Claim FAQ

All doctor, hospital, surgical, pharmacy and other health care serves necessary for treatment of your work-related injury or occupational disease are paid directly by Puget Sound WCT. Other services may include, but are not limited to, medication, emergency ambulance service, special or home nursing care, dental repair, convalescent center care, crutches, braces, artificial limbs, glasses and hearing aids. Some automobile and home modification costs are covered for workers suffering amputation or paralysis.  These workers also receive lifetime prosthesis maintenance, including replacements needed because of normal wear and tear of the prosthesis or related physical changes.

Yes.  You may choose any doctor who is qualified to treat your condition and is reasonably convenient to you.  Qualified doctors include:  medical, osteopathic, chiropractic, naturopathic and podiatric physicians; dentists; optometrists; and ophthalmologists.

Yes.  You may change doctors or ask for a consulting opinion from another doctor if you feel you are not making progress with your current doctor.  However, to ensure proper payment of medical bills, you must get approval from your claims manager at Puget Sound WCT before changing doctors or seeking another opinion.

Health care providers should send their bills to Puget Sound WCT at 800 Oakesdale Ave. SW, Renton, WA 98057.  Usually, there are no out-of-pocket expenses to you.  However, if your eligibility for benefits is in doubt, a provider may bill you.  In that case, keep a copy of your invoice, receipt and prescriptions.  If your claim is approved, you can send it to Puget Sound WCT for reimbursement.

Your doctor must certify that your condition is work-related and that you are unable to perform your work.  Your doctor must also notify your employer and  claims manager that you are unable to work as a result of the injury.

These benefits are paid if you unable to work for more than the 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 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, then remained off work through the fourteen days.

Puget Sound WCT will pay you within 14 days of being notified of your claim.

You will receive time-loss payments approximately twice a month as long as your doctor verifies that your condition prevents your return to any work.  You and your doctor must keep your employer and Puget Sound WCT informed of your progress.  Without this information, your time-loss compensation check could be delayed or stopped.

If your claim ultimately is rejected because your employer 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 your 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.

You may contact your physician's office and obtain an “Application to Re-open Claim” form.  You must fill in your portion and your physician must fill in their portion.  The physician is responsible to submit the application to Puget Sound WCT or to the Department of Labor and Industries, Self Insurance Section.  Remember, this form is an application only and does not automatically re-open your claim.  Further investigation and information must be obtained before an order is issued from the Department of Labor and Industries.

Puget Sound WCT has contracted with a preferred provider, CorVel.  You will received a prescription card in the mail when we received medical information of your claim.  You should show the card to your pharmacy when having your prescriptions filled.

When your attending physician has prescribed, prosthetics, braces, crutches etc. the Puget Sound WCT has a preferred provider which coordinates all durable medical equipment.  Your attending physician will need to call your claims manager at Puget Sound WCT for pre-authorization and arrangement of issuing this equipment.

An Independent Medical Evaluation is formally a second opinion.  Certain circumstances may arise in managing your claim or to establish your claim which will entail an Independent Medical Evaluation.  It is not necessarily scheduled for only closing a claim.  It may be scheduled to determine if the treatment you are receiving is the best treatment suitable for your condition.  Other reasons that an Independent Medical Evaluation is scheduled are ratings, confirmations, and investigative.

For medical visits and treatment, travel expense is only payable when you have to travel more than 10 miles one-way from your home to the nearest point of adequate treatment, unless Puget Sound WCT has requested it.  Travel expense is not payable beyond the nearest point of adequate treatment, even if you prefer to seek treatment at another location.  Travel expenses are not payable when your claim is closed or you are on pension, unless Puget Sound WCT requested it.  Travel expenses are not payable for driving to the pharmacy to get your prescriptions filled.  Puget Sound WCT can only reimburse you if we receive your reimbursement form within 12 months from the date you traveled.

No.  Time loss compensation is only payable if your physician certifies that you are unable to perform your job.  Treatment visits are to be paid out of your sick leave or unpaid

It is required that your attending physician examines you to determine if your condition is at maximum medical improvement.  Please schedule a final appointment with your attending physician so that appropriate closing medical may be obtained for your claim closure.

Only six massage therapy visits are allowed under your claim.  If your physician determines that more are necessary, a pre-authorization from your claims manager at Puget Sound WCT is necessary.

Time loss compensation is tax free.