L&I and Workers' Compensation Claims in Washington
About 70% of workers’ compensation claims in Washington are handled by the Washington Department of Labor & Industries (L&I). Essentially, L&I is a state-run insurance company that provides benefits to workers who are injured or develop a work-related disease or illness on the job. The remaining workers’ comp claims are handled directly by employers that are self-insured.
What is L&I?
L&I is short for the Washington State Department of Labor & Industries, which handles workers’ compensation claims for employees who are injured or develop certain illnesses at work.
How Does L&I Work?
When a Washington employee gets hurt, falls ill or contracts certain types of disease at work, they are entitled to workers’ compensation benefits. They can start the L&I claims process by filing a claim online through the L&I website, by calling the L&I office at (877) 561-3453, or at their doctor’s office. If all goes as planned, the injured worker’s claim is accepted by L&I and the worker receives various benefits. However, due to the bureaucratic nature of the claims process, 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 reverse an initial denial.
What Qualifies as a Workers Compensation Claim?
In most cases, if it is determined that the injury or illness occurred as a result of the worker’s job, career, or work-related functions or activities, the L&I claim is accepted and the worker is entitled to various benefits. However, claims can be denied for a number of reasons, including the following:
- The 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.
Who is Covered by L&I?
Virtually all employees in Washington state are covered by workers’ compensation insurance. About 70% of Washington workers are entitled to workers’ comp benefits through L&I. The remaining 30% file claims directly through their self-insured employers.
Am I Covered by L&I or my Employer?
Contact your human resources department to determine what type of workers’ comp coverage you have.
Workers Compensation Benefits
If you’ve been injured at work and have an accepted L&I workers’ comp claim, you have the right to benefits to help pay for treatment costs and replace lost wages during the recovery period.
What Does Workers Compensation Pay For?
L&I has a range of benefits at its disposal designed to help employees return to work. However, L&I does not pay for healthcare for any other medical conditions unrelated to the workplace injury, medical care not covered by workers’ compensation, or treatment from providers who are not part of L&I’s provider network (other than the initial emergency room visits).
Medical costs that are directly related to the injury or illness will be paid as long as the healthcare providers are in the L&I provider network. Certain prescription medications are also covered.
Also called “time loss compensation,” wage replacement typically pays between 60-75% of the workers’ earnings prior to the injury or illness up to a maximum cap. In order to ensure consistent time loss compensation payments, which are usually made twice per month, your doctor needs to provide regular certification of your health condition.
Workers who are disabled as a result of their injury or occupational illness can generally receive two types of monetary benefits: lump-sum settlements for workers who can return to their jobs, and pensions for workers who cannot.
These are monetary awards that are paid out when your claim closes and you can return to work. In order to receive PPD compensation, a doctor must evaluate your injury or illness and conclude that you are permanently partially disabled.
Workers over the age of 50 who cannot gain employment due to a work-related injury or illness are entitled to a pension. Like time loss compensation, a structured settlement pension covers 60-75% of the workers’ wages prior to the injury, with twice-monthly pension payments continuing for the remainder of the worker’s life.
Worker Displacement and Retraining
Another benefit sometimes offered to workers in lieu of a pension is job retraining (also known as Vocational Rehabilitation). Basically, L&I seeks to certify you in a new line of work with the assistance of a Vocational Rehabilitation Counselor (VRC). But unless you are capable of carrying out the work demanded of you in a new industry, the retraining process may put you in a worse position.
Relatives of workers who have died from a workplace injury are also entitled to workers’ compensation. Benefits include survivor pensions, burial reimbursements or a lump-sum payment to the deceased worker’s spouse or domestic partner.
What is a Third Party Claim?
If injured by a third party in Washington State, workers cannot sue their employer for compensation. However, when injuries are caused by defective products or machinery, or by someone who is not a co-worker, you may be able to file a third party injury claim to cover the costs of your injury.
How to File an L&I Claim
If you are injured at work, 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.
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 Accident Report form.
Should You Hire a Lawyer for Workers Compensation Claim?
Just because you are eligible for workers’ comp does not mean that you are guaranteed the assistance. The claims process can be time-consuming and complex, filled with red-tape, paperwork and legal technicalities. Without the right tools and resources, navigating the maze of an L&I claim can easily aggravate a stressful situation. Emery Reddy has years of experience litigating L&I Claims. We are the only law firm that specializes in all three areas of workers’ compensation, employment law, and third party injury claims, and we take the time to analyze your case thoroughly to make sure all possible claims are identified.
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