Common Questions About L&I — Workers’ Compensation Medical Benefits
What Happens After My Washington State L&I Claim is Approved?
If your Washington state 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 medical treatment costs and replace lost wages during the recovery period.
What Is an Independent Medical Exam (IME)?
An Independent Medical Exam (IME) is a medical evaluation requested by the Washington State Department of Labor and Industries (L&I) or a self-insured employer (SIE) to review your medical history and accident details, to establish findings, opinions, and conclusions about your physical condition. Independent Medical Examinations (IMEs) are conducted by approved L&I providers and IMEs are intended to be objective, so no patient-provider relationship is established. However, IMEs can be problematic. Call Emery | Reddy today to speak with an experienced Intake Specialist and to learn more about how we may be able to help. No fee unless we recover for you.
Can I Receive Travel Reimbursement for Approved L&I Related Medical Visits?
Travel reimbursement is for expenses incurred in connection with medical treatment and must be pre-authorized. Workers’ comp travel reimbursement will be provided if:
- Your medical treatment is with an L&I-approved provider.
- The provider is further than 15 miles one way from your home (30 miles round trip).
- The Travel Reimbursement Request form is complete, including a copy of all expense receipts.
- You needed to pay for parking over $10, tolls, and some other travel expenses.
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 on the L&I Travel Reimbursement Form.
When Does My Washington State L&I Claim Close?
After you file your Washington state L&I claim, you will follow several steps in order to reach claim closure and, with the help of an experienced Washington workers’ compensation and L&I attorney, receive the benefits to which you are entitled.
- You will complete an Independent Medical Exam (IME) from an approved L&I provider stating that you have reached maximum medical improvement (MMI) and that your medical care is complete.
- Your Vocational Counselor will release you to work.
Your Washington state L&I 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 will release a written closing order.
What If I Need More Care after My Washington State L&I Claim Is Closed?
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.
The amount of time that you have to reopen your Washington state L&I claim depends on the benefits you are seeking.
- For medical treatment only, you may apply at any time.
- For both time-loss benefits and medical benefits, 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.
What If My Washington State L&I Claim Is Denied?
If your Washington state L&I claim is denied, 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
