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L&I And Workers' Comp Medical Benefits

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When an injury or illness occurs at work, it is crucial that you seek medical assistance as soon as possible. Some injuries require minimal care, while others require extensive treatment. L&I medical benefits will cover all medical costs associated with your claim. This can include doctor appointments, treatments, surgeries, occupational therapy, and prescription medications.

What Is Not Covered By L&I—Workers’ Compensation Medical Benefits?

It is important to understand that only certain medical conditions and treatments are covered by L&I. To qualify for medical benefits your injury or illness must be work-related. Some of the reasons that you may not be entitled to workers comp medical benefits include:

  • Medical conditions not related to your workplace injury or occupational illness
  • Treatment that continues after the worker is medically stable
  • Treatment from providers who are not enrolled in L&I’s network

L&I—Workers’ Compensation Medical Benefits

In order to receive workers’ compensation 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.

L&I Medical Provider Network

Workers’ compensation 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.

Protest Or Appeal Denial Of Medical Treatment

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 treatment, 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.

Who Pays For L&I Medical Benefits?

L&I will pay for all medical bills that are directly related to the on-the-job injury. L&I will only pay for medical care that is related to your accepted workplace injury or occupational illness. Proper and necessary services may be either curative or rehabilitative.

  • Curative treatment: treatment provided to a patient with the goal of curing a workplace injury or occupational illness.
  • Rehabilitative treatment: treatment intended to allow an injured or ill worker to regain or improve the abilities needed to get back to work.

These benefits typically end when a workers’ comp claimant reaches maximum medical improvement (MMI) or when the claim closes.

How To Choose A Workers’ Comp-Friendly Doctor

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. Your attending provider is responsible for:

  • Managing the worker’s treatment.
  • Reporting progress to the L&I Claims Manager.
  • Helping the worker return to work as soon as safely possible.

Your attending provider may refer you to a specialist as long as they are in the L&I-approved network. Some of these providers may include:

    • Psychiatrists,
    • Chiropractors,
    • Dentists,
    • Optometrists,
    • Advanced registered nurse practitioners,
    • Naturopathic physicians,
    • Podiatry physicians and surgeons,
    • Physician assistants,
    • Surgeons, and
    • Orthopedic specialists.

You may also change doctors if:

    • The new doctor is qualified to treat your accepted injury or illness.
    • The new doctor has joined L&I’s approved provider network.

What Is An Independent Medical Exam (IME)?

An Independent Medical Exam (IME) is a medical evaluation requested by L&I or a self-insured employer to review your medical history and the details of your accident to establish findings, opinions, and conclusions about your physical condition. IMEs are conducted by approved L&I providers.

The purpose of an IME is to help the insurance company determine the reality and extent of your injury. The L&I doctor’s findings are then used to deny or award benefits for your workers’ compensation claim to help you recover and pay for treatment. Here are our tips on how to beat an IME and see past IME doctor tricks.

Can I Receive Travel Reimbursement For Approved L&I Related Medical Visits?

Travel reimbursement for mileage, parking fees (over $10), tolls, food, lodging, and lost wages could be paid in connection with medical treatment if they 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) if pre-approved.

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 on the L&I Travel Reimbursement Form.

Billing Process for L&I Medical Treatment

If your workers’ compensation claim is open and allowed, L&I or your self-insured employer will cover medical bills related to your injury until your doctor certifies your injury has stabilized and reached maximum medical improvement (MMI).

Your Maximum Medical Improvement (MMI)

Your L&I claim closes when a physician certifies that further treatment will not improve your condition, meaning that you have met maximum medical improvement (MMI), and you have returned to work or that L&I has determined that you are fit to return to work.

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.

Closing The L&I Claim

An L&I claim closes when an L&I-approved provider certifies the following:

  • The worker is at maximum medical improvement (MMI).
  • The worker has been released to work (reasonable, gainful employment) not necessarily the type of work you were doing when injured.

What If I Need More Care After My Claim Is Closed?

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 L&I 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 workers’ comp 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 Your Claim Is Denied?

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 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

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 Strong L&I Claim?

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, Emery | Reddy may be able to help you with your claim.

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.

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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.

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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.

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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Timothy W. Emery

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Patrick B. Reddy

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Karolina S. Arthur

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Paul Cipriani, Jr.

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