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  • Washington Application for Loss of Earning Power (LEP) - Compensation...

Washington Application for Loss of Earning Power (LEP) - Compensation Medical

Category:
Workers Compensation - Official
State:
Washington
Control #:
WA-SKU-3346
Format:
PDF
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Description Lni Lep Form

Application for Loss of Earning Power (LEP) - Compensation Medical
Washington Application for Loss of Earning Power (LEP) — Compensation Medical is an application used to apply for compensation from the Washington Department of Labor & Industries (L&I) for lost wages due to a work-related injury or illness. This form is also known as the LEP-1. It can be used to request compensation for lost wages, additional costs, and other benefits. This application is available in two versions: one for employees and one for employers. The employee version is used to request compensation for lost wages, additional costs, and other benefits. The employer version is used to report a claim to L&I and request benefits for the employee. The two versions of the Washington Application for Loss of Earning Power (LEP) — Compensation Medical are free and can be downloaded from L&I’s website.

Washington Application for Loss of Earning Power (LEP) — Compensation Medical is an application used to apply for compensation from the Washington Department of Labor & Industries (L&I) for lost wages due to a work-related injury or illness. This form is also known as the LEP-1. It can be used to request compensation for lost wages, additional costs, and other benefits. This application is available in two versions: one for employees and one for employers. The employee version is used to request compensation for lost wages, additional costs, and other benefits. The employer version is used to report a claim to L&I and request benefits for the employee. The two versions of the Washington Application for Loss of Earning Power (LEP) — Compensation Medical are free and can be downloaded from L&I’s website.

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How to fill out Washington Application For Loss Of Earning Power (LEP) - Compensation Medical?

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FAQ

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.

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.

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.

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.

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.

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Olympia WA 98504-4291. Medical certification must indicate that the worker's loss of earning capacity is due to the industrial injury or occupational disease.Edit, sign, and share lep compensation form washington state online. No need to install software, just go to DocHub, and sign up instantly and for free. Download Application for Loss of Earning Power (LEP) - Compensation Medical (F242-208-000) – Department of Labor and Industries (Washington) form. Like time loss compensation, your doctor must certify your entitlement to LEP benefits. Loss of Earning Power (LEP) Application - Completion of this form is not a guarantee of benefits. Fill Out The Application For Loss Of Earning Power (lep) - Compensation Medical - Washington Online And Print It Out For Free. The most common benefits are medical treatment and timeloss benefits. Loss of Earning Power (LEP) Application - Completion of this form is not a guarantee of benefits.

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