When dealing with Labor and Industries (L&I) claims, it’s crucial to navigate the process with care and attention to detail. Unfortunately, many individuals inadvertently make errors that can significantly impact the outcome of their claims. These mistakes often arise from misunderstandings of L&I procedures, insufficient documentation, or failure to adhere to deadlines. Consequently, claimants may face delays, denials, or reduced compensation. Understanding and avoiding these common pitfalls is essential for ensuring a smoother and more successful claim process. By addressing these issues proactively, claimants can enhance their chances of obtaining the L&I benefits they need in a timely manner while minimizing potential complications along the way.
What Are the Most Common Claim Mistakes?
Failure to File Your L&I Claim Promptly
If you want the best chance of receiving the L&I benefits to which you are entitled, you need to report your injury and start the L&I claim process right away. 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 illness. If you miss these deadlines, it’s very likely your claim will be permanently barred by these statutes of limitation.
Underestimating Self-Insured Employers
Self-insurance is less common than L&I insurance, but it’s popular among larger corporations as it allows them to save money because these employers hire third-party firms — instead of using L&I — to evaluate workers’ compensation 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.
Downplaying Your Injury
One common Labor and Industries 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 an 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.
Receiving an Unfavorable Independent Medical Exam (IME)
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 workers’ compensation claim to 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.
Accepting the Wrong Impairment Rating
Many Labor and Industries 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 a 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.
Not Realizing That Mental Health Issues Are Valid L&I Claims
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 Labor and Industries claim. One of the biggest issues with L&I claims involving mental health injuries stems from the injury itself — and if you find it difficult to address your L&I claim on your own, hiring one of the experienced L&I Lawyers at Emery | Reddy, PLLC immediately is crucial to receiving the L&I benefits to which you are entitled.
Forgetting That You Are Being Monitored
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 Labor and Industries 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.
Refusing Work Offered by Your Employer after Filing Your L&I Claim
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 to an experienced Intake Specialist to learn about how we may be able to help you with your claim. 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 L&I attorney, they can help you craft that argument and ensure that you get the proper time you need to heal.
Returning to Work Too Soon after Your L&I Claim
Accepting a Smaller Award Amount than You Deserve
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. 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 Employment Law Attorneys at Emery | Reddy may be able to help with a retaliation case alongside your L&I — workers’ compensation claim.
To determine the value of your Labor and Industries claim, you first need to understand the different types of workers’ compensation awards offered in Washington state. L&I awards are 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.
L&I disability pensions are the best benefit awarded by L&I, and they are hotly contested — less than 2% of all workers’ comp claims end up settled in this manner. Because these claims are expensive to fund, it’s sometimes cheaper for L&I or the self-insured employer (SIE) to fight a claim rather than just pay it. In other words, your claim is valuable, and as such, you should expect to fight hard for it.
Waiting to Protest or Appeal Your L&I Claim
Don’t make the common 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
Not Doing Enough to Help Yourself
If you’re proactive regarding your 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 L&I attorney to help fight for your claim is a great step in the right direction.
Failure to Investigate Whether You May Also Have an Employment Law or Third-Party Claim
At Emery | Reddy, our experienced 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.
HOW IT WORKS
Watch This Video to Learn More about How Employment Law and L&I Claims Work Together
Your L&I Claim Is Worth More If You Also Have an Employment Claim
A significant number of L&I — workers’ compensation claims often involve additional legal claims such as employment 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 claim or a third-party claim. Pursuing additional legal action with the help of an experienced Labor and Industries attorney has the potential to significantly increase a claim’s overall compensation.
At Emery | Reddy, our experienced 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.
What Is an Employment 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 who 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. Third-party claims are private matters and are typically litigated directly with the Washington State Superior Court.
How do I Know If I Have a Strong L&I Claim?
If you have an L&I claim or wonder if you should seek the assistance of an experienced worker’s compensation attorney, ask yourself the following:
- Have I been denied the medical care benefits to which I am legally entitled?
- Has L&I asked me to undergo an Independent Medical Exam (IME)?
- Do I have questions about the L&I claim process?
If any of the above apply to you, Emery | Reddy may be able to help.
Navigating a workers’ compensation claim can be difficult and very time-consuming, especially when you’re ill or injured. You want to focus on healing and make sure your bills are paid, but if you don’t file things properly or on time, your health, home, and job could be in jeopardy. Many individuals miss out on much-needed L&I benefits because they don’t understand what to do or how to get the most compensation for their injuries. If you are experiencing any challenges in your case, a Labor and Industries attorney can assist you. By contacting Emery | Reddy as soon as possible after you’ve been injured, we can help you avoid the common pitfalls of filing and navigating an L&I claim. Our Seattle L&I Attorneys are here for you every step of the way.
Emery | Reddy Can Help You with Your L&I Claim
Emery | Reddy 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 for a Free Case Review with an experienced Intake Specialist to learn more about how Emery | Reddy may be able help you.
Want More Information?
If you sustain a serious or life-changing injury and are no longer able to work, you could be entitled to a Washington state L&I disability pension.
The Labor and Industries claim process is anything but straightforward. Find out the answers to your L&I — workers’ comp questions today.
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.
WE FIGHT FOR YOU
Meet the Team
The L&I Attorneys at Emery | Reddy, PLLC 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 Labor and Industries Attorneys use that knowledge coupled with over three 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.
If you’re struggling with an L&I claim, injury, or legal issue at work, call us for a Free Case Review with an experienced Intake Specialist to learn more about how Emery | Reddy may be able to help you today.
“Very prompt, understanding, and, Annie French was very helpful and walked me through all documents needed to be signed.”
— Mitch Smith
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