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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??

Most people suffering with 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’s what you need to know:

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?

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:

  • 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.

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 an occupational disease.

Can I Choose Any L&I Doctor I Want?

You can choose your own L&I doctor, yes. 

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, 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 examiner. 
  • If you see your primary care doctor first and they’re not an approved examiner, you can switch to a different doctor of your choice. 
  • Should you wish to change your doctor for an L&I claim, you would complete a specific care transfer form. 

So, if you’re asking “can I choose any L&I doctor I want”, the answer is usually yes.  

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 Accident Report 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 Accident Report form

The Accident Report 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 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.

L&I Pensions

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 health care 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 suitableL&I attorney in Seattle 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 1-800-831-5227 or the provider hotline at 1-800-848-0811. 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 worker’s 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.

Could you have an L&I pension claim? Contact an L&I attorney in Seattle for a free case analysis.

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 an L&I claim. 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 attorney in Seattle, Emery Reddy 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 –  you won’t get better advice.

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