Why Is Your L&I Claim Taking So Long to Resolve?

What Is the Claims Investigation Process?

Your Claims Manager will investigate your Washington state L&I claim with a fine-toothed comb, often causing delays when it comes to receiving your workers’ comp award. Your Claims Manager will need to review all necessary documents and make sure everything is up to regulation.

Due to the amount of fraud that finds its way into L&I claims, this process can be stringent and lengthy. The Claims Manager will need to verify that you were indeed injured and that the severity of the injury meets L&I guidelines. They may also request that you undergo an Independent Medical Exam (IME). 

Why Is Your L&I Claim Taking So Long to Resolve?

L&I claims usually take a few years to resolve. There are many reasons your claim could be delayed, including but not limited to:

• Legal delays: Your award could be delayed due to court system delays or a lack of resources when it comes to settling the massive number of appeals being considered.

• Fraud prevention: L&I Claims Managers need to go over claims meticulously to ensure no fraudulent claims result in a settlement. Many suspicious claims make it through the system, creating a need for a careful and stringent screening process.

• Medical reporting delays: The delay could be coming from your attending provider. For various reasons, your doctor could be taking their time to provide their report to L&I. They could also be waiting until your condition reaches maximum medical improvement (MMI).

• L&I delays: Remember that Labor and Industries is running a business. Often, they are focused on what is best for L&I, which isn’t always paying a claimant.

• Employer dispute: Any dispute coming from your employer regarding your case could result in a delay.

While it might seem like there are a lot of reasons your workers’ comp claim could get delayed, don’t get discouraged. You can do your part to avoid any potential setbacks. One of the biggest ways to expedite the process is to work with an experienced legal team. An experienced L&I lawyer knows the process and what routes to take to get results. They can help you organize your case, collect necessary information and documents, and ensure everything is filed and prepared on time.

You can also do your part to review your case and make sure reports and claims are filed on time. Double-check to make sure you meet deadlines on time and that you have followed the rules and regulations in place.

What If Your L&I Claim Is Denied?

You, your employer, and your doctor all have the right to protest any decision made about your workers’ compensation claim. L&I must receive a written protest within 60 calendar days of the date the decision was received (15 days for decisions about vocational benefits) or the decision will become final.

You may also appeal directly to the Board of Industrial Insurance Appeals (BIIA). The decision becomes final if your written appeal is not received within the following legal time limits from the date you received the decision:

• 60 days to appeal a claim decision or a payment decision

• 20 days for providers to appeal a billing decision that reduces the amount paid, or demands repayment

When Should You Start to Receive Workers’ Compensation Payments?

Workers’ comp awards are paid out once the claim is closed, though the total compensation amount awarded upon claim closure depends on the size of the claim. L&I award amounts vary widely and typically fall into three categories:

Permanent Partial Disability (PPD) Award

You may be rated for a PPD award before L&I closes your claim if you have completed treatment and are able to work but have suffered a permanent loss of function, and a qualified doctor provides L&I with a PPD rating. Time-loss and medical benefits will end when you receive your disability award unless the L&I claim is reopened.

L&I Disability Pension

An L&I disability pension is a special category of pension only awarded to the most severely injured workers. If you are eligible for an L&I disability pension, you will receive a non-taxable payment every month for the rest of your life.

Under Washington state law (WAC 296-14-150), gainful employment is defined as a regular occupation for income, salary, or wages. If your doctor or vocational counselor says that you cannot ever work again because of a job-related injury or illness, you may be eligible for an L&I disability pension.

Claim Resolution Settlement Agreement (CRSA)

A CRSA is an L&I settlement option where all parties agree to close an injury claim for a specified amount. When agreeing to this workers’ comp settlement type, the injured worker exchanges all future benefits, except medical, for the payment.

Self-insured employers are more likely to use CRSAs. The most common reason for this is to save money and will, unfortunately, make it more difficult for you to get your compensation. The SIE will do everything in their power to deny it. However, they still need to follow L&I’s rules for self-insured companies. If you disagree with their decision, you have the right to appeal. Contact an experienced L&I lawyer for help as soon as possible to help with the process.

Who Is at Fault for a Workplace Injury?

L&I is a no-fault system, ensuring compensation for any workplace injury. However, if a third party is involved in causing the injury, you may be able to pursue legal action against them for additional compensation under third party claims.