L&I Benefits And Workers’ Compensation
If you’ve been injured at work and have an accepted L&I workers’ compensation claim, you have the right to a variety of L&I benefits to help pay for treatment costs and replace lost wages during your recovery period. Call our legal team today to find out if our award-winning Seattle L&I attorneys can help you with your case. Please remember to have your L&I claim number readily available.
What Are Washington State L&I Benefits?
The Washington State Department of Labor and Industries (L&I) has a range of workers’ compensation benefits at its disposal to help employees recover from a workplace injury or illness, including the following:
In order to receive medical benefits from L&I there are two very important things that you must do right away, even before a claim is filed:
- Get medical help.
- Tell your employer.
L&I, or your self-insured employer, can approve your claim if your doctor certifies that you were the victim of a workplace injury, or if you have an occupational illness. If your claim is approved, you may be eligible for medical benefits.
Medical benefits will be available to you for as long as your claim is open, even if you have returned to work. Your first visit to a doctor for a workplace injury is covered by L&I, even if your claim is not approved. If you need medical care after the first visit, you will need to see an approved provider in the L&I network.
Sometimes, workers who feel they have fully recovered will later find that they still need additional medical care for the same ongoing injury. If your claim was closed prematurely and you need further compensation, our Seattle L&I attorneys can work to reopen your case to ensure that any additional medical bills will be covered, including L&I disability benefits.
Time-loss is partial wage replacement for an L&I claim and is paid every two weeks while you are not working due to a job injury or an occupational illness. See RCW 51.08.178 & 51.32.090 for additional details. In such cases, L&I will reimburse you for lost time with benefits between 60-75% of the worker’s earnings prior to the injury or illness up to a maximum cap. The IRS considers time-loss compensation to be a disability benefit, not earned income, so income tax laws do not apply.
Time Loss Calculator
Your estimated time-loss compensation is
How Do I Qualify For Time-Loss?
- Have an open and allowed L&I claim.
- Have a doctor certify that you are not released to work without restrictions.
- Verify that you are not currently working. You can do this by filling out a Work Status Form and submitting it to L&I.
- If released to light/modified duty but there are no opportunities where your workplace injury occurred.
- No vocational decision has been made indicating that you are able to work.
What Activities Are Prohibited While Receiving Time-Loss?
- You may not work while on time-loss.
- Do not post anything on your social media accounts that may contradict your L&I claim.
- Most importantly, do not miss your medical appointments and follow your doctor’s advice about activities, including sports and recreational activities.
Each time-loss compensation case is different depending on details like marital status and claimed dependents. Our Seattle L&I attorneys will guide you through these complex regulations, which include regular doctor certification of your health condition so that you earn maximum compensation for lost wages due to your workplace injury.
Loss Of Earning Power (LEP) Benefits
An injured worker can return to their job and be entitled to LEP benefits with a doctor’s medical clearance.
How Do I Qualify For LEP Benefits?
Your loss of earnings must be greater than five percent of wages at the time of injury. Some examples include:
- Returning to work for less pay.
- Returning to work at your regular wage, but at reduced hours.
Your doctor must certify that your loss of earning capacity is due to your work-related injury or occupational illness. If your doctor approves a written light-duty or transitional job and you choose not to accept the work, you are not entitled to LEP or time-loss compensation.
What Are Examples Of Light-duty Jobs?
Light-duty or transitional work can be:
- Working shorter hours.
- Performing some of your original duties part-time, then gradually increasing back to your full-time work responsibilities.
- Performing different duties with lighter physical demands as you transition back to your regular job.
- Adjusting your job or worksite to meet your physical limitations by providing accommodations like tools, equipment, or the appliances that you need to perform your job as expected by your employer.
- Starting a new job with a new employer and losing more than 5% of your earnings.
Concerns about returning to work—and the possible impact on your claim—are normal but don’t let these concerns stop you from talking to your employer. You can continue to receive L&I benefits for your claim until you’ve reached maximum medical improvement (MMI).
Permanent Partial Disability (PPD) Awards
You may be rated for a PPD award before L&I closes your claim if you have completed treatment and are able to work but have suffered a permanent loss of function, and a qualified doctor provides L&I with a PPD rating. Time-loss and medical benefits will end after receiving your disability award unless the L&I claim is reopened.
How Do I Qualify For A PPD Award?
Washington State law broadly defines PPD as a physical or mental impairment arising from an injury that is fixed, lasting, and stable, and can’t be improved with further medical treatment, also referred to as having reached maximum medical improvement (MMI).
How Are L&I PPD Awards Paid?
PPD awards are based on the type of injury and the level of severity of the injury, measured by a category rating. 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.
L&I PPD Awards Are Paid When Your L&I Claim Is Closed
- Small awards: 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) will send out a check for that amount at the time of claim closure.
- Larger awards: If the award exceeds more than three times the State’s average monthly wage at the date of injury, a down payment of that amount is made. L&I or the SIE will send the balance of the award paid once a month in installments equal to the monthly time-loss compensation (at the time of closure).
Permanent Partial Disability Settlement Calculator
The Permanent Partial Disability settlement calculator is the L&I Disability Awards Charts and it is calculated as part of the claim closing process. Your final award amount is determined by converting the rating received from your Independent Medical Exam (IME) to settlement dollars. Use the Permanent Partial Disability Award Charts from the Washington State Department of Labor & Industries to see the dollar figures.
L&I Disability Pensions
An L&I disability pension is a special category of pension only awarded to the most severely injured workers. If you are eligible for an L&I disability pension, you will receive a non-taxable payment every month for the rest of your life.
Under State Washington law (WAC 296-14-150), gainful employment is defined as a regular occupation for income, salary, or wages. If your doctor or vocational counselor says that you cannot ever work again because of a job-related injury or illness, you may be eligible for an L&I disability pension.
How Do I Qualify For A Washington State L&I Disability Pension?
You may receive L&I benefits in the form of a monthly pension if you are certified as permanently and totally disabled, AND:
- The medical and vocational evidence finds that your injury prevents you from becoming gainfully employed, OR
- You have lost, or lose the use of, both legs, both arms, an arm and a leg, or your vision. These are administrative pensions and operate differently than traditional pensions.
How Are L&I Disability Pensions Paid?
An L&I disability pension is a payment received once monthly for the rest of your life. The monthly dollar amount is roughly equal to your combined twice monthly time-loss payment.
L&I disability pensions are hotly contested, and less than 2% of all L&I claims end up settled in this manner. Because these claims are expensive to fund, it’s sometimes cheaper for the State or self-insured employer to fight a claim rather than just pay it. In other words, your claim is valuable and you should expect to fight hard for it.
Claim Resolution Settlement Agreement (CRSA)
A CRSA is 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, except medical, for the payment.
SIEs are more likely to use CRSAs. The most common reason for this is to save money and will, unfortunately, make it more difficult for you to get your compensation. The SIE will do everything in their power to deny it. However, they still need to follow L&I’s rules for self-insured companies. If you disagree with their decision, you have the right to appeal. Contact an experienced L&I lawyer for help as soon as possible to help with the process.
How Do I Qualify For A CRSA?
You must meet certain criteria to receive a CRSA from the Washington State Department of L&I. Some of these criteria include:
- You must be over the age of 50.
- Your claim must be allowed and at least 180 days old.
How Are Claim Resolution Settlement Agreements Paid?
CRSAs are awarded in one lump sum when your L&I claim is closed.
Vocational rehabilitation is an L&I benefit available to injured workers who are unable to return to their existing profession. The following services are included in vocational rehabilitation training:
- Vocational recovery
- Ability-to-work assessment
- Plan development or work relating to prior job experience, education, or other transferable skills
- Plan implementation (vocational training)
- Job placement
L&I cannot close your claim until you either return to work or your doctor has deemed that you are able to return to work. See RCW 51.32.095.
How Do I Qualify For Vocational Rehabilitation?
In order to qualify for vocational rehabilitation, you must be unable to return to work in the same or modified position. You must also have no sufficient transferable skills that allow you to gainfully return to the workforce. L&I determines if you qualify for vocational rehabilitation during the ability-to-work assessment. The final report to L&I includes the following:
- Your age, education, and work experience
- Your transferable skills
- Preexisting physical and mental conditions and their effect on your employability
- Physical and mental conditions caused by your injury or occupational illness and their effect on your employability
- Your wage at the time of injury
- Your work pattern
- Significant barriers to your employment
- Surveys of potential jobs (referred to as “labor market surveys”)
- Complete work history, explaining any gaps in employment and any licenses or training that you may have had in addition to your formal education
It is strongly advised that you talk to an L&I attorney before you start working with a Vocational Rehabilitation Counselor (VRC). VRCs and L&I claim managers are skilled at finding ways to argue you can return to the workforce in some other job—even if it’s a job you’ve never performed.
Seattle Paid Sick And Safe Time (PSST)
Seattle PSST is a law that requires employers to provide paid leave to their employees that can be used for medical reasons or domestic assault situations. The law was originally passed in 2012 and has evolved to include different types of workers and uses. Seattle PSST is available to any employee who works in Seattle, Washington and does not already receive a paid time off benefit from their employer.
How Can I Use Seattle PSST?
Workers can use their Seattle PSST for medical or assault-related reasons, including:
- Doctor’s appointments
- Medical treatments or procedures
- Caring for a sick family member or taking a family member to a doctor’s appointment or medical procedure
- Caring for a child when their school or daycare is closed
- Domestic assault, sexual abuse, or stalking situations
You do not have to provide a doctor’s note of any kind. If your employer demands/requires one, contact a Seattle L&I attorney.
Washington State firefighters receive special L&I benefits that can make the success of a workers’ compensation claim far more likely. For example, firefighters who have had their claim denied can then take that claim directly to the Board of Industrial Insurance Appeals (BIIA). Washington State is also one of the only states that will reimburse attorney fees if a firefighter wins their appeal.
Firefighters who have been exposed to an undue hazard at the emergency response site can also file a third-party claim. Common third-party claims for firefighters include improper asbestos mediation, harmful or illegal substances that increase the toxicity of smoke, and faulty design or planning.
Finally, and perhaps most importantly, Washington is one of the few states to recognize the inherent risk in the profession as it relates to occupational illness. Inherent risks include the following illnesses:
- Respiratory disease
- Heart problems, experienced within seventy-two hours of exposure to smoke, fumes, or toxic substances, or experienced within twenty-four hours of strenuous physical exertion due to firefighting activities
- Infectious diseases considered to be occupational diseases under RCW 51.08.140
Travel reimbursement for mileage, parking fees (over $10), tolls, food, lodging, and lost wages could be paid in connection with medical treatment if you are pre-authorized.
If you must visit a health care provider that requires traveling a distance greater than 15 miles, you can be reimbursed for bus or train fare, fuel costs, and parking costs (depending on the mode of transportation).
How Do I Qualify For Travel Reimbursement?
To receive travel reimbursement, you must make your request within one year of the trip. You must include the date, destination, and your reason for travel. You must also save and submit all of your receipts.
Property reimbursement (also known as expense reimbursement) is a minor L&I benefit that covers a limited range of items including clothing and personal protective equipment (PPE), prescription eyeglasses or contacts, and shoes or boots.
Death Benefits And L&I Survivor Pensions
A workplace injury or occupational illness that results in death entitles the injured worker’s spouse and dependents to L&I death benefits, also known as L&I survivor pensions. These can include a one-time lump sum payment to the deceased’s spouse or registered domestic partner, burial reimbursements, or monthly survivor pensions.
What Is A One-Time Immediate Payment?
A one-time immediate payment will be made to the deceased worker’s spouse or registered domestic partner, child, or dependent when death is related to an industrial injury or occupational illness. The amount of the immediate payment is 100 percent of the average monthly wage in the state.
Who Is Eligible For L&I Survivor Pensions?
If an injured worker dies as a result of their injury, their spouse (or registered domestic partner) and children may be eligible for L&I survivor pensions and death benefits.
- If you were married prior to the injury or illness and remained married until your death, your spouse or domestic partner would be eligible to receive any L&I disability pensions awarded to you for the duration of your lifetime.
- If you were not married on the date that your L&I disability pension was granted you cannot later marry and pass on your pension.
What Are Burial Benefits?
L&I will pay burial benefits if an injured worker dies as a direct result of an injury or occupational disease. The amount awarded will depend on the date of death. See Death and Burial Rates Chart.
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 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 Case?
The bottom line is that anyone who isn’t familiar with L&I claims should seek the input of experienced L&I attorneys who are.
After years of helping injured workers, Emery | Reddy, PLLC has recovered hundreds of millions for our clients. Our team of L&I attorneys is experienced in litigating L&I claims, injury law claims, and employment violations. We understand how to leverage each claim in state (or federal) court and before the Board of Industrial Insurance Appeals to maximize the value of all of your claims.
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 (workers’ compensation) settlement 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 what drives us every day.
We know how L&I and big companies think, and we understand the tactics they use. Our L&I 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.
With our law office location in Seattle, we serve communities throughout the region, including Vancouver, Bellevue, Everett, Olympia, Shoreline, Spokane, and Tacoma. 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.
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