- Figure out why time loss ended and solve the problem. If you don’t know why time loss ended, review your file online and talk to the claims manager
- If the employer has made a job offer, be sure that job offer complies with the Time loss and Job Offers issues covered by INTERIM POLICY 5-15.
- If the self insurer unreasonably delays or refuses to pay benefits as they become due, ask for a penalty. RCW 51.48.017 and WAC 296-15-266
- Talk to an attorney
How to keep time loss going
- See your doctor
- communicate your work situation
- make sure he reports to L&I
- Communicate with your claims manager
- Help get information to them
- Make it easy for them to pay you
What If My Time Loss is Often Late?
Late time loss is no fun. You should do something about it. What you do depends upon the reason it is late.
How much time loss do I get?
Your time loss rate is determined by multiplying wages times a family status percentage [wage rate x family status percentage = time loss rate].
- your date of injury wages
- contractual bonus
- wages from a second job, if any
- reported tips
- board, housing, fuel, or other consideration of like nature,
- the employers cost of health care insurance, if any, you may have lost since the injury.
Family status determines the % of wages
- Single = 60%
- Married = 5% more
- Children = 2% more each up to 10% maximum
- The child’s portion is paid to the parent/guardian with legal custody
- Child’s 2% only to age 18 or 23 if in school full time.
Maximum Time Loss Rate. The above % of wages figures are limited for high income earners. There is a dollar maximum per month, which is set for your claim as of your date of injury. This maximum changes yearly. For details see L&I’s Maximum Time Loss Rate
Minimum Time Loss Rate. The % of wages figures don’t apply to persons who earn very low wages. For details see L&I’s Minimum Time Loss Rate
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