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How Does L&I Work – Everything you need to know about Washington L&I

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.

However, the workers’ compensation process in 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?

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 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.

Why are L&I Claims Denied?

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.

Doctors make mistakes. Especially independent medical examiners (IME), 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 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.

How Do I Start the L&I 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.

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.

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