Common Mistakes In L&I Claims
Most injured workers report the injury to their employer and go to the hospital rather than filing their L&I claim right away. Instead, they start working with their Human Resources Department to navigate the process of getting their wages and medical bills paid while they recover.
Many workers make the mistake of following L&I’s or their employer’s instructions without asking the right questions or considering the consequences. Any mistakes made early on in the claim can spell disaster for the claim down the road. If you’ve been injured, don’t make these costly L&I claim mistakes— here’s what to do in an L&I claim.
Not Reporting Your L&I Claim Right Away or Downplaying The Injury
Although many injured workers report the injury immediately and seek the medical treatment they need, others don’t. Instead, they downplay the injury to their supervisors or coworkers, either because they’re worried about claiming, or because they want to see how badly they’re hurt before they report or file their L&I claim.
Often, people worry about whether filing an L&I claim will affect their career or income. They might use vacation or sick time rather than using the workers’ comp system.
In other cases, the boss persuades an injured worker not to file, knowing that an L&I claim could increase the employer’s workers’ comp costs. And worse yet, some don’t report their injury at all.
How To Fix It
If you want the best chance of getting workers’ comp, you need to report the injury and start the L&I claim process right away. One of the biggest L&I claims mistakes you can make is failing to file promptly.
Any delay opens the door for your employer or L&I to question whether you were hurt at work. Your employer and Claim Manager are more likely to support and accept your claim if the injury is reported in real-time.
You have one year from the date of your injury to file a claim for L&I benefits, or two years if the injury is an occupational disease. If you miss these deadlines, it’s very likely your claim will be permanently barred by these statutes of limitation.
Seeing The Doctor Your Employer Or L&I Chooses For Your L&I Claim
It’s in your employer’s best interests to recommend a healthcare provider who serves the company. Seeing this doctor could result in a medical opinion that doesn’t reflect the true nature or extent of your injuries. Issues with L&I claims can stem from unsupportive medical opinions—once it’s on the record, it’s difficult to overcome it.
During the course of your workers’ comp claim, you may be required to complete an Independent Medical Exam (IME) conducted by a doctor other than your primary provider. The purpose of this exam is for L&I to get an expert opinion regarding your medical condition. However, independent medical examiners sometimes misdiagnose a patient or mischaracterize a workplace injury as a preexisting condition.
If you’ve been asked to attend an IME exam, make no mistake—your L&I claim is on the line. Washington IME doctors work for L&I and their opinions are designed to support L&I decisions. Check out our IME tips for more information.
How to Fix It
See your own doctor for an impartial medical opinion, no matter what your employer or L&I says.
Downplaying The Injury
Some workers downplay their injury when they first see a doctor. This is a common L&I mistake. 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.
How to Fix It
First, don’t downplay your symptoms, but don’t exaggerate them, either. You don’t want to risk your L&I claim’s credibility before it starts.
Next, don’t say that the injury was your fault. This jeopardizes your case.
Finally, don’t leave out any details. Be clear about what happened, how it affected you, and what level of pain you’re experiencing. Be honest about the nature and extent of your injuries.
There are always risks associated with talking to a doctor for an L&I claim. However, you’ll avoid making some of the most common mistakes if you’re honest about your injuries and the impact they’ve had on your life.
Forgetting Everything You Say About Your L&I Claim Can Be Used Against You
From the moment you are injured at work, you should expect to be monitored. L&I defense firms regularly use surveillance companies to try to catch an injured worker doing physical activity that contradicts the L&I claim. IME staff and doctors also look for any sign that an injured worker could be overplaying his or her 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.
How To Fix It
If you’re at all unsure about what to say in an L&I claim, or how to file an L&I claim, you should hire an experienced workers’ comp attorney. They will have your best interests at heart, and they’ll make sure you are prepared every step of the way through the claims process.
Refusing Work Offered By Your Employer After Your L&I Claim
Being offered light-duty work can put you in a very tricky situation. If your employer offers you light duty, it forces you to make a big decision, often in very little time. You may get offered a different position despite the fact that your injury prevents you from doing it. Worse, your employer could force you to give them an answer without time to think. And if you don’t respond, your employer might use your refusal to argue that L&I should deny your claim.
Your employer is required to get approval from your doctor for the offer, but the approval can be as simple as a verbal okay.
How To Fix It
If you find yourself in this situation, the first thing you should do is contact an L&I attorney immediately. The second thing you should do is contact your doctor. If the doctor disagrees with the light-duty job in writing, you will have a good argument to L&I that you remain unable to work.
In most circumstances, you should not outright refuse an offer for light-duty work. You may find you can cope with light-duty work if it’s pitched at an appropriate level. Otherwise, you (or your attorney) must explain why light work is not an option—this is not an easy case to make.
Waiting To Appeal Your L&I Claim
Every L&I decision can be protested or appealed. You have 60 days to appeal or protest an L&I decision. If you miss this important deadline, the decision will likely become final.
In short, if you miss an appeal, you’re stuck with the outcome. This is one of the key issues in L&I claims—the rules are very strict, no matter how severely injured the claimant is. Entire cases have been lost because a claimant simply forgot to appeal or protest an adverse decision within the 60-day window.
How To Fix It
If you have the opportunity to appeal, don’t delay! In an ideal world, everyone would get in touch with an L&I attorney as soon as they’re injured. Many of our clients come to us after receiving unhappy news from L&I. While it’s not impossible to turn it around, it’s a lot easier when we’re with you from the beginning. So although you don’t need a lawyer for an L&I claim, you should seriously consider hiring one.
Returning To Work Too Soon After Your L&I Claim
If you have the opportunity to appeal, don’t delay! In an ideal world, everyone would get in touch with an L&I attorney as soon as they’re injured. Many of our clients come to us after receiving unhappy news from L&I. While it’s not impossible to turn it around, it’s a lot easier when we’re with you from the beginning. So although you don’t need a lawyer for an L&I claim, you should seriously consider hiring one.
For example, an employer who wants to fight an 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. Or, unscrupulous employers sometimes use the period after the injured worker returns to work to place the worker on a PIP (performance improvement plan) until the employee is fired or quits.
How To Fix It
To help avoid issues with your L&I claim, don’t return to your old working capacity until you know you’re fully healed. It can be hard, especially when your income is affected, but trust us—returning to work too soon can negatively impact your case.
Accepting The Wrong Disability Rating
For many claims, L&I issues a disability rating, which determines how much an injured worker will get paid. Before you agree to the rating, though, you need answers to the following questions:
- Who issued the rating?
- Did the IME provide the rating?
- Which doctors support the rating?
- Have you finished your medical treatment?
- Have you truly reached maximum medical improvement (MMI)?
- Do you agree with the rating?
- Are you ready to go back to work?
- Are you concerned that you might need another procedure?
- Do you just need more time to see if you’re healing?
You only get one shot at maximizing the amount you receive for your workplace injury, so it’s important that you have the right medical opinion and support to ensure that you receive the highest rating available.
How To Fix It
This is where our L&I attorneys really shine. We’ve tried thousands of workers’ compensation claims throughout Washington State, and we regularly obtain claim approvals, benefits, and exceptionally large awards for our clients.
Do you need a lawyer for your L&I claim? Generally, yes. By hiring the right attorney, you’ll know you’re getting the advice and support you need to make the most of your L&I claim.
Not Realizing That Mental Health Issues Are Valid L&I Claims
Some sick or injured workers experience mental health issues like depression. In other cases, a mental health injury even forms the basis for their L&I claim.
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 L&I claim. One of the biggest issues with L&I claims involving mental health injuries actually stems from the injury itself—if someone is depressed or anxious, they might find it harder to fight their L&I claim through to the end.
How To Fix It
Mistakes in L&I claims often stem from simply not knowing where to turn for help. If you find yourself in this situation, reach out to an attorney and explain your situation. An experienced L&I attorney can discuss your rights and options and will seek to represent you if they feel you have a case.
Get Good Advice Sooner Rather Than Later
Sometimes, L&I claims go through without a hitch. You file a claim, a doctor gives you a favorable report, and L&I accepts your claim. Before you know it, you’re back at work, and you’re happy with your settlement. This doesn’t happen often, though.
L&I claim mistakes are all too common, and often, people damage their claims without even knowing it. Prepare to file your L&I claim by:
- Seeking treatment or medical care immediately, even if you’re not sure how injured you are yet.
- Speaking to an independent doctor about your injuries.
- Clarifying exactly what happened and how you feel about your injury.
- Knowing where to turn for legal help and advice.
Whether you don’t know how to file an L&I claim properly, or you just don’t know where to turn for advice, don’t make a mistake with your claim before it gets off the ground. Instead, contact Emery | Reddy, PLLC right away. Our legal team can provide a free case review to determine if you have a case. Please remember to have your L&I claim number readily available.