L&I Claim Closure
An L&I claim closure is when an L&I-approved provider certifies the following:
- The worker is at maximum medical improvement (MMI).
- The worker has been released to work.
L&I Claim Closure Process
- You will complete an Independent Medical Exam (IME) from an approved L&I provider stating that you have reached MMI and that your medical care is complete.
- Your vocational counselor will release you to work.
- L&I will release a written closing order.
Maximum Medical Improvement (MMI)
MMI occurs when your medical condition is considered fixed and stable. This means that your workplace injury or illness status will not change, with or without treatment.
Released To Work
Your claim can also be closed when your doctor has released you to work. This may be released to full duty, released to full duty but with reduced hours, released to light duty, or released to light duty with reduced hours.
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.
Future Employment Issues
L&I must address future employment issues before your L&I claim can close. If your workplace injury or illness prevents you from returning to your previous position or prevents you from working at all now or in the future, you are entitled to compensation.
In order to determine if you are employable you may be asked to attend an Independent Medical Exam (IME). An Independent Medical Exam (IME) is a patient interview and evaluation requested by L&I or a self-insured employer to review your medical history and the details of your accident and to establish finding, opinions, and conclusions about your physical condition. IMEs are conducted by approved L&I providers and as such, it is important to note that they are not always on your side.
This doctor will also rate your injury and its severity to determine your level of impairment as part of your claim and send the information to your employer, L&I, and your primary doctor. An IME is not a medical treatment appointment. It should be considered more of an evaluation where the L&I-approved doctor gathers all critical information about your injury and how you are currently healing so they can provide a comprehensive rating in accordance with the L&I PPD Awards Charts.
Permanent Partial Disability (PPD) Claim Closure
PPD awards are based on the type of injury and the level of severity of the injury and are measured by an impairment rating calculated with the L&I PPD Awards Charts. In general, the higher the rating, the bigger the payout. An experienced L&I lawyer and the right doctor are usually the winning combination to unlocking the maximum amount of L&I benefits to which you are entitled.
- Permanent Partial Disability in Washington State is calculated when L&I closes your claim.
- Your impairment is rated by a doctor or your attending physician during a PPD rating exam, followed by an approved L&I doctor during an Independent Medical Exam (IME) once you have reached maximum medical improvement (MMI).
- You will receive your award after you get medical care for your injury, become employable, get a rating exam, and have your claim closed by L&I.
- If the award amount is less than three times the State’s average monthly wage at the date of injury, L&I or the self-insured employer (SIE) sends a check for that amount.
- If the award exceeds more than three times the State’s average monthly wage at the date of injury, L&I or the SIE makes a down payment. The balance of the award is paid once a month in installments equal to the worker’s monthly time-loss compensation (at the time of closure).
What If Your Claim Is Denied?
If your claim is denied at claim closure, you, your employer, and your doctor all have the right to protest or appeal 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 worsens after claim closure, 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.
How Much Time Do I Have To Reopen My L&I Claim?
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.
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 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.
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 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
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 settlements 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.
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.
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 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.