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L&I and Workers' Compensation Medical Benefits

If you’ve been injured at work and have an open L&I claim for workers’ compensation, you are entitled to L&I medical benefits.

What is Covered by L&I Medical Benefits?

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 will cover all medical costs associated with your injury or illness. This can include doctor appointments, treatments, surgeries, occupational therapy, and prescription medications.

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

Can I Choose My Own Doctor?

As long as your treatment is deemed proper and necessary, you have the right to choose your own doctor from the L&I network of medical providers. It’s important to secure a supportive doctor. When necessary, your doctor can also refer you to specialists. Approved doctors are paid directly by L&I or the self-insured employer at your doctor’s discounted rate. Your doctor is not allowed to bill you the difference between the regular rate and the discounted rate. One thing to note: when you first seek medical care, your initial doctor visit or emergency room visit will be covered by l&i, regardless of whether they are in network or not.

What Medical Benefits Are Not Covered By L&I?

L&I medical benefits do not cover healthcare for any medical conditions unrelated to the workplace injury, or treatment from providers who are not part of L&I’s provider network (other than the initial emergency room visits). They also will not cover treatments for injuries that cannot be measured objectively by a doctor or treatment that continues after a worker is considered “medically stable”.

Third Party Claims

If you have a third-party claim, you should consider filing a workers’ comp claim immediately, in order to obtain L&I medical care. L&I medical care is usually the best option when compared to using your own private insurance or fighting with your insurance company (if you have PIP), or the other party’s insurance company. It is also recommended that you contact an L&I attorney experienced in third party claims and injury law – they can determine the best course of action and make sure you get the best care possible.

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

If your L&I claim is closed and you still require care, you have some options. If it’s within 60 days (2 months) after your claim is closed, you and your doctor can protest closure. If it’s more than 60 days, you will need to work with your doctor to have your claim reopened, which could cause some delays in getting your medical care covered.

What Do I Do If L&I Denies My Medical Care?

If L&I or your self-insured employer denies the medical care or procedures that you require, you should contact an experienced workers’ compensation attorney. A good L&I attorney will provide a free consultation and tell you how to secure treatment that doesn’t require out-of-pocket payments or private insurance. Once a denial occurs, it can be difficult to persuade L&I or the self-insured employer that the requested treatment or procedure is in fact necessary.

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