Denied Workers' Compensation Claims
L&I workers’ compensation claims are denied for any number of reasons, such as missed deadlines or disputes about whether the injury was work-related. It takes experience and persistence to get The Washington State Department of Labor and Industries (L&I) to reverse a denied workers’ comp claim.
How Do I Know If I Have A Denied Workers’ Comp Claim?
L&I will issue a decision stating whether your claim has been approved or rejected. If your claim is not receiving the attention you think it deserves, contact an experienced L&I attorney as soon as possible.
What To Do If I Have A Denied Workers’ Comp Claim
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 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.
What Is The Difference Between A Protest And An Appeal?
According to the Washington State Department of Labor and Industries (L&I), both appeals and protests relate to disputes or disagreements with decisions made by the department. However, there are differences in terms of the situations they address and the processes involved:
A protest typically occurs when you disagree with a specific decision or action taken by the Department of Labor and Industries, such as a determination related to a workers’ compensation claim or a citation issued by the department.
Protests are often the first step in addressing a disagreement. They are a way for individuals or businesses to formally challenge a decision and present additional information or arguments in support of their position.
Protests are usually filed within a specified timeframe after receiving notice of the decision you are protesting. Failure to file a timely protest may limit your ability to challenge the decision.
An appeal comes into play if you are dissatisfied with the outcome of the protest or if you want to challenge a decision that has already gone through the protest process.
Appeals involve a more formal legal process and may be heard by an administrative law judge or another designated authority. The appeals process provides a forum for a more thorough review of the case, including presenting evidence, witnesses, and legal arguments.
The decision reached during the appeal process is usually considered final, but in some cases, further legal avenues, such as a review by a higher court, may be available.
It’s important to note that the specific procedures and timelines for protests and appeals in Washington State may vary depending on the type of case or decision being challenged. Therefore, individuals involved in disputes with the Department of Labor and Industries should consult the department’s guidelines, rules, and regulations, or seek legal advice to ensure they follow the appropriate procedures and deadlines.
How To Protest Or Appeal An L&I Order Or Decision
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 becomes final.
How To Protest A Vocational Determination
If you disagree with a vocational determination on your claim, you may submit the Vocational Dispute Form with your concerns. The dispute form is not required but may prove to be a useful tool.
You may appeal in writing to:
The Washington State Department of Labor and Industries
Vocational Dispute Resolution Office (VDRO)
P.O. Box 44880
Olympia, WA 98504-4880
Your dispute must be sent within 15 calendar days of receipt of a notification letter. The 15-day deadline may be extended by VDRO if good cause is shown. It’s best to dispute on time. If you miss this deadline, consider reconsideration or appeal which have 60-day deadlines.
Are Time-loss Benefits Affected During The Vocational Dispute Period?
L&I will not pay time-loss benefits if the vocational determination finds the injured worker employable or during the VDRO review process.
Can I Reopen A Denied Workers’ Comp Claim?
If your workplace injury or occupational disease 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.
How Do I Know If I Have A Labor & Industries Case?
If you have an L&I claim or wonder if you have an injury case, ask yourself the following:
- Have you been denied the medical care benefits to which you are legally entitled?
- Has L&I asked you to undergo an Independent Medical Exam (IME)?
- Do you have questions about the L&I claim process that you don’t understand?
If any of the above apply to you, you may have a case!
Navigating an L&I 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 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
- Medical costs.
- Ongoing medical coverage including surgery costs.
- Lost back wages.
- Permanent partial disability (PPD) award.
- An L&I pension.
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.
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Work-related injuries and illnesses are unfortunately common occurrences in the construction industry, with injuries occurring at a higher-than-average rate for construction workers.
The L&I workers’ compensation process is anything but straightforward. Find out the answers to your L&I workers’ comp questions today.
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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 it’s 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 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.
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.