How Does L&I Work – Common Workers' Compensation Questions
On-the-job injuries can seriously upend a worker’s life, forcing them to take weeks, months, or years off of work while costly medical bills pile up. Fortunately, the vast majority of workers are covered by a form of insurance commonly known as L&I that can help make up for lost wages, pay for medical treatment, and rehabilitate the injury. But what is L&I? How does an L&I claim work, and how much could I get if I file an L&I claim due to a workplace injury? Let the experienced L&I attorneys at Emery Reddy your workers’ comp questions.
Most people suffering from a work-related injury or illness have questions similar to these. Below you’ll find some answers to common questions that we’ve encountered from injured workers. The bottom line is that filing an L&I claim is the best way to move forward in order to get the proper care for your injury.
However, the workers’ compensation process is anything but straightforward. Without the right tools and resources, navigating the maze of an L&I claim can easily aggravate a stressful situation. Here are the answers to your workers’ comp questions:
What Is L&I?
Before even getting to the question of, “How does L&I work?” we should talk about its structure and mission. L&I refers to the Washington State Department of Labor & Industries, which is like a state-run insurance company that compensates workers who are injured or develop a work-related disease or illness on the job. Like an insurance company, L&I decides which claims to pay and makes those payments. Note: About 30% of employers in Washington are self-insured, meaning they use third-party administrators to evaluate claims. The following Q&A focuses on claims evaluated by L&I.
How Does L&I Work?
When Washington employees get hurt, fall ill, or contract certain types of disease at work, they are entitled by Washington state law to file a workers’ compensation claim. If all goes to plan, the injured worker’s claim is accepted by L&I, which then provides the worker with various L&I benefits.
What Benefits Does L&I Provide Injured Workers?
The following is a partial list of L&I benefits:
How Does the L&I Claims Process Actually Work?
Due to the bureaucratic nature of L&I, many cases get bogged down in red tape, paperwork, and technicalities. An L&I claim could be denied for almost any reason, and once the claim is denied, it takes experience and persistence to get L&I to reverse an initial denial. You can still obtain L&I benefits, but it takes skill to handle this situation when it gets to this point.
Why Are L&I Claims Denied?
What is L&I—really—if it denies claims for unexplainable reasons more often than many would think? While L&I claim managers are required to fully and fairly evaluate an injured worker’s L&I claim, they can deny it for any reason. Common reasons for claim denials include:
- Workplace injury is considered preexisting.
- The injury is determined to have occurred outside work.
- An opinion that the injury is not as bad as claimed, or non-existent.
- The injury occurred in a parking lot, which means it is not covered.
- If the injury is a mental health condition, it is often denied due to a lack of medical documentation.
- A doctor feels that the injury as described doesn’t match the diagnosed medical injury.
Claim managers often make mistakes: sometimes they miss critical evidence. Sometimes they choose to disbelieve the evidence. They sometimes have biases, opinions, and belief systems that make them ineffectual in deciding to allow a given claim. There are examples of some claim managers misunderstanding an injured worker’s mental health issues or misreading key medical files. Others simply believe that certain mental health conditions do not exist. Washington L&I is staffed with people, and people are not perfect. When mistakes are made, you need help correcting them.
Doctors make mistakes: especially independent medical examiners (IMEs), who work for L&I. They sometimes misdiagnose a patient, apply a wrong category rating, or mischaracterize a workplace injury as one that is preexisting, or that occurred outside of work. Sometimes they simply err in putting the correct language into a medical report, which renders that report useless as legal evidence. And sometimes they don’t understand or believe the amount of pain the injured worker is experiencing. This happens frequently, especially when an independent medical examination is involved.
Employers also make mistakes: sometimes they believe that an injured worker was hurt outside of work, especially if they didn’t actually witness the injury. Sometimes they don’t understand or believe that their workplace could cause a mental health issue. Sometimes they don’t agree that the workplace is harmful enough to cause occupational disease.
Can I Choose Any L&I Doctor I Want?
You can choose your L&I doctor from a pre-approved list.
When you have an open L&I claim, you’re entitled to medical care. However, your employer can’t make you choose a specific care provider, and they can’t force you to see a certain doctor to begin your L&I claim.
Instead, you have the right to choose your own doctor from the pre-approved list provided by L&I, and it’s crucial you select the right care provider who will take your claim seriously and fully explore your injury. Here’s how it works.
- You can choose any doctor who is also an approved L&I provider.
- If you see your primary care doctor first and they’re not an approved examiner, you can switch to an L&I-approved different doctor of your choice.
- Should you wish to change your doctor for an L&I claim, you would need to complete a specific “Transfer of Care” form.
How Do I Start The L&I Benefits Claim Process?
You have three options to file a Washington state L&I claim:
- File by phone at 877.561.3453.
- File online.
- File at your doctor’s office, if you complete the “Report of Accident” there.
To file an L&I claim, you will need help from your doctor. Your doctor will need to complete each of the following tasks:
- Confirm that your injury is, in fact, work-related.
- Determine your ability to return to work.
- Complete the “Report of Accident.”
The “Report of Accident” form must be signed by a doctor or ARNP (Advanced Registered Nurse Practitioner). The doctor will typically diagnose the injury and recommend treatment.
You also have the right to consult with an attorney at any time, including before or after filing an L&I claim. Seek counsel from an attorney if you feel like your doctor is not supportive. Medical examiners you might be referred to often work closely with L&I and their medical opinions often reflect that relationship.
How Do Taxes Affect L&I?
If you’re wondering whether you need to pay taxes on L&I payments, the answer is no. No matter whether you are receiving wage loss benefits weekly, or received a lump sum, workers’ compensation is not taxable.
The IRS states: “The following payments are not taxable…Workers compensation for an occupational sickness or injury if paid under a workers’ compensation act or similar law.”
Additionally, Washington state tax does not apply to a weekly workers’ compensation check. You will not receive a W-2 or any tax notification documents.
All of that said, if you are on workers’ compensation pay as well as social security disability income, there may be a tax notification.
Emery | Reddy, PLLC has years of experience litigating L&I Claims. We help workers. Call us if you have an L&I, workers’ comp, or other employment law claim. You won’t get better advice.
What Is The Statute Of Limitations For L&I?
A “statute of limitations” is a time limit that determines how long you have to make claims for compensation for various injuries, such as personal injuries and workplace injuries. Washington has a statute of limitation for L&I claims, which means you only have a certain amount of time to file an L&I claim against your employer. In our state, the statute of limitations is one year from the incident date —so, if you file an L&I claim more than a year after the event, you won’t be entitled to any compensation because your claim is time-barred.
In exceptional circumstances, you may have longer to make a claim. For example, if you’re suffering from an occupational disease, there’s usually a fairly long diagnostic process involved. In this case, you have two years from the date of a medical diagnosis to file your claim instead of the standard year.
Don’t leave it until the last minute to make your claim. Consult an L&I attorney in Seattle as soon as possible to make sure you don’t run out of time.
How L&I Settlement Amounts Work
When someone is injured at work in the state of Washington, an L&I claim is needed to determine the settlement of a particular amount. But while private arbitration is common with claims in other states, most claims in Washington go through an L&I settlement, and the amounts can vary wildly.
The good news is that workers’ compensation claims typically fall into one of three main types, which are: pensions, structured settlements, and Permanent Partial Disability (PPD). Here’s how each breaks down, as well as what you can expect when filing an L&I injury claim.
Also known as a permanent total disability pension, a lifetime L&I pension is an annuity payment that is guaranteed for the rest of a claimant’s life. It’s based on the worker’s wage at the time of injury, as well as dependents, and is paid out monthly for life. Qualifying for an L&I pension requires meeting two important criteria:
- Did you sustain a workplace injury that is permanent and disabling?
- Are you unable to ever return to work?
If your injury meets these two criteria, you may be able to obtain a large L&I settlement amount for the rest of your life. That said, getting an L&I pension can be a complicated matter, and working with a competent L&I attorney can mean the difference between qualifying for an L&I pension or re-entering the workforce with a significant injury that could prevent you from being able to make a decent living.
L&I Structured Settlement
As a lump sum payment that can permanently settle a workers’ compensation claim, an L&I structured settlement is often offered when a claimant is unable to qualify for a larger payment such as an L&I pension. However, the full settlement amount can vary wildly and depends on a multitude of factors, such as:
- Your age
- The type and severity of your injury
- The threat of legal action if both sides can’t come to an agreement
- The reputation and history of your attorney, if you hire one
- The likelihood of losing the case
- Whether or not you may pursue a pension
As you can see, legal representation is very important when fighting for an L&I structured settlement, and retaining the right attorney can mean the difference between prevailing with your claim and having your L&I claim denied.
L&I Permanent Partial Disability (PPD)
If your injury is not determined to be permanently disabling, you may qualify for a one-time payment known as a Permanent Partial Disability (PPD). The L&I settlement amount is based on the type and severity of your injury, as well as other factors that may increase or decrease your payment, such as:
- The testimony of a doctor or healthcare worker
- Whether an independent medical examiner agrees or disagrees with the claims made
Note that all injuries are given a rating that the state uses to determine the exact L&I settlement amount. That said, some types of injuries can easily earn 10x or more on your claim while others could leave you with a pittance and require you to exercise other options. In order to protect your rights and your money, it’s important to retain a suitable Seattle L&I attorney so that you can obtain an award that is rightfully yours and matches the severity of your injury.
How To Check L&I Claim Status?
If you want to check on your L&I claim status, you’ll need to contact the Washington State Department of Labor & Industries. Their capacity to respond to phone calls due to the coronavirus pandemic has made it a bit more difficult to get a representative on the phone, so you may want to use the L&I website to check the status of your claim via the L&I Claim and Account Center.
You can also call the claim information hotline at 800.831.5227 or the provider hotline at 800.848.0811. Make sure to have your claim number ready; you may be required to leave a voicemail with your name, contact information, and claim number for your claim manager to return your call.
Is L&I The Same As Workers’ Compensation?
While L&I is the primary form of workers’ compensation, it is not the only option in Washington. Employers can obtain workers’ comp coverage via the Washington State Department of Labor and Industries (L&I) or pay for their own self-insurance if they meet certain requirements. Neither will affect the rights of injured employees as benefits to you won’t change. However, the management of an L&I claim does differ, and self-insurance means that you’ll have to go through your employer rather than L&I to complete your workers’ compensation claim and get paid.
What Is an L&I Pension?
If you have been injured on the job and are unable to return to work, you may qualify for an L&I pension. This type of L&I claim means lifetime payments for those that cannot ever return to work due to their injury or illness, and are roughly equal to the qualifying time loss payment for the rest of your life. In fact, an L&I pension is the largest settlement offer that can be received under an L&I claim, and it has nothing to do with whether your company has a pension plan of any kind as the claim is paid out by the state, not your employer.
Do Temporary Workers Get L&I Benefits?
Under Washington state’s L&I laws, it doesn’t matter whether you’re a temporary or permanent worker—if you’re injured on the job, you may be eligible for L&I benefits. Even if you were recruited by another agency and ended up working temporarily for a third party, you can file an L&I claim against the employment agency instead of the place of business where the injury occurred.
What Is a Third-Party Claim?
As an L&I law firm in Seattle, Emery | Reddy, PLLC has years of experience litigating L&I Claims, and we help ensure workers receive the compensation they’re entitled to if they’re injured in the workplace. Call us if you have an L&I workers’ comp, or other employment law claim you need assistance with.
Can I Have An Attorney Represent Me For A Workers’ Compensation Claim?
All workers in Washington have the right to be represented by an attorney in workers’ compensation claims. An attorney can help you prepare the best case possible for your injury. In some cases, you may be able to advocate for yourself if your injury is only a minor one. But if your injury prevents you from doing significant parts of your job or makes it difficult to work at all, an attorney can be very helpful in advocating for the full amount of benefits that you deserve based on your injury’s severity.
You may need a workers’ compensation attorney if:
- You or your loved one suffered severe injury.
- Your employer is not supportive of your L&I claim.
- Your workers’ compensation or benefits were denied.
In any of these cases, an experienced attorney can help ensure you receive the benefits and rights to which you’re entitled.
When looking for a workers’ compensation attorney, make sure to find someone with a track record of positive results that can build a case and gather evidence to present your claim as effectively as possible.
Why Should I Hire an Attorney to Represent Me for My Workers’ Compensation Claim?
Hiring a workers’ compensation attorney can help you avoid being taken advantage of by insurance companies. You can also ensure that all negotiations and transactions are handled by a professional who understands how to build a solid case and negotiate the best possible settlement for your claim. Additionally, hiring a workers’ compensation attorney will ensure you’re getting the best care for your case and the best settlement possible. If your injury makes it difficult to advocate for yourself, a workers’ compensation attorney can be a huge help in fighting for you and your rights.
If you’re looking for an experienced attorney for your workers’ compensation claim, look no further than Emery | Reddy. Our attorneys are well versed in handling workers’ compensation claims and will advocate for you and your family in your time of need.
Can I Get an Overpayment With L&I?
If you’ve been injured at work and previously had a policy with an employment agency, you may receive an L&I overpayment for that injury. An L&I overpayment occurs when the insurance company pays you more than what they’re obligated to provide. This might happen if your employer or employment agency fails to carry its own L&I insurance or policy. In the case of overpayment, the insurance company is required to attempt an offset before it sends you a check, by returning that check to its own bank account to pay for the L&I overpayment.
What Does This Mean For You?
If you have received an overpayment from L&I, you need to understand the following: you will owe the overpayment amount back to L&I.
Check your mail. The insurance company will send a letter explaining what it is attempting to recover, how much it cost, and why it is making the attempt. You are entitled to an explanation of the insurance company’s reasoning for this offset and any other information on the overpayment or its status
If you don’t repay the L&I overpayment, you could be sued by the insurer. Any judgment against you could result in a lien placed on your property and may be reported adversely to credit bureaus.
Can I Fight An L&I Claim?
You, your employer, or your doctor may challenge the validity of an L&I claim. If you are injured off the job, your doctor may make a written statement claiming that your injuries are not work-related and should be excluded from coverage. Your employer may also challenge the L&I claim. Your employer may deny that your injury was caused by an event or exposure at work, or say they didn’t know about the event or exposure. You may also make a written statement regarding what happened and who should be held responsible.
If you choose to protest or appeal your L&I claim, you have 60 calendar days from the date you received the decision to send a written notice. If written notice is not received within this time frame, the L&I decision will be final.
To protest an L&I claim:
- Find out the name of your claim manager on the L&I notification you received.
- Write a letter to the claim manager stating why you disagree with L&I’s decision. Include any relevant information or documents, such as witness statements if available.
- Include your name and L&I claim number on all pages of your protest.
- Send the written notice along with any relevant information or documents to the address on your L&I notification letter.
For more information on how to file a claim or appeal visit: https://lni.wa.gov/claims/for-workers/file-a-claim/.
Once L&I has issued a decision, it can be almost impossible to get them to reverse. Having an L&I attorney on your side can help. The L&I attorneys at Emery | Reddy have assisted hundreds of injured workers appeal their claims successfully as well as identified additional claims that other lawyers miss. Give us a call today to see how we can help you.
Call Emery | Reddy today for a free case review.
What Is A Permanent Partial Disability (PPD) Settlement?
As one of the three main types of L&I settlements, a permanent partial disability (PPD) settlement is a designation that can help you obtain money due to a work-related injury. Specifically, a PPD settlement is the result of an L&I claim where the claimant is able to eventually return to work. Other types of L&I settlements include pensions, or lifetime monthly payments, as well as structured settlements, which represent a lesser version of the benefits from an L&I claim.
As the most common type of L&I claim settlement, a PPD award is given when the claimant has been injured on the job to the point where they are unable to continue performing their job function. After filing an L&I claim, you’ll receive an impairment rating and a prognosis for your medical care. If it’s been determined that you are unable to return to work and you’re dealing with a permanent disability even after you’re recovered from the initial injury, you’ll have a PPD settlement on your hands. In order to establish the recovery timeline, something known as maximum medical improvement will be used, which helps establish when your medical care has exhausted all avenues as you continue to battle the effects of your injury.
For many L&I attorneys, the best settlement option for those who will eventually return to work is a PPD. As for how much money you can expect to get, that depends on when your injury occurred, how serious it is, and whether there are any liens on your claim. The all-important disability rating comes from a medical professional, though you should be wary if your employer schedules or offers a health review of their own—they could be trying to manipulate your claim. For this reason and others, it’s best to get the medical opinion of a trusted third-party doctor, as well as the guidance of an Seattle L&I attorney.
Does Emery | Reddy Handle Third-Party Claims?
To make matters more confusing, L&I claims can actually be combined with personal injury claims since the same event can lead to both. If you have an L&I claim and a personal injury, that personal injury is known as a third-party claim. Fortunately, Emery | Reddy takes care of third-party claims, and you may even be deserving of a larger award because of the facts of your case.
For an idea of how this works, think about an injury at work that was caused by your employer or a co-worker. That’s known as a simple L&I claim, though it’s also possible that an injury at work may have been caused by someone other than your employer or a co-worker. For example, if you’re driving for work and you’re injured by another driver, you’d have an L&I claim because you were working at the time, but you’d also have a third-party claim because you were injured by a third party—the other driver. The same event caused the two claims, and that can be advantageous when it comes to seeking an award as a result of that injury.
However, keep in mind that not all third-party claims are so cut and dry. Sometimes, a prior L&I can actually work against your third-party claim due to a workers’ comp lien on your third-party settlement. Since your employer has already paid benefits to you as a result of your injuries, they’ll look to get some of that back when you settle your third-party claim. The nature of the return depends on specific formulas and your settlement amounts, and it’s even possible for a third-party settlement to reduce your L&I claim because of how offsets work.
Will L&I Pay My Medical Bills?
If you work anywhere in the state of Washington, you are covered by the state’s accident and disability coverage. This is also referred to as L&I, meaning the Washington State Department of Labor & Industries. However, there are two types of L&I claims in the state—one that goes through the Washington State Fund and another that goes through your employer’s policy. Also known as worker’s compensation, L&I in Washington is available to all employees in the state.
That said, an L&I claim will cover an injury and pay your medical bills only if the injury occurs while you’re on the job during normal working hours. In fact, it’s your responsibility to show that the injury occurred at work and work alone.
About 100,000 people report L&I injuries on the job in Washington each year, as well as 50,000 more that report injuries to company self-insurance. Whether you report your injury to L&I or your own company depends on whether your employer has its own insurance or not. If they do, you’ll go through your company’s insurance coverage; otherwise, it’s through L&I, though they’re both largely treated the same.
Keep in mind that L&I will only pay your medical bills if your claim is approved. Merely filing an L&I claim isn’t sufficient, and not all filed L&I claims will be accepted. Some valid claims may even be denied, which means that it’s crucially important that you hire an L&I attorney to help argue your claim. By working diligently on your claim, our L&I attorneys in Seattle will ensure that your claim is filed properly and ultimately accepted, which can help you pay for medical bills and other costs associated with your injury. The good news is that an L&I claim will help pay for medical care and treatment for as long as they’re deemed necessary.
Does Workers’ Compensation Pay For My Lost Wages?
For those who are worried about whether workers’ compensation will pay for lost wages, the answer is that it can, but not entirely. That’s because, while an L&I claim in Washington can help you with lost wages as a result of a workplace injury, you won’t be able to get more than 60 to 75 percent of your wages reimbursed since the date of your injury. You’ll have to get a certification from a doctor and file an L&I claim, though you won’t be able to keep the entirety of your regular paycheck during the time that you’re out due to an injury.
According to Washington state L&I laws, the maximum benefit that you can receive is 60 to 75 percent of your wage. The actual amount is based on the number of dependents you have with specifics set by the state legislature. Sometimes it can help to request another position at your employer so that you can continue to work in another capacity, but this may not be possible depending on your injury and whether there are any open positions to fill.
As for actually receiving that claim money, it all depends on the filing and acceptance of your L&I claim. Checks are typically mailed as soon as 14 days after filing a claim, and they’ll also be sent every two weeks (by mail or electronically) as long as your doctor maintains that you can’t work and you send a Worker Verification Form to your claim manager. Payments must be deposited or cashed within 180 days, otherwise, they’ll be canceled and forfeited. If you lose or misplace a check, you may be able to request a new one via your L&I claim manager. One positive aspect of the process is that the payment won’t be taxed because it’s considered a disability benefit, not earned income.
Call Emery | Reddy today for a free case review.
Can I Sue L&I?
Injured workers might want to sue their employers or the Washington State Department of Labor and Industries. But per Washington State Law, workers can’t sue employers, co-workers, or the department of L&I, meaning that all L&I cases in Washington are handled by the Washington State Department of Labor, not the courts.
Even if you are unhappy with the outcome of your case, you can’t sue L&I, your employer, or another coworker. L&I insurance exists to help mediate claims and get assistance for injured workers without going to court. Generally, the L&I system doesn’t seek to assign blame and L&I attorneys often refer to it as a no-fault system.
Exceptions exist for companies that are negligent, but these cases can be challenging in a court of law due to the existing L&I system.
What Is The Difference Between An Injury And An Occupational Disease?
The difference between an injury and an occupational disease is that an injury is a sudden event, while an occupational disease is something that develops over time. For example, an injury might be a fall, while an occupational disease might be black lung disease.
In an L&I claim, in order to be eligible for benefits, you must be able to show that your injury or disease was caused by your job. This can be difficult to do, especially in the case of an occupational disease which may have many causes.
If you are not sure if you have an occupational disease or an injury, you should talk to an attorney. They can help you determine if you have a case and how best to proceed.
What Is A Third-Party Claim?
A third-party claim is when you file a lawsuit against someone other than your employer or L&I insurer. This could be the manufacturer of a defective product that caused your injury or the driver of a car that hit you. You may want to file a third-party claim if your employer or L&I insurer denies your claim or if you think you can get a bigger settlement from the other party.
A third-party claim can add complexity to your workers’ compensation case, and it’s important to have an experienced attorney helping you through the process.
Can I Get Job Retraining If My L&I Injury Does Not Allow Me To Return To My Old Job?
You can get job retraining after workers’ comp if you are not able to return to your old job because of your injury. The L&I claim process will include an evaluation of your ability to return to work. If it is determined that you cannot return to your old job, you may be eligible for job retraining. If you are eligible for job retraining after workers’ comp, the process will be coordinated by the Department of Labor and Industries (L&I). Your employer may also be able to provide some job retraining options for you.
It is important to have an experienced attorney helping you through the L&I claim process, especially if you are considering job retraining. An attorney can help make sure that you receive all the benefits to which you are entitled.
Why Does Workers’ Compensation Take So Long To Settle?
Resolving an L&I claim in Washington can take months–sometimes even years. Once a claim is opened, you must complete any medical treatment ordered by your doctor and receive the “okay” to work again. Additionally, your injury will receive a rating, which determines the amount and type of settlement. After all the steps have been completed as established by the Washington Department of Labor, L&I will then issue your settlement, whether it’s a Permanent Partial Disability or a structured settlement (lifetime pensions are a different process, and difficult to obtain; it is best to hire an L&I attorney if you go this route).
As for time loss payments, they’re often relatively quick. L&I stipulates payments will go out within 14 days of receiving and processing a valid L&I claim. Payments may be delayed if a medical certification is missing or there’s something else wrong with the claim. When in doubt, contact an L&I attorney to help you navigate your L&I claim. Contact us for a free case analysis today!
What Is The Average Settlement Time Of An L&I Claim?
While the amount of money you receive varies according to your injury settlement amounts for L&I claims are awarded when the claim closes–after medical services are rendered, the case has been reviewed by medical professionals and Washington L&I makes its decision. Most settlements will be resolved in a few months, though some complicated cases can take a year or longer.
Why Has My L&I Claim Been Delayed?
If you’re having difficulty resolving your L&I claim, an L&I attorney can help move things along.
Any missing or incorrectly submitted forms or a lack of time-loss or loss of earning power calculations can delay an L&I claim. If the worker or their representative obstructs or prevents the L&I department from resolving a claim— such as not showing up for medical appointments or not participating in physical therapy—suspensions and other delays may occur.
If you are seeking an L&I settlement in Washington, you must be medically stable and able to work before L&I can issue any payment. Additionally, your injury must receive a rating, and L&I must close out the claim and decide on an award. This typically takes a couple of months after all forms and reports are submitted.
Call Emery | Reddy today for a free case review. Please remember to have your L&I claim number readily available.