Workers Compensation - Washington

Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

Workers Compensation Attorney and L&I Lawyer

Thank you for visiting my blog. My name is Tara Reck and I am a managing attorney at Reck Law, PLLC. Our Workers’ Compensation and L&I attorneys are dedicated 100% to representing injured workers in Washington State. We have several offices in the Puget Sound area and we represent injured workers all over the state.


If you need help with your L&I claim, self-insured employer claim, or any other workers’ compensation or work injury claim, please give us a call to schedule a free consultation. We help with claim management, appeals and litigation with L&I and the Board of Industrial Insurance Appeals, Washington State Superior Court, Court of Appeals, and Washington State Supreme Court, as needed.


   

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Reck Law, PLLC – Office Locations
Seattle & Bellevue

2731 77th Ave SE #203
Mercer Island, WA 98040

Map and directions

(206) 395-6141
Tacoma

2367 Tacoma Ave S #110
Tacoma, WA 98402

Map and directions

(253) 999-9828
Renton

707 S Grady Way #600 Suite R
Renton, WA 98057

Map and directions

(425) 800-8195
Port Orchard

219 Prospect St
Port Orchard, WA 98366

Map and directions

(360) 876-4123
 

Self-Insured Claims in Washington State: How to Get Your Claim File and Updates?

If you have an L&I Claim, you can easily find the status of your claim. You can just log onto Claims and Account Center (CAC). It’s available on the L&I website. There, you can find everything about your claim. From reports, to orders, claim file notes, and more. However, if you have a self-insured claim, then things are not that simple. In fact, it can be very difficult to find the status of your claim.

 

Self-insured Employer Claims

Self-insured workers’ compensation claims are generally not available on CAC. Therefore, work injury claimants don’t have on-demand access to claim files. Consequently, it makes it very difficult to keep track of self-insured claims. Yet, there are ways to track the developments in these claims. More specifically, you can request your claim file and updates.

 

Self-insured employer claim file

First, you must request (in writing) a copy of your claim file. Then, under RCW 51.32.195 and WAC 296-15-420, self-insured employers have 15 working days to provide a complete copy of the claim file. Interestingly, either you or your representative can make the request.

 

Generally, the employer maintains the worker’s claim file. Sometimes, it can be the claim administrator. Either way, the claim file should include:

1) Information that L&I received or prepared for the claim;

2) All the info that the employer produced or received;

3) All data and information from the third-party claim administrator (TPA).

 

What information is in my worker’s comp claim file?

When you ask for the claim file, you can specify the information you need. Alternatively, you can submit a non-specific request. With non-specific requests, the employer must include the following:

(1) Information to evaluate the claim. For example, evaluating for claim allowance or to provide claim related benefits. The information may include forms and incident reports. It can also include worker statements, witness interviews, and so on.

(2) Medical records and reports. This includes: (a) all records related to independent medical examinations (IMEs) or consultations; (b) nurse case management notes and reports; (c) the records from the employer’s on-site medical facility; and (d) all records and reports from treating and consulting providers.

(3) Vocational and return to work activities. These activities may include vocational provider reports, vocational plans, and more.

(4) Records of all activities completed on the claim.

(5) Records of claim communications. Specifically, records contain electronic, phone notes, logs, or other media.

(6) Incoming and outgoing claim correspondence.

(7) Orders and decisions issued in the claim.

(8) Employer payroll records and worker earnings. Furthermore, any other documents used to determine wages under RCW 51.08.178.

(9) Records of payments. In detail, this includes time-loss compensation payments and loss of earning power benefit. On top, it includes kept-on-salary payments. Furthermore, it’ll have you’re PPD rating and permanent partial disability calculations and payments, as applicable.

(10) Bills on the claim and actions regarding each bill: Whether a bill was paid, denied, adjusted, and when. Note, however, that the self-insured employer doesn’t have to provide bills information. For bills, you have to specifically request them.

 

Complete work injury claim file vs claim file updates

Self-insured employers provide a first complete copy of the claim file for free. Then, after the initial copy, the self-insured employer may charge a fee for additional complete files. Therefore, it’s always good to request an initial complete file. After that, I recommend requesting claim file updates only. The updates contain new documents since the last request. You can request them on a regular interval. Usually, workers ask for claim file updates every 30 days.

 

Attorney-client materials in a workers’ compensation claim file

Often, self-insured employers and claim administrators work closely with their legal representatives. In turn, employers may decline to provide some claim file material. That’s because it may contain attorney-client privileged material. In addition, it may include attorney work product. It is a valid basis for withholding certain materials. However, it’s not a reason to withhold all information. Therefore, if a self-insured employer is working with attorneys, you may want to retain your own legal representative.

 

Conclusions

To summarize, it’s very important to know what’s happening in your workers’ compensation claim. Yet, self-insured claims can be difficult to follow. But it doesn’t mean it’s impossible. Work injury claimants can regularly request copies of claim file materials. Finally, when you write a request to receive your claim file, the self-insured employer must provide all claim materials within 15 days. That is, 15 days from receiving your request.

 

Falling From a Roof – Why We Must Take Work Safety More Seriously

The Department of Labor and Industries (L&I) governs work safety matters in Washington State. Recently, L&I published a news bulletin showing that not all employers are taking workers’ well-being seriously. Unfortunately, some employers continuously ignore very basic safety precautions.

 

Roofing Work Injury Examples and Hazards

In its publication, L&I reported that Allways Roofing Inc and United Roofing Solutions Inc are severe safety violators. The two roofing companies are in Western Washington. What makes these companies severe violators? Ongoing safety inspection failures resulting in repeat citations. In fact, the two companies racked over $3M in penalties, combined.

 

Interestingly, L&I says it inspected Allways Roofing 11 times in the past 3 years. The company repeatedly violated fall protection regulations. Consequently, L&I considers the company’s behavior egregious and willful. These recurring safety violations resulted in high numbers of work injury occurrences. In detail, at least seven employees sustained serious workplace injuries. They include five falls from heights and two eye injuries from nail guns. Furthermore, Allways Roofing appealed its past citations.

 

Falling from a roof is a serious work injury

In addition, L&I inspected United Roofing Solutions Inc more than 6 times since 2009. L&I issued them citations for repeat safety violations. Per L&I, the most recent citation was for repeated, willful, serious violations of not using fall protection. Unsurprisingly, the company appealed this determination.

 

L&I and federal workplace safety programs track statistics for roofing accidents. They concluded that falling from heights is one of the leading causes of workplace deaths and serious injuries. Wake up people! These statistics alone justify fall protection and safety regulations. Not to mention inspections and citations for failing to follow regulations.

 

L&I claims that come through my office

Every day, I see the very real and devastating effects that serious workplace injuries have on workers. And, the horrific impact of catastrophic work injuries on families. EVERY-SINGLE-DAY! Companies that repeatedly ignore safety regulations. Placing profits over people. These companies deserve to receive citations and penalties. In fact, they deserve the extra scrutiny that comes with the Severe Violator Enforcement Program.

 

When it comes to L&I claims, there’s so much disagreement regarding claim administration and processing. However, there’s one thing I think we can all agree on. Preventing work injuries is the single best outcome in the L&I setting. In my opinion, both employers and employees should take measures to increase workplace safety. We cannot tolerate willful safety violations. Personally, I am grateful for L&I for prioritizing workplace safety.

 

L&I Denied My Claim for Occupational Disease – Why? What can I do?

Last week, we talked about cases where L&I rejected a work injury claim. Here, we’ll discuss examples and reasons when L&I denies claims for occupational disease. Remember, an occupational disease is when you develop a medical condition due to your work settings. In contrast, a work injury is when a sudden accident happens at work.

 

Occupational disease L&I claim

Occupational disease is sometimes called industrial illness. In Washington State, the law that governs this topic is RCW 51.08.140. By law, “occupational disease” means a disease or infection arising naturally (or approximately) out of employment conditions. That’s a complex definition. In simple words, it refers to cases where unique work conditions cause an illness or infection. Usually, these diseases develop over time due to your workplace environment.

 

The law in Washington State favors work injury claimants. Simply put, it’s more likely that L&I will approve or allow your workers’ compensation claim than not. To allow an occupational disease claim, there must be objective medical evidence. On top, the medical facts must show that your distinctive employment conditions are the reason for the disease.

 

Why did L&I deny my claim?

You must file your L&I claim on time. Don’t delay or file late. For timing, the rules for an occupational disease claim are different than for a workplace injury. Here, the time limit is 2 years. More explicitly, it’s 2 years from when a medical provider informs you (in writing) that you have an occupational disease.

 

Generally, filing and timing is almost never an issue. However, the top 1 most common reason for L&I to deny a claim is lack of causation. In other words, it’s when you don’t show how your work conditions caused the disease. Furthermore, if we dig deeper, then there are 2 main issues with showing causation. The first is lack of distinctive conditions at your job. Then, the second is when there are other conditions in your life that are more likely to cause the disease.

 

L&I claim denied – a deeper dive

Let’s talk about the first issue. Remember, your work environment must have unique conditions that can cause the illness. To meet this requirement, you have to show how your employment, more probably than not, gave rise to your sickness. Your work conditions have to be truly unique. They can’t overlap with conditions you encounter in everyday life. Or in other general jobs. To approve your claim, L&I must be able to connect the dots between your work and the illness. And, unless the connection is obvious, you have to help them.

 

For example, say you catch the flu at work. There’s no chance that L&I will approve your claim. Why? Because you’re equally likely to catch the flu outside of work. Even if you work in a hospital treating flu patients daily (with one exception for Covid – please refer to other articles on my blog to learn about Covid workers’ comp claims).

 

Identifying the reason and source of your industrial disease

The second issue with claim denial is causation. Even if you show unique work conditions. Still, you must also show how the conditions are responsible for the illness. One challenge I see often is that there are many different causes for diseases. For instance, Carpal Tunnel Syndrome (CTS) is an occupational disease with many legal contentions. Many times, your employer will contest your claim for Carpal Tunnel Syndrome.

 

Medical literature supports that certain work activities are risk factors for Carpal Tunnel Syndrome. For example, repetitive forceful pinching and grasping. However, there are other known potential contributing factors. They include age, gender, body weight and pregnancy. Frankly, blaming causation on other risk factors (especially aging) is the most common reason to deny a workers’ compensation claim.

 

Workers’ comp claim denial due to causation

L&I can deny your claim for more complex reasons. Sometimes, in certain work environments, the medical community is still trying to understand the sources of certain sicknesses. For example, we now know that working in nuclear power plants caused workers to develop cancer. However, workers weren’t aware of these risks when they worked there. Furthermore, the cancer diagnosis came years later. The Hanford nuclear site in Washington State is a good example. Occupational disease claims stemming from working at Hanford remain highly contested.

 

Another more complex reason is showing exposure. Particularly, this problem arises when workers get exposure to certain toxins at work. In such cases, workers don’t need to show that a specific toxic agent caused the disease. It’s probably already known in the medical literature. Yet, they still must prove their exposure at work. As before, workers must show how the exposure to the toxins (in contrast to other factors) caused the disease. This can be extremely difficult to prove without identifying specific toxins. Moreover, identifying toxins in the workplace requires significant expertise. It can be a very expensive process.

 

Final notes

Occupational disease claims are complex. They have many moving parts. Plus, there are many reasons why L&I denies industrial illness claims. However, no matter what, if you believe you have an occupational disease, go see a medical provider. Then, file a claim at the provider’s office. After that, if L&I rejects your claim, you only have 60 days to protest or appeal the decision. Use these 60 days to figure out why L&I denied the claim. Assemble evidence to show why they should allow the L&I claim. Advocate for L&I to change their decision. As always, if things get too confusing, contact a workers’ compensation attorney for help.

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