Frequently Asked L&I Questions
What is L&I?
The term L&I refers to the Washington State Department of Labor & Industries. L&I is tasked with administering the Washington’s workers’ compensation system. L&I is both an administrative agency and insurer. This means it decides which claims to pay, and is also responsible for that payment. L&I has 19 offices and 2,800 employees, including a very large number of Case Managers. L&I primarily acts through its Case Managers when determining which workers’ compensation claims to pay and which to deny. Case Managers have the decision-making ability to issue a range of L&I benefits, including: payment for lost wages, injury payments, and even lifetime annuities for workers who have been permanently and totally disabled in workplace accident.
If you have a state-fund L&I claim, L&I has an inherent conflict of interest in deciding whether or not to pay your claim and the medical bills connected to it. Just like an insurance company decides whether to pay your claim, it is incentivized to deny it. Likewise, L&I is incentivized to deny claims. Other types of workers’ compensation claims can be accepted or rejected based on their merits, but L&I may reject a claim simply because it doesn’t want to pay. This happens on a regular basis.
There is no agency or regulatory oversight for L&I. No official is checking to make sure that the L&I Case Managers treat injured workers fairly. That’s why it’s important to consult a workers’ compensation attorney before the L&I claim goes into the appeal process.
How does L&I work?
When a Washington worker sustains an injury or develops a work-related disease or illness at work, the worker is entitled by Washington state law to file a workers’ compensation claim. When the L&I process works smoothly, the injured worker files a claim that is accepted by Labor & Industries, and then L&I (or the employer, if the employer is self-insured employer) must pay the worker lost wages at a reduced rate, in addition to medical expenses and costs connected to the work-related injury.
L&I acts primarily through its Claim Managers. Claim Managers have wide latitude to accept or reject a workers’ compensation claim. A Claim Manager’s first task in any filed claim is to review key information related to it. This information includes, but is not limited to, reviewing the claimant’s medical records, medical history, the medical provider’s objective findings, and the medical provider’s opinion as to the injury and whether it was likely to have been sustained at the work site, or in connection with work performed for the employer.
After the Claim Manager completes the review, the next step is to determine what benefits to pay the claimant. L&I has a range of options it can provide an injured worker. These fall into several categories:
Medical Benefits – This includes payment to medical providers in the L&I network for healthcare and treatments that are directly related to the work-related injury. This does not include: Health care for other medical conditions unrelated to the injury. Medical care not covered by workers’ comp. Or, treatment from providers who are not part of L&I’s provider network (other than the initial emergency room visits).
Wage Replacement – This is called “time loss compensation” and includes payments by L&I, or the injured worker’s self-insured employer to the claimant to replace a fraction of his or her lost wages. Time loss compensation never pays for the first three days of missed work following the work injury if these are the only days missed – L&I considers the first three days a “waiting period.” It is important to note that time loss compensation does not cover full wages. It is paid at a rate of between 60-75% of the workers’ wage just prior to injury (up to a set cap). The percentage range depends on the number of the worker’s dependents. Time loss compensation is typically paid twice per month and requires regular certification by the worker’s medical provider. Workers that miss a certification will not receive their time loss compensation payment for that period of time, although they can seek to receive it as back time loss if they can obtain and send certification at a later date. Any worker receiving time loss compensation through a lawyer or law firm should ensure that they receive electronic payments, to avoid any delays in payment.
Prescription Medications – Certain prescription medications are covered so long as the injured worker’s L&I claim has been accepted or if there is a specific treatment order for a medication for a life-threatening condition. Any prescriptions for conditions unrelated to the claim must be paid directly by the injured worker or his or her private health insurer. A list of approved/unapproved medications can be found here: https://www.lni.wa.gov/ClaimsIns/Claims/Benefits/PrescMeds/Default.asp
Travel Reimbursements – This is payment for an injured worker’s travel expenses for any visits to a health care provider that requires traveling a distance of greater than 15 miles. The claimant can be reimbursed for bus or train fare, fuel costs, and parking costs, depending on the mode of transportation. L&I will often deny requests, however, for travel reimbursement if the claimant: (1) is within 15 miles of an L&I approved medical provider, but simply chooses not to see that provider; (2) is traveling only to pick up prescription medication; or (3) the travel reimbursement is not preauthorized. In other words, you must get L&I to preauthorize these expenses or L&I won’t reimburse them. It is important to note that L&I never reimburses for the first and last 15 miles of the trip – so you can only get reimbursed for each mile after mile 31.
Property Reimbursement – This is a minor benefit and covers a limited range of clothing and equipment replacement, such as prescription eye glasses, personal protective equipment, and shoes or boots. When L&I denies requests for these benefits, the best move is often to just pay for the clothing or gear and seek reimbursement later in the process after proof has been developed and the claim has been approved.
Permanent Partial Disability or PPD – When an injured worker’s claim has been accepted, and he or she has reached maximum medical improvement (MMI), the injured worker is entitled to be paid for his or her injury. You cannot obtain a PPD without a medical opinion. In other words, your doctor must both support your right to a PPD payment, and must rate your injury so that L&I can evaluate it and determine the appropriate amount to pay you for your permanent partial disability.
PPD rates are governed by the Permanent Partial Disability Award Schedules found here: http://lni.wa.gov/ClaimsIns/Files/SelfIns/ClaimMgt/2018PpdSched.pdf. As you can see from the link, this is the current version of the schedule, and it changes each year. The schedule is organized by injury type. The first portion covers major injury types, like internal organ injuries, loss of functions, mental injuries, and back/neck injuries. Each injury type also has ratings that indicate the severity of the injury type. Severities range from a level of 1-6, with the level of “1” indicating a more minor injury, and a level of “6” indicating a severe injury. The second portion of the schedule lists very specific injuries that might occur to each part of the body. Ever injury cross references to a specific dollar amount that an injured worker with an accepted PPD claim is entitled to receive as a result of the workplace injury. The more severe the injury, the greater the PPD payment to which the injured worker is entitled. For example: A category 6 lumbosacral PPD entitles the workers’ comp claimant to $154,113.82, while a category 2 lumbosacral PPD payment is only $10,274.25. It is critical to ensure that your doctor is supportive and agrees with your rating before moving forward. Given the disparity in PPD benefits between a category rating of 1 and a category rating of 5 or 6, ensuring that the attending physician understands the injury and can opine on it correctly is a key event in any workers’ compensation case. An unsupportive opinion (or an opinion from an L&I IME, which is often unsupportive) can result in a lower rating or can destroy the injured worker’s chances of getting a PPD rating altogether.
It is highly recommended that you consult with an L&I attorney before attempting to get a PPD rating from your doctor. And because most independent medical examiners work closely with L&I, if you are scheduled to get an IME PPD rating from an independent medical provider, skipping the consult could spell disaster for your case. A good L&I attorney, or team of attorneys will have medical experts and physicians with whom they regularly consult.
Pensions – Permanent Total Disability – Any injured worker who is over the age of 50 and is incapable of being employed on a permanent basis due to a work-related injury is entitled to a pension. A pension consists of regular payments to the worker for the duration of his or her life to cover his or her lost wages. The pension amount is between 60-75% of the worker’s wage prior to injury (up to a cap) and is paid twice monthly. The pension is the single best award available through the L&I / workers’ compensation system.
Obtaining a pension is a complicated and lengthy process that involves working closely with a vocational expert as well as expert physicians. Only a very small percentage of those who apply for a pension on their own are actually approved to receive one and it is extremely rare for workers to be able to obtain a pension without legal assistance. L&I, and self-insured employers fight pensions hard because of the great cost involved in paying them over the lifetime of the injured worker.
The key to overcoming these odds is to obtain legal assistance from a talented attorney or team of attorneys that will: (1) obtain a solid, objective, medical opinion from a specialist physician who is qualified and experienced in rendering bullet-proof opinions; (2) appeal any and all orders that might affect the claimant’s chances of obtaining pension; (3) limit the issues on appeal to those that are winnable and relevant to obtaining the pension; (4) hire and work with vocational experts qualified and experienced in testifying that an injured worker is, in fact, permanently disabled; (5) deal effectively with opposing opinions by L&I’s, or the self-insured employer’s independent medical examiners and vocational counselors; (6) appeal as much as necessary before the Board of Industrial Insurance Appeals and, if necessary, in Superior Court, until the Board or Court agrees to accept a pension as the appropriate workers’ compensation benefit for the injured worker. The process of obtaining a pension can take time and requires a deep understanding of the L&I system, the vocational process, and a willingness to litigate until the job is done.
Survivor Benefits – Workers’ compensation benefits are available to survivors of a worker who has died from a workplace injury. These may include a one-time payment to the deceased worker’s spouse or registered domestic partner, survivor pensions in the form of monthly payments, and burial benefits or reimbursements.
Structured Settlement – Structured settlements are sometimes offered by L&I if an injury is so serious that the worker may be unable to work, the worker is over 50, and he or she has a claim that has been open for at least 180 days. In most cases, L&I will not sign off on a structured settlement until the worker has been advised by an attorney of his or her rights. A structured settlement may prevent the worker from seeking a pension and typically bars all future claims in connection with the workplace injury. Structured settlements are almost always negotiable and there is often a wide range between what is offered by L&I and what the Department will eventually accept. Consult with an attorney immediately if you have been offered a structured settlement.
Retraining – This is a benefit sometimes offered to injured workers in lieu of other benefits such as a pension. The process consists of L&I referring the injured worker to a Vocational Rehabilitation Counselor (VRC) who will then assess the worker and decide what other jobs the worker can do. Typically, the injured worker is then offered retraining to train him or her in a line of work different from the one they performed at their job of injury, and in line with the work restrictions resulting from the injury.
If you are sent to a VRC, be very cautious. This is a tactic by L&I to certify you as able to work in some other line of work. For example, L&I has been known to assess a worker as able to work as a “cashier” even when the worker is clearly unable to perform that or any other job. VRC’s can be adept at their jobs of classifying workers at various positions, and the VRC’s work is often calculated to ensure that injured workers do not receive other benefits to which they are entitled as a result of the workplace injury, such as a pension. If you are referred to a vocational Rehabilitation Counselor, seek legal advice immediately.
How do L&I claims really work?
L&I has broad power to accept or deny an injured worker’s L&I claim. When the system works correctly, L&I claims are processed efficiently and under reasonable timelines. When the system breaks down, injured workers experience a bureaucracy filled with red-tape, paperwork, technicalities, and deadlines. An L&I claim could be denied for almost any reason, and once the claim is denied, it takes talent, tenacity, and experience to get L&I to reverse an initial denial.
Claims are denied for many reasons. Technically, L&I Claim Managers are governed by certain guidelines that require a full and fair evaluation of an injured worker’s L&I claim. Self-insured claim administrators are likewise governed by specific guidelines known as the “Self-Insurance Claims Adjudication Guidelines. In reality, a Claim Manager can decide to deny a claim for any reason. Common reasons for claim denials include:
- A determination that the workplace injury is “pre-existing” (meaning that the worker already had the same type of injury before the work injury occurred).
- A determination that the injury occurred somewhere else other than 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 under the “parking lot rule.”
- A doctor feels that injury as described doesn’t match the diagnosed medical injury. This happens frequently, especially when an independent medical examination (IME) is involved.
- When it is a mental condition, it is often denied because of a lack of medical support.
Claim managers often make mistakes. Sometimes they miss critical evidence. Sometimes they choose to disbelieve the evidence. They sometimes have own 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, 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 error 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.
Employers make mistakes. Sometimes they believe that an injured worker was injured 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.
In most situations an injured worker in Washington is best served by talking to an attorney immediately following the workplace injury. Most L&I attorneys and workers’ compensation law firms will, at the very least, tell the injured worker if he or she has a case. And they will often help the worker navigate next steps even if they can’t personally accept the case.
How do I file a workers’ compensation claim?
You have two options to file a Washington State L&I claim:
- File by phone at (877) 561-3453.
- File online https://www.lni.wa.gov/ORLI/ECS/default.asp?Pub=Worker.
To file an L&I claim, you will need help from your doctor. Your doctor will need to do 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 (or Provider’s Initial Report, if your employer is self-insured).
The 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. If you do not have a supportive Attending Physician, you should seek counsel from an attorney. Intendent medical examiners to whom you might be referred often work closely with L&I and their medical opinions often reflect that fact.
Can I choose my own doctor?
Yes. You have the absolute right to choose your own doctor.
Can I change my doctor to another doctor?
The doctor you choose is called your Attending Physician. The medical opinion of your Attending Physician is given the most weight – even more weight than an IME, typically. If you wish to change your Attending Physician to a new doctor, simply fill out this form: https://www.lni.wa.gov/forms/pdf/F245-037-000.pdf.
Do I have to bring a company representative or nurse with me to the doctor?
No. You can choose who, if anyone, you want to bring to the doctor with you. You do not have to have anyone with you if you choose to go alone. Your L&I attorney is not legally permitted to attend an IME, and you are not allowed to record an IME. However, having a good witness present at a doctor’s visit, especially an IME, might help you in your claim. Your attorney cannot be a witness, and you are not permitted to record the IME. You are, however, permitted to make an audio recording. If you make an audio recording of the IME, make sure you notify the doctor before doing so.
How long do I have to file an L&I claim in Washington?
One year from the date of injury for all injuries except occupational diseases. For occupational diseases, you have two years from the time your doctor diagnosed the occupational disease.
How do I check the status of my L&I claim (or workers’ compensation claim)?
You can check online at https://www.lni.wa.gov/ClaimsIns/Claims/Status/default.asp or call (360)902-5999. Practically speaking, L&I rarely has answers until they have determined whether to accept your claim. If you have an L&I lawyer, the best way to check the status of your L&I claim is to simply ask your attorney. Your L&I attorney should have direct access to the Claim Manager and can get you more detailed information, including the timing for a response from L&I.
What if I’m injured out of state?
Living out of state does not negatively affect any of your L&I rights. You have the rights as a worker to time loss, vocational services, treatment for your injury, disability payments, and any other benefits to which you would have been entitled had you been injured while physically present in Washington. The law says that you’re covered if you have a “contract for hire” in Washington even if your employed in another state. You can read the full statute here: RCW 51.12.120. The attorneys at this firm have represented many clients who were injured abroad, outside of the US and Canada.
What if I’m injured while sent out of state for work?
For Washington State workers sent out-of-state to work, workers’ compensation coverage extends to those workers for the duration of their out-of-state work so long as the work is not covered under federal jurisdiction.
This means that the out-of-state work cannot include: Maritime work. Work at commercial piers and harbors. Military and defense work, including overseas military and work for the DOD.
What do I need to do for my L&I claim?
- File a claim.
- Work with your doctor.
- Show up to doctor appointments.
- Keep L&I or your attorney informed of any employment.
- Cooperate with your vocational counselor.
- Attend L&I arranged independent medical examinations.
- If you receive an adverse order, if you suspect the claim administrator might deny your claim, if you are having difficulty with your VRC, or for any other complication, consult with an attorney immediately. Most attorneys will tell you for free whether they can assist you with your case.
What is a third party claim?
A third-party claim occurs when a third party may be responsible for your injury at work. When a third party claim occurs, you have both an L&I claim against your employer and a third party claim against some other person or company. These are separate legal claims, but based on the same accident or injury. The L&I claim typically proceeds at the Board of Industrial Insurance Appeals, while the third party claim is typically resolved in state court. A good example of a case with both a third party and L&I claim is a construction worker injured at work by a faulty safety strap. The construction worker would have an L&I claim because he or she was injured at work, and the worker would also have a third party claim against the safety strap manufacturer for creating and selling an unsafe product.
It is important to note that while you cannot sue your employer for a workplace injury, if a third party is even partially responsible for your injury, you can recover from that third party. There is no cap on your recovery amount for a third party claim. If you think a third party might be responsible in part for your injury, consult with an attorney immediately. The statute of limitations (meaning the time between the injury and the time you are barred from suing) is almost always different for third party injuries than it is for workplace injuries.
How do I know if I have a third party claim?
Any person who has an L&I claim should ask an attorney whether they also have a third party claim. Since you cannot sue your employer in Washington state, pursuing a third party claim is the only way an injured worker can sue a third party for that third party’s negligence. The legal analysis is often complicated, so an injured worker should consult an attorney to inquire whether they have a third party claim.
Injured at work Washington state
See How does L&I work?.
Can I sue my employer?
You cannot sue your employer for a workplace injury. Your single option for recovery is to file an L&I claim.
However, if you also have an employment law claim, you can and should pursue action against your employer. Additionally, some workplace claims also give rise to third party claims if some other third party is even partially responsible for causing your workplace injury. Check with an L&I attorney who also has experience with injury and employment law to fully research your options.
Can I sue L&I?
No. This is the purpose of Washington State’s workers’ compensation system under Title 51. The Washington State Legislature removed the right to sue employers and replaced it with L&I. Your only option is to file an L&I claim. Anyone considering filing an L&I claim should consult first with an attorney. Competent L&I attorneys can provide filing tips and advice that will assist an injured worker from having his or her claim rejected. L&I attorneys typically provide an initial evaluation free of cost in order to tell you whether you have a case that they can accept and litigate.
L&I claim settlement
In general, workers who are 50 or older may be eligible to settle their claims under L&I’s structured settlement system. Those workers employed by self-insured employers may also be eligible for a settlement. Finally, anyone who has an active claim (filed or unfiled) against their employer may have options to settle their claim outside of the L&I system. L&I typically will not settle unless the injured worker is represented by an attorney. Settling an L&I claim for full value requires a deep understanding of workers’ compensation law, employment law, and injury law, an ability to negotiate skillfully, and the threat of litigation if settlement does not occur.
Injured workers whose L&I claims are accepted are entitled to a range of benefits options under Washington’s L&I system. These options include: medical benefits, wage replacement, prescription medications, travel reimbursement, property reimbursement, permanent total disability (also known as pensions), time loss compensation, vocational training, and permanent partial disability.
L&I claim number
The Department of Labor & Industries assigns a new case number to each new L&I claim. This case number is typically printed at the top of correspondence from L&I sent to a claimant.
An injured worker with an allowed claim can expect to receive benefits such as time loss compensation, which is intended to reimburses the worker for lost wages. Time loss compensation benefits may be evaluated and processed under a fairly short time frame. In contrast, long delays in L&I payments for time loss compensation and other benefits can occur if L&I or the employer wishes to fight an injured worker’s claim. It is not uncommon for disputed payments to be delayed several years in hotly contested cases. Further, benefits such as permanent partial disability (PPD) payments are almost never paid until a worker has been declared by a doctor to have reached maximum medical improvement (MMI).
What is Maximum Medical Improvement?
Maximum Medical Improvement, or MMI, means that the injured worker has healed as much as he or she is going to heal. It does not mean that the injured worker has fully recovered from the workplace injury. It just means that the worker will not heal any further. L&I will not agree to some benefits, such as a PPD, until the injured worker has reached MMI.
L&I claim form
L&I claim forms are found here https://www.lni.wa.gov/FormPub/.
Can I sue my employer for a workplace injury?
No. Washington’s Title 51 “no-fault” system replaced the private right of action of workers against their employers. The law now holds that workers cannot sue their employers or co-worker for job injuries covered under the workers’ compensation and L&I system. There are some exceptions to this rule, but not many. You can sue a third party other than your employer if the third party is responsible for your injury, and you may be able to sue your employer and co-workers if one of them intentionally caused your injury.
Can you get fired while on workman’s comp?
It is illegal to fire an injured worker because he or she filed an L&I claim. This is known as retaliation. If you were fired for filing a workers’ comp claim, you should seek counsel from an attorney that is experienced in both employment law and workers’ compensation / L&I law. Hiring an employee that understands both areas of law and is skilled in representing clients in Washington state and federal courts and before the Board of Industrial Insurance Appeals is key to maximizing your recovery against your employer.
What do you do if you get injured at work?
Call an attorney. The L&I system appears to be simple, but is in reality very complex and filled with pitfalls that often result in denials of benefits or long delays. Most attorneys will provide a free initial consultation and tell you whether they can help you with your case.
How long does it take to know if my claim has been accepted?
Doctors have up to five days to send their report to L&I (or self-insured employer). The timing for the next steps will then vary and is largely dependent on what type of claim you might have. Checks have been issued in as little as two weeks in certain cases, such as claims for wage-replacement benefits or other simpler claims, L&I (or self-insured employer). However, this timeframe is extremely rare, and even the smallest complication in your case could delay the process by weeks or months.
What are the statute of limitations in Workers’ compensation claims?
There are exceptions, but the general rules are:
- One year from the date of injury for workers’ compensation injuries.
- Two years from the doctor’s diagnosis for occupational diseases contracted as a result of work.
- Three years from the date of injury for any third-party claims.
- Three years for illegal, deliberate acts by the employer.
Do I have an L&I claim if I was injured out of work?
The answer is maybe. Courts look at the definition of “course of employment” to determine whether the injured worker was working in the course of his or her employment when the worker was injured. A quick way to tell is whether the worker was taking some action in connection with work, such as traveling for a work trip, versus whether the worker was merely acting on his or her own behalf, such as running a personal errand. There are carve outs to this general rule when dealing with employees who have no fixed place of work and commuting to and from work. Employees without a fixed place of work are often covered under L&I unless they are specifically pursuing their own personal activity. Employees are not, however, covered under L&I if they sustain an injury commuting to-or-from work or in a parking area.
Can I get help understanding the L&I claim process?
Yes. You have a right to speak to an attorney about your case. Many law firms will provide an initial consultation free of charge. Be aware that this consultation might be limited to an attorney of staff member determining if you have a case the law firm can accept. Most law firms will only accept cases they feel they can take through trial and/or appeal with a more probable than not chance of winning. There is no risk in talking to a law firm and every lawyer and staff member is required by ethical rules to keep any information you provide confidential.
What medical benefits can I receive through L&I?
You are entitled to receive from a physician of your choice “proper and necessary” treatment for any accepted condition. This includes any medical services such as those that are diagnostic, rehabilitative, or curative. Even experimental medical procedures may be covered. Common treatment includes MRIs,
x-rays, injections, and surgeries.
What is partial disability?
This is the loss of either one foot, leg, hand, arm, eye, or one more fingers or toes, and any dislocation that severed one or more ligaments. It also includes any other injury diagnosed as a permanent partial disability.
What do I do if I’m not ready to return to work?
If L&I, your Vocational Counselor, or your employer is requiring you to return to work, and you are not yet physically able to begin working again, you need to contact an L&I lawyer. A competent attorney can advise you of your rights and tell you how best to proceed. In general, whenever L&I makes a decision with which you disagree, you have the right to appeal that decision.
How do I calculate my workers’ compensation (L&I) benefits?
The default method is based on monthly wages. If the worker has received a bonus within 12 months before the injury, that bonus should be averaged by month and added to the total wages when determining the amount worker’s L&I benefits. After calculating wages, the next step is to determine the correct percentage of the wages to calculate the applicable time loss compensation. Every payment order and payment should be scrutinized. The process of calculating the correct payment and L&I makes errors that sometimes negatively affect the injured worker. As a general rule of thumb, you should expect to receive approximately 60-75% of your wages as time loss compensation, up to a maximum cap.
What is an occupational disease?
Any disease or infection that occurs as a result of the worker’s employment. Lead poisoning and repetitive activity injuries are examples of occupational diseases. Proving an occupational disease is a complex process that requires a careful strategy, a knowledge of the many pitfalls in doing so, and expert opinion(s) from a supportive physician.
Can I file an L&I claim for mental illness or a psychological illness?
Yes. Workers with work-related, documented psychological conditions are entitled to workers’ compensation benefits as a result of these conditions. A mental condition brought on suddenly by stress could be classed as a covered injury if that mental condition occurred as a result of a sudden, tangible, and traumatic event. Stress itself is not typically considered an industrial injury. In one Washington case, a worker was permitted to file an L&I claim for an industrial injury based upon a psychological illness that allegedly resulted from being forced to clean up a suicide scene at a school.
How do I file a board appeal?
You can file a board appeal electronically at http://www.biia.wa.gov/FileAppeal.html. You must file your appeal within 60 days of the decision that you wish to appeal. Failure to file within 60 days will result in the decision becoming final and the possible denial of your benefits for your lifetime. While filing an appeal with the Board is not technical, there are pitfalls that you must look out for. For instance, failing to identify all of the legal issues or things that you want the Board to do in your appeal could result in the denial of benefits. If you have already filed your appeal, and you think you have missed some issues or relief that require from the Board, you may file an amended appeal in order to correct those mistakes. Since the Board follows the Washington State Rules of Civil Procedure and Washington State Rules of Evidence, you may only have the ability to amend the appeal once without filing a motion to amend with the judge assigned to your case. Once the appeal is filed, the Board will assign a Hearings Judge and Mediation Judge. It is important to research the Hearings Judge that you are assigned to in order to determine whether or not they may be the best judge to hear your case. If you do not like the judge that has been assigned to your case, you may file an Affidavit of Prejudice to have a different judge put in place, but this must be filed within 30 days of the notice of the assignment of judges and before any hearings or conferences takes place. During the mediation phase, the Mediation Judge will ask you technical questions such as: “Do you stipulate to the jurisdictional history of your case?” You should be very careful to ensure that all of the legal issues are covered in your appeal before you make such a stipulation. If mediation is unsuccessful in resolving your appeal, your case will be transferred to the assigned Hearing Judge and your hearing will be scheduled. At this phase, without legal training, it can be very difficult to prevail in your appeal given the technicalities of the Rules of Evidence and Rules of Civil Procedure. You should contact an attorney to discuss your appeal.
How do I protest an L&I decision?
You may protest any decision of the Department of Labor and Industries within 60 days of the date of that decision by sending a “protest” or request for reconsideration in writing to L&I at: Claims Section, The Department of Labor & Industries, P.O. Box 44291, Olympia, WA 98504-2401. You may send it via mail or electronically using these instructions https://www.lni.wa.gov/ClaimsIns/Claims/Appeals/Instructions/. Mail gets lost, so any written protest should be confirmed. Failure to protest a decision within the applicable time period means the decision will become final and binding.
What is the board of industrial insurance appeals?
The Board of Industrial Insurance Appeals is an independent state agency funded by the industrial insurance accident fund and medical aid fund. although the agency is completely independent of the Department of Labor and Industries, they do work closely together including sharing certain inter-agency information. This means that once your appeal is before the Board, you should be aware that the agencies spend far more time working together than they do on deciding your case. Aside from that close relationship between L&I and the Board, it is important to understand that the Board otherwise acts and feels like a Washington State Superior Court. This means that the Board applies the Washington Rules of Evidence and Washington Rules of Civil Procedure in order to decide your appeal, just as though you filed a lawsuit in court. The only practical difference between the Board and a court is that you are not entitled to a jury to decide your case at the Board. However, if you lose your case at the Board, you may appeal the decision to the Superior Court in the county in which you live, and at that point you are entitled to a jury to hear your case.
Where is the board of Industrial Insurance Appeals?
The Board is headquartered in Olympia, but has many offices throughout Washington. You can see their locations here: http://www.biia.wa.gov/OfficeLocations.html.
How long does an L&I appeal take?
An L&I claim appeal that has been accepted by the Board typically takes between 6 to 9 months in order to receive a written decision. However, sometimes, L&I has the right to take an appeal back from the Board before the appeal gets underway and reconsider its prior decision. Although there are laws governing the time period under which L&I can reconsider its decisions, L&I has been known to take many months beyond such time periods to render a final decision on a given case that can be appealed to the Board. This can cause delays in receiving benefits far longer than the duration of the 6-9-month Board Appeal. In addition, all parties have the right to continue to appeal cases, which can further delay benefits. The only way to expedite the process is to hire an attorney who understands the L&I and appeals systems and how to efficiently navigate them.
How do I get a new L&I doctor?
Under Title 51 you have the right to choose your own doctor at any time so long as the doctor is a member of the L&I provider network. You can find a list of eligible doctors on the L&I website at http://www.lni.wa.gov/ClaimsIns/Claims/FindaDoc/. In order to change your doctor to one of the doctor’s in the provider network, you must complete a transfer of care form, found here: https://www.lni.wa.gov/forms/pdf/F245-037-000.pdf, or write a letter to your claim manager and request that the attending physician be changed to one of the other members of the provider network. If you choose a doctor that is not approved by L&I as an L&I provider, your request to transfer care will be denied and your current attending physician will remain your doctor. You must be careful when deciding whether to change your doctor because it could have an adverse impact on your claim. Sometimes L&I or a self-insured employer will accuse you of “doctor shopping” when you change your provider. Other times it is essential that you change your doctor before your claim closes. In order to determine whether or not you should change your doctor, you should speak to an attorney.
How do I prepare for an IME?
- Audio record the IME, but make certain to record yourself telling the doctor that you are recording the IME.
- Take notes of the IME noting any oddities, the start time, the finish time, and exactly what body parts the IME examined. Don’t wait to take notes. Bring a notepad in and write notes if you are waiting for the doctor. Then finish your notes right after exam in the car, on the bus, or when you get home.
- Don’t video record the examination. That is illegal under workers’ compensation rules.
- Bring a witness to the IME. Having a trusted loved one present can help corroborate exam irregularities later before the Board or court. Note: your attorney cannot be a witness.
- Be aware that you are under constant observation from the time you arrive in the parking lot or building until the time you leave the premises. The IME will search for any signs that he or she feels indicates that your injury is not as you’ve indicated. IMEs have even been known to try to trick injured workers by dropping things for you to pick up or by making loud noises that might trigger a sudden movement like turning your head.
- Ensure that you do not sign any paperwork other than the sign-in sheet.
- Be cooperative, polite, and nice. With that said, if you are asked obviously irrelevant questions, you don’t have to respond.
- Do not agree to any painful procedures, intensive examinations, or invasive tests or procedures that your doctor has already performed. You are not required to endure painful procedures.
- Know your medical history, including major and minor procedures, dates, times, etc. You need to be accurate and detailed when responding about questions about your medical history. Failure to remember or inaccuracies may be used later to attack your credibility.
- Don’t hide the pain or try to be brave. The independent medical examination process is the time to talk about your pain and your injuries. Failure to do so may result in the IME doctor missing important information he or she needs to effectively evaluate you.
What is an IME
Under Title 51, L&I has a statutory right to send you to a doctor that it hires in order to render a medical opinion about you and your L&I claim. This is referred to as an independent medical examination or IME. The statute does not limit the number of IMEs L&I may send you to, nor does it require that you be given more than 14 days’ notice that an IME is to take place and the location of the IME. Failure to attend an IME could result in L&I denying your benefits. There are a number of ways in which you can convince L&I to cancel an IME or to reschedule an IME, but they are technical and often require expertise and experience in order to be successful. Some common non-technical reasons to cancel or reschedule an IME are: because it interferes with work, another medical appointment, family emergencies such as a funeral, to care for a sick loved one, or the geographical areas in which the IME is scheduled is too far away from you home to attend. Once the IME is scheduled it typically takes 2 weeks from the date of the exam to get the report or results from the IME. L&I and self-insured employers will not send you a copy of the report unless you send a demand for a copy in writing.
How will I know if my claim is accepted?
If your L&I claim is accepted you will receive a decision from L&I stating that your claim has been accepted. At this point, your employer would have 60 days to appeal such a decision. Even though there are legal requirements for L&I to accept or reject a claim in a timely manner, it is not uncommon for L&I to take over 6 months to one year to accept or reject certain claims. This is why it is extremely important to seek the advice of legal counsel if your claim is not quickly accepted. This is because L&I may claim substantial benefits while a claim is pending, then later reject the claim. A rejection after benefits are paid under these circumstances will result in an overpayment that you will be required to repay.
What happens if my employer appeals an L&I decision?
If your employer appeals a favorable L&I decision, you should contact an attorney immediately. While it is possible to “wait and see” while L&I battles your employer, it is important to note that when an employer disputes a claim, it is most often or nor a never-ending battle until your clam eventually closes, it is also not uncommon for L&I to change its mind very quickly once an employer gets heavily involved. In such a case, you could wind up with the very difficult challenge of fighting both L&I and your employer.
Can L&I secretly video me?
Yes. L&I and self-insured employers, as well as other employers who are not self-insured, may legally conduct video surveillance of you in any public place or location that is visible from a public place, such as through a window in your home that is visible from the street. Such surveillance must be without audio. If the surveillance includes audio, it is illegal unless a search warrant has been issued to permit wiretapping.
What do I do if my employer offers light duty
If your employer offers you a light duty job, you must proceed extremely cautiously. First of all, you may have very little time within which to respond to the light duty job offer since there is no technical legal requirement that the employer provide you with significant advance notice. While the employer is required to obtain your doctor’s approval of the light duty job offer, such approval may be as simple as a verbal approval over a phone call with your employer. In such a case, you may not even know whether your doctor thinks it’s appropriate for you to return to light duty. As soon as you find out your employer may be offering you light duty, or you actually receive a light duty job offer in writing, you should make an appointment with your doctor to discuss the light duty job offer. At the very least, you should call the doctor or an assistant to discuss whether your physical or mental limitations exceed the requirements of the light duty job offer. Failure to accept the light duty job offer typically results in the denial of future time loss benefits. Such a situation can forever ruin your entitlement to benefits under that particular claim. On the other hand, employers often provide bogus or incomplete light duty job offers that you should not accept. Because this area is highly technical and involves both workers’ compensation and employment law, you must consult with an attorney before you decline a light duty offer.
What is a self-insured employer?
A self-insured employer is any employer who is approved by L&I to provide and administer workers’ compensation benefits to its own employees using company funds and or insurance. The self-insured employer assumes the risk for paying L&I benefits to its employees when the employees are injured at work. About one third of Washington businesses, typically the larger businesses in the state, are self- insured. A list of all self-insured employers can be found here: https://www.lni.wa.gov/ClaimsIns/Insurance/SelfInsure/EmpList/FindEmps/.