Washington Application for Loss of Earning Power (LEP) — Compensation Medical is a form used by injured workers in the state of Washington to apply for compensation for lost wages due to an illness or injury suffered on the job. It is a two-part form, with Part A used to provide information about the injury or illness, and Part B used to provide wage and medical information. There are three types of Washington Application for Loss of Earning Power (LEP) — Compensation Medical forms: 1) Regular LEP; 2) Temporary Total Disability LEP; and 3) Permanent Total Disability LEP. The Regular LEP form is used to apply for compensation when the injured worker is unable to work or has a reduced capacity to work. The Temporary Total Disability LEP form is used when the injured worker is completely unable to work, and the Permanent Total Disability LEP form is used when the worker is unable to return to any type of work.
Washington Application for Loss of Earning Power (LEP) - Compensation Medical
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L&I maintains a list of self-insured employers. Your employer or their representative handles your paperwork and pays for the claim. They will give you a Self?Insurer Accident Report (SIF?2) form. Fill out the form completely and return it to your employer or their representative.
Checks are mailed (or sent electronically) twice a month, as long as: Your doctor certifies that you cannot work (supported by objective medical findings). Your claim manager receives your signed Worker Verification Form.
In order for a worker to be eligible for loss of earning power benefits: The worker's loss of earnings must be greater than 5 percent of wages at the time of injury. Medical certification must indicate that the worker's loss of earning capacity is due to the industrial injury or occupational disease.
Your first check will be mailed within 14 days from the date L&I or your self-insured employer receives notice from your doctor that you are unable to work if you are eligible and no further information is needed.
Initial payment: At least 25% of the state's average monthly wage, but no more than 6 times the state's average monthly wage. Subsequent payments: At least 25% of the state's average monthly wage, but no more than 150% the state's average monthly wage.