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What Happens When You File a Workers’ Comp Claim?

Photo credit: iStockphoto.com/Cineberg

Workers who are injured or develop a work-related illness in Washington state are entitled to benefits through the workers’ compensation insurance system. About 70% of workers’ comp claims are administered by the state’s Department of Labor and Industries (L&I), while the rest are overseen by self-insured employers.

When the workers’ comp process works smoothly, a claim is promptly accepted and benefits like wage replacement are available within a few weeks.

However, there are a number of steps that occur between the time a worker files a claim and when they receive benefits. Mistakes, misunderstandings and bureaucracy can delay the process. Knowing what to expect and how to navigate the system will help reduce your stress and secure the benefits you deserve.

Read below to find out what to expect once you’ve filed a workers’ comp claim.

How Do I File?

First things first, you have three options to file an L&I claim in Washington state:

  • File by phone at (877) 561-3453.
  • File online.
  • File at your doctor’s office.

Whichever route you decide to take, you’ll need help from your doctor to complete the following tasks:

  • Confirm that your injury is work-related.
  • Assess your ability to return to work.
  • Complete the Accident Report.

Your doctor or ARNP (Advanced Registered Nurse Practitioner) must sign the Accident Report and send it to L&I within 5 days. 

If you work for a self-insured employer, your doctor will complete a Physician’s Initial Report (PIR) and mail it to your self‑insured employer’s claim representative.

Your claim officially goes on file when your doctor submits the workers’ compensation paperwork to L&I or your self-insured employer.

Keep in mind that L&I must receive your Accident Report within 1 year of your injury date, or within 2 years from the date of your medical diagnosis of an occupational disease.

Learn more about the workers’ comp claim process.

Claim Filed. Now What? 

Once your claim is filed, it is assigned to a claim manager who will assess your eligibility. You should expect to receive several documents in the mail or email about your claim. These could include legal documents such as orders and notices, copies of all correspondence related to your claim, or other claim-related information.

The amount of paperwork you receive will depend on the type of injury or occupational disease you are claiming.

Be sure to open all mail from L&I or the company representing your self-insured employer, read it carefully and comply with any requests. Also, make sure to keep copies of all claim-related documents.

You can also check the status of your claim online or call 1-800-831-5227. However, L&I rarely has answers until they have determined whether to accept your claim. If you have a workers’ comp lawyer, the best way to check the status of your claim is to ask your attorney. 

Claim Accepted

If all goes as planned and your claim manager approves your claim, you will receive a written order from L&I explaining your benefits.

For example, if you’re eligible for wage replacement benefits, and no further information is required, L&I will send your first benefit check within 14 days of receiving the Accident Report.

Independent Medical Examination 

L&I may order an Independent Medical Exam (IME) at any point during the claim process. 

Typically, an IME request signals that L&I either needs more information to decide whether or not to accept or deny a claim, or it is preparing to fight your claim.

While the IME may not result in an immediate claim denial, it can be used to gather information that could support a permanent denial down the road.

Keep in mind that L&I has close relationships with independent medical examiners throughout Washington state. These doctors work for L&I and their opinions are often biased in favor of L&I decisions.

Denied Claim 

Claim managers have wide latitude to accept or reject a workers’ compensation claim, which means they can deny a claim for any number of reasons. 

Common reasons for claim denials include:

  • A determination that the workplace injury is “pre-existing.”
  • A determination that the injury occurred somewhere else other than work.
  • An opinion that the injury is not as bad as claimed, or non-existent.
  • The injury occurred in a parking lot, which means it is not covered.
  • When it is a mental condition, it is often denied because of a lack of medical support.
  • A doctor feels that the injury as described doesn’t match the diagnosed medical injury. This happens frequently, especially when an independent medical examination (IME) is involved.

Mistakes are another common reason for denied claims. Claim managers might miss critical evidence or ignore evidence whether out of neglect or incompetence. 

Doctors, especially independent medical examiners who work for L&I, sometimes misdiagnose patients or mischaracterize the nature of their injuries. 

Employers may argue that a worker was injured outside of work, especially if they don’t understand or believe that their workplace could cause a mental health issue. Sometimes they don’t agree that the workplace is harmful enough to cause an occupational disease.

Click here for a list of common claim worker mistakes.

You have the right to protest any L&I decision within 60 days of its issuance by writing a letter to your claim manager. If you disagree with the claim manager’s decision about your protest, you can appeal to the Board of Industrial Insurance Appeals.

It’s highly recommended that you consult an experienced workers’ comp attorney to protest and appeal your rejected claim. 

How to Win An L&I Claim Case

You have the right to consult with an attorney at any time, whether before or after filing a workers’ comp claim

Attorneys at Emery Reddy have extensive experience in insurance defense litigation, complex and multi-party litigation, criminal prosecution, and federal plaintiff’s litigation. The courtroom is where we shine. You won’t find a firm anywhere in Washington state that is better at representing injured workers for their L&I claims.

Get in touch now for a free consultation. Our team will analyze your case and see how to get workers’ comp for your injury.

Send us a message or call us at (206) 771-7749.

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