Have you been injured at work? Did you file an L&I claim with the Washington State Department of Labor and Industries (L&I) or are you still waiting for your settlement? Have you found yourself asking why an L&I claim takes so long to close? As with any legal process, it takes time and patience. Keep reading to learn more about the workers’ comp claim process, what can cause delays, and how you can keep moving forward.
How Does The L&I Claims Process Work?
The L&I claims process can be extremely complex and time-consuming, even when you’re not the injured or ill party. Follow the steps below to ensure that your L&I claim is closed quickly and in your best interests:
- File your claim: You can file your on the L&I website via the File Fast tool, by calling the L&I office at 561.3453, or at your doctor’s office.
- Complete an Independent Medical Examination (IME): An IME is conducted by an approved L&I provider and may be requested by your Claims Manager. If you receive a favorable IME report, your L&I claim will be approved and you will receive a written order from L&I explaining your benefits.
- Receive your benefits: You will receive benefits which may include medical benefits and limited wage-replacement.
- Claim closure: Your L&I claim will close when you have met maximum medical improvement (MMI) and your treatment is successful and complete.
- Reopen your claim: If your workplace injury or occupational illness worsens, you and your doctor may apply to reopen your claim.
- Denied claims: You, your employer, and your doctor all have the right to protest any decision made about your workers’ compensation claim. If your claim is denied, call your doctor and the L&I attorneys at Emery | Reddy, PLLC to reopen it and get the care and compensation to which you are entitled.
What Is The Claims Investigation Process?
Your Claims Manager will investigate your 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 My 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 settlement 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 Claim 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 delay: Remember that L&I 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 Seattle 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
Reopen A Claim
If your workplace injury or occupational disease objectively worsens, you and your doctor may apply to reopen your claim. There must be medical evidence from an L&I-approved provider stating that after your claim closed, the condition caused by the original workplace injury worsened and needs more medical attention. The amount of time that you have to reopen your L&I claim depends on the benefits you are seeking:
- For medical treatment only, you may apply at any time.
- For both wage replacement benefits and medical treatment, apply within 7 years of the date your claim was first closed (10 years for eye injuries).
- If your claim has been closed for more than 7 years, you may apply for medical benefits. However, only the L&I Director may grant additional disability benefits such as wage replacement or disability awards for these claims.
L&I Claim Approval
If your L&I claim is approved you will receive a written order from L&I explaining your benefits. You have the right to a variety of L&I benefits to help pay for treatment costs and replace lost wages during the recovery period.
Getting Your L&I Benefits
Workers’ compensation benefits will cover your medical bills and treatments. If you are eligible for additional benefits, the Seattle L&I attorneys at Emery | Reddy, PLLC will help you proceed with seeking wage replacement, return-to-work help, pensions, or disability compensation if necessary — things that L&I won’t offer you unless you fight for it. Remember, they will often do as little as possible to get you back into the workforce.
Closing The L&I Claim
An L&I claim closes when an L&I-approved provider certifies the following:
- The worker is at maximum medical improvement (MMI).
- The worker has been released to work.
When Should I 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) Awards
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 your receive your disability award unless the L&I claim is reopened.
L&I Disability Pensions
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 State Washington 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.
How Can I Check My L&I Claim Status?
To check on your L&I claim status, you must contact L&I via the L&I Claim and Account Center or call the claim information hotline at 800.831.5227. Be sure to have your claim number readily available.
Your L&I Claim Is Worth More If You Also Have An Employment Law Claim
A significant number of L&I workers’ compensation claims often involve additional legal claims such as employment law or third-party claims. Many people file their claims without seeking representation from an L&I attorney and thus never discover that in addition to their L&I claim, they may be missing out on the ability to file an employment law claim or a third-party claim. Pursuing additional legal action has the potential to significantly increase a claim’s overall compensation.
What Is An Employment Law Claim?
Many injured workers find that their employer has taken, or plans to take, adverse action against them because they filed an L&I claim or they are out of work. You can file a lawsuit against your employer for several reasons, including retaliation, wrongful termination, disability discrimination, or unpaid wages. An L&I attorney that is experienced in both L&I workers’ compensation law and employment law can help you with your L&I claim while simultaneously filing a federal or state law claim for the violation of workers’ rights by your employer.
What Is A Third-Party Claim?
A third-party claim is one in which someone other than your employer or co-worker is responsible for your injury. If you have been injured on the job due to someone else’s actions or negligence, you may be entitled to additional compensation through a third-party claim, which combines your L&I claim with a personal injury claim using the same facts.
Unlike workers’ compensation payments, there is no limit to the amount of compensation an injured worker may seek in third-party damages.
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.
How Do I Know If I Have A Case?
The bottom line is that anyone who isn’t familiar with L&I claims should seek the input of experienced L&I attorneys who are.
Emery | Reddy Can Help You With Your L&I Claim
Emery | Reddy, PLLC is the only law firm in Washington State that is equipped to provide comprehensive representation on your case from every angle. Our Seattle L&I attorneys thoroughly assess every case to determine if our clients have additional claims, and at times this can extend far beyond the underlying workers’ compensation claim.
If you have been injured in the workplace, call Emery | Reddy today to speak with our legal team for a free case review. Please remember to have your L&I claim number readily available.
Want More Information?
To determine the value of your L&I claim you first need to understand the different types of L&I awards offered in Washington State.
The L&I workers’ compensation process is anything but straightforward. Find out the answers to your L&I workers’ comp questions today.
Self-insured employers account for one-third of workers’ compensation in Washington State, and they provide benefits directly to injured workers.
Meet The Team
The L&I attorneys at Emery | Reddy are passionate about helping workers with L&I claims and employment law issues. We Help Workers®: it’s our motto and what drives us every day.
We know how L&I and big companies think, and we understand the tactics they use. Our Seattle L&I attorneys use that knowledge coupled with over two decades of experience to help our clients get access to the L&I benefits to which they are legally entitled and hold employers accountable when they break the law.
With our law office location in Seattle, we serve communities throughout the region, including Vancouver, Bellevue, Everett, Olympia, Shoreline, Spokane, and Tacoma. If you’re struggling with an L&I claim, injury, or legal issue at work, please call us and see how Emery | Reddy can help you today.