Washington State L&I Claims

Self-insurance is less common than L&I insurance, but it’s popular among larger corporations. It allows them to save money by hiring third-party firms — instead of using L&I — to evaluate Washington state L&I claims, which can cause endless headaches for injured workers. Other tactics that self-insured employers may use are claim suppression, harassment, and even denying benefits. If your employer is self-insured, you are at a disadvantage from the onset.

One common Washington state L&I claim mistake workers make is downplaying their injuries when they first see a doctor. However, if you don’t tell the doctor exactly what you are experiencing, the doctor’s records won’t reflect your injuries and pain, and L&I or your employer could use these records to later prove that:

• Your injuries and pain are less severe.
• You weren’t really injured at all.
• Your injuries are the result of something that happened outside of the workplace.

There are always risks associated with talking to a doctor for a Washington state L&I claim. However, you’ll avoid making some of the most common L&I claim mistakes if you’re honest about your injuries and the impact they’ve had on your life from the very beginning.

L&I or your self-insured employer (SIE) may require that you seek an Independent Medical Exam (IME) from an approved L&I provider who can validate your injury and provide a neutral second opinion on your condition. The purpose of an IME is to help the insurance company determine the reality and extent of your injury. The L&I doctor’s findings are then used to deny or award benefits for your Washington state L&I claim which will ultimately help you recover and pay for treatment. Visit our page about how to beat an IME exam and learn how you can see past IME doctor tricks.

Many Washington state L&I claims are issued an impairment rating, which determines how much an injured worker will get paid based on their injury and the effect it has on their daily life. Before you agree to the rating, you need answers to the following questions:

• Who issued the rating?
• Did the IME provider provide the rating?
• Which doctors support the rating?
• Have you finished your medical treatment?
• Have you truly reached maximum medical improvement (MMI)?
• Are you concerned that you might need another procedure?

It is important that you don’t make this common L&I claim mistake by ensuring that you have the right medical opinion and support to receive the highest possible rating. If you feel that you have received an inappropriate rating, you can ask L&I for increased impairment benefits.

Depression, anxiety, and other mental health issues can develop when a work injury or industrial disease causes prolonged pain, prevents someone from carrying on their work, or alters the nature of their family and social life. The Washington state L&I Attorneys at Emery | Reddy, PC take mental health as seriously as any other physical injury and will fight to ensure that you get the full treatment and benefits to which you may be legally entitled. Call Emery | Reddy today to speak to an experienced Intake Specialist to learn more about how we may be able to help you with your claim. No fee unless we recover for you. Mental health issues are treated similarly to physical injuries when they occur in the workplace; however, it’s not easy to find a mental health professional capable of supporting a mental health Washington state L&I claim. One of the biggest issues with L&I claims involving mental health injuries stems from the injury itself. If you find it difficult to address your L&I claim on your own, hiring one of the experienced Workers’ Compensation Lawyers at Emery | Reddy immediately is crucial to receiving the L&I benefits to which you are entitled.

Make no mistake, from the moment you are injured at work, you should expect to be monitored. Workers’ compensation defense firms regularly use surveillance companies to try to catch an injured worker doing physical activity that contradicts their Washington state L&I claim. Independent Medical Exam (IME) staff and doctors also look for any sign that an injured worker could be overplaying their injury. Defense counsel has been known to hire investigators to research and record social media posts and online activity. Employers are incentivized to use resources to fight an L&I claim because accepted claims affect the amount they pay for workers’ comp insurance.

In most circumstances, you should not outright refuse an offer for light-duty work. You may find that you can cope with light-duty work if it’s pitched at an appropriate level. If you find yourself in this situation, the first thing you should do is call Emery | Reddy to speak with an experienced Intake Specialist to learn about how we may be able to help. The second thing you should do is contact your doctor. If your doctor disagrees with the light-duty job in writing, you will have a good argument to L&I that you remain unable to work; if you hire an experienced Seattle workers’ compensation attorney, they can help you craft that argument and ensure that you get the proper time you need to heal.

An employer who wants to fight a Washington state L&I claim may use the employee’s return to work as evidence that the worker is in fact able to work full-time again. Occasionally an employer may use the period after the injured worker returns to work to place the worker on a Performance Improvement Plan (PIP) until the employee is fired or quits. This is retaliation, and it is illegal. If this happens to you, call for a Free Case Review with an experienced Intake Specialist to see how the local Washington state Attorneys at Emery | Reddy may be able to help with a retaliation case alongside your Washington state L&I claim.

To determine the value of your L&I claim, you first need to understand the different types of workers’ compensation awards offered in Washington state. If you receive a an L&I settlement or award it is paid out when the claim is closed, though the total settlement amount awarded upon claim closure depends on the size of the award. Workers’ compensation award amounts vary widely and typically fall into three categories:

• L&I disability pension: a life-long benefit awarded to injured workers who will never be able to return to gainful employment due to a severe or life-threatening injury.
• Permanent partial disability (PPD) award: A one-time sum paid to injured workers when their L&I claim is closed. The worker can re-enter the workforce following a PPD award.
• Claim resolution settlement agreement (CRSA): an L&I settlement option where all parties agree to close an injury claim for a specified amount. When agreeing to this settlement type, the injured worker exchanges all future benefits, excluding medical, for the payment.

Don’t make the common Washington state L&I claim mistake of waiting too long to protest or appeal your claim. You, your employer, and your doctor all have the right to protest any decision made about your claim. The Department of Labor and Industries or your SIE 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 becomes 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

If you’re proactive regarding your work injury claim and work hard to ensure your claim has the correct information, you could earn more in your award payout. The more you can do to prove to L&I or the SIE that you are willing to help yourself, the more likely you are to get a better award and further treatment. Hiring an experienced Seattle workers’ compensation attorney to help fight for your claim is a great step in the right direction.

At Emery | Reddy, our experienced Workers’ Compensation Attorneys practice both Employment and Workers’ Compensation Law, which means we will investigate all aspects of your claim to make sure you aren’t missing out on any potential benefits.

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 Washington state 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. Third-party claims are private matters and are typically litigated directly with the Washington State Superior Court.

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