Washington Stay-at-Work Reimbursement Packet: A Filing Checklist

Why the Packet — Not Just the Application — Decides Your Reimbursement

The application form is the smallest part of a Washington Stay-at-Work (SAW) filing. What actually gets the money out the door — or gets a reimbursement day disallowed — is the supporting record behind it.

Here is a scenario that plays out more often than coordinators expect: an employer runs a worker on light duty for ten weeks, submits the SAW application on time, and gets a partial reimbursement back. Not because the claim was ineligible. Not because the application was late. Because several days in the middle of the schedule had the worker logging six hours when the provider-approved job description specified four. Those days were ineligible, and without a clean daily time record tied to the approved description, there was no way to separate the good days from the bad ones before submitting. The reimbursement was rebuilt from scratch — minus those days.

The packet discipline exists to prevent that. Under the program as it stands for injuries on or after January 1, 2025, the maximum reimbursement is 50% of the worker's base wages for up to 120 days worked, with a cap of $25,000 per claim. (AGC of Washington, 2025.) That is real money for a mid-sized operation. Getting the packet right protects every dollar of it.

This checklist walks through every document category, what each one must contain, and the sequencing rules that determine whether a day is reimbursable before you ever touch the application. Use it alongside the complete Washington Stay-at-Work program guide for full program context.

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How Reimbursable Days Are Earned — Before You File Anything

Before covering what goes in the packet, it is worth being precise about what makes a day reimbursable at all. The SAW program reimburses wage costs for light-duty days that satisfy three concurrent conditions:

1. The attending provider has approved a transitional job description in writing before or on the day worked.
2. The hours worked that day fall within the approved hours stated in that job description.
3. The day falls within the approved duty period covered by the job description.

A partial day counts as one reimbursable day — that is favorable. But a day worked outside the approved job description or outside the approved hours is ineligible for that day entirely, even if every other day in the period is clean. (WA L&I Complete Stay at Work Guide, 2024.) The documentation stack below exists to prove each of these three conditions, day by day, across the entire light-duty assignment.

See how to track approved dates only for a deeper look at structuring the day-by-day log.

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The Five Document Categories in a Stay-at-Work Reimbursement Packet

The checklist below is organized by the category of proof each document supplies. Confirm current form numbers and submission instructions directly with WA L&I before filing — form versions change and the program parameters in this article reflect L&I guidance as of 2024–2025.

1. Provider-Approved Transitional Job Description

What it is. A written description of the light-duty position the worker will perform, approved and signed by the attending provider before the worker begins that assignment.

What it must contain:

• Specific duties and tasks (not a generic "light duty" label)
• Approved hours per day and days per week
• Physical restrictions the job is designed to accommodate (e.g., no lifting over 10 lbs, no overhead reach, seated work only)
• Provider signature and date of approval
• Start date of the approved assignment

Filing notes. Submit the job description to the provider as early as possible in the claim — ideally before or on day one of light duty. (WA L&I Complete Stay at Work Guide, 2024.) If the provider modifies the restrictions mid-assignment, you need a revised, signed job description for the new period. Each approved description covers only the period it specifies; do not carry a description forward into a period it was not written for.

The job description is the keystone document. Every other record in the packet is validated against it.

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2. Work Restriction Record

What it is. The clinical documentation establishing that the worker has a medical restriction that prevents return to the full pre-injury job, and specifying what those restrictions are.

What it must contain:

• Attending provider's name and contact information
• Date(s) of restriction assessment
• Specific functional restrictions (weight limits, positional limits, duration limits)
• Expected duration or review date for restrictions
• Provider signature

Filing notes. The restriction record typically comes from the provider's office as an Activity Prescription Form (APF) or equivalent clinical note. Keep the original. The job description should be visibly consistent with the stated restrictions — if the restriction record says no lifting over 10 lbs and the job description mentions lifting up to 20 lbs, the mismatch is a problem. Resolve inconsistencies before filing.

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3. Daily Time Record (The Approved-Day Log)

What it is. A day-by-day record of every date the worker performed light duty, the hours worked that day, and confirmation that those hours fell within the approved schedule.

What it must contain:

• Calendar date of each day worked
• Actual hours worked that day
• Approved hours for that day (from the job description)
• A clear indicator of whether the day is within the approved period
• Running count of reimbursable days toward the 120-day maximum

Filing notes. This is the document most likely to disqualify days if it is not maintained in real time. A day where the worker logged six hours against a four-hour approved schedule is ineligible — even if the worker was trying to be helpful. (WA L&I Complete Stay at Work Guide, 2024; ERNwest, 2025.) Reconstruct these records from payroll after the fact and you will miss overages that were not flagged at the time. The log should be updated each day the worker is on light duty, not assembled at filing time.

The state reimbursement programs hub covers how this tracking requirement compares across Oregon, Ohio, and Texas programs.

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4. Wage Documentation

What it is. Payroll records proving what the employer actually paid the worker during the light-duty period.

What it must contain:

• Gross wages paid per pay period covering the light-duty assignment
• Base wage rate (hourly rate or salary equivalent)
• Pay period dates aligned to the daily time record
• Employer name, EIN, and contact information on the payroll record

Filing notes. SAW reimburses 50% of base wages paid during the eligible light-duty days. (AGC of Washington, 2025.) The reimbursement calculation runs against base wages — not overtime, not shift differentials, not bonuses. Keep the payroll extract clean and clearly labeled. The reimbursement application requires the employer to have actually paid wages for the days claimed; document the payroll disbursement, not just the wage rate.

Worked example. If the worker's base wage is $25/hour and works four approved hours per day, the daily wage cost is $100. SAW reimburses 50%, or $50 per approved day. Over 60 approved days, that is $3,000 in reimbursement — well within the $25,000 per-claim cap. Adjust the example inputs to your own payroll; the formula is the same.

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5. The SAW Application Form

What it is. The L&I-issued reimbursement application — the form that pulls together the claim number, employer information, and summary of eligible days and wages to generate the reimbursement request.

What it must contain:

• Claim number and worker name
• Employer name, address, and account number
• Dates of light-duty work claimed (aligned to the daily log)
• Total eligible days (capped at 120 per claim for injuries on/after Jan 1, 2025)
• Total wages paid for eligible days
• Employer certification/signature
• Supporting documents attached (job description, restriction record, time log, wage records)

Filing notes. Obtain the current version of the SAW application form directly from WA L&I — do not use a cached copy from a prior year without confirming it is current. The application must be received by L&I within one year after the light-duty work is done. (WA L&I, 2025.) There is no reimbursement after claim closure, and no reimbursement for dates worked more than one year before the application. (WA L&I Complete Stay at Work Guide, 2024.) Confirm the precise deadline trigger and submission method (mail, upload, fax) with L&I before filing — see needs_verification above.

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Pre-Filing Audit: Questions to Answer Before You Submit

Run through these before sealing the packet:

• Does each light-duty day in the time log have a corresponding provider-approved job description covering that date?
• Are there any days where actual hours exceeded approved hours? If yes, flag those days as ineligible before calculating wages claimed.
• Does the wage documentation cover every pay period within the light-duty period, with no gaps?
• Is the total eligible day count at or below 120 days? (For injuries on or after Jan 1, 2025.)
• Is the application being submitted within one year of the last light-duty day worked?
• Is the claim still open? (No reimbursement after claim closure.)
• Are there any period gaps where the provider's job description had lapsed and was not yet renewed? Days in a gap period are not reimbursable.
• Is the restriction record consistent with the job description — no tasks in the job description that exceed the stated restrictions?

A packet that clears all eight questions is ready to submit. Any "no" answer is a documentation gap to resolve first.

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Tracking the Packet in Real Time, Not at Filing Time

The reimbursement timeline the SAW program provides — up to $25,000 per claim (AGC of Washington, 2025) — is worth protecting from the first day of light duty, not from the day you start assembling the application.

The mechanics that cost employers reimbursement dollars are almost always timing failures: a job description not submitted to the provider until week two, a daily log reconstructed from memory, a payroll export pulled months after the fact with no connection to the approved schedule. None of these are documentation failures in the sense of missing information — they are sequencing failures. The information existed; it just was not captured in the format and at the time the program requires.

The Transitional Duty Case Tracking Workbook is built around this sequencing discipline — it structures the daily log, the approved-day count, and the document checklist as a running case file rather than a retroactive assembly project. If you are managing more than two or three concurrent light-duty cases, a purpose-built tracking system removes the reconstruction risk entirely.

For a full case management framework that connects SAW tracking to the broader RTW process, see the return-to-work case management guide.

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Start the Packet on Day One

The SAW reimbursement packet is not a form — it is a record built across the entire duration of the light-duty assignment. Every eligible day produces a line in the time log, a payroll entry, and an implicit reference to the provider's approved job description. The application at the end is a summary of that record.

Set up the packet structure on the first day of light duty. Confirm the job description is provider-signed before the worker clocks in. Log the day's hours against the approved schedule that evening. Pull the payroll data at each pay period rather than at filing time. When the assignment ends, the packet is nearly complete.

Ready to build a tracking system that keeps the packet current automatically? Start a free trial of Transitional Duty Manager and see how the case file structure maps directly to the SAW filing checklist.