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
 

L&I Claim News: Physical Therapy and Occupational Therapy Guideline

The Department of Labor and Industries (L&I) has been working on a new Work Rehabilitation Guideline. The overarching purpose of the guideline is to address physical therapy and occupational therapy in L&I claims.

 

L&I claim work rehabilitation and utilization review

L&I collaborated with professionals from multiple relevant disciplines to develop the guideline. In fact, they worked with physical therapists, occupational therapists, and vocational counselors. In addition, they collaborated with representatives of the Office of the Medical Director at L&I. The 58-pages guideline draft is currently available on the L&I website.

The goal for the new guideline is to instruct providers and shape the policy for work rehabilitation. Importantly, it’s also intended to improve the L&I claim utilization review process. Personally, I think this new guideline extends L&I’s approach towards more uniform practices across all L&I claim medical providers. Furthermore, it seems to focus on early intervention and return to work (RTW).

 

Work rehabilitation in a workers’ compensation claim

If you have an L&I claim or workers’ compensation claim in Washington State, you might be eligible for work rehabilitation. In general, for eligibility, a work injury claimant must meet the following criteria:

1) The L&I claim attending provider must opine that the work injury claimant is ready to participate in the program.

2) The injured worker must have had at least 2 months of recovery since the injury.

3) The person with the work injury must demonstrate good likelihood of succeeding in the program. Claim managers consider multiple factors when assessing the worker’s likelihood of success. Overall, these factors include vocational issues, behavioral health needs, and support network.

4) The claim administrator must clearly identify a return-to-work goal. Also, the goal has to include an applicable job analysis. Alternatively, it can include a description of job demands.

5) The program intensity has to match the work injury claimant’s individual needs. It must also consider the job demands and the availability of modifications-to-the-job within the labor market.

 

The new guideline and the Industrial Insurance Act in Washington State

From my perspective, this new guideline seems to offer some good improvements. For example, I’m happy to see that L&I is focusing on the specific needs of each injured worker and their return-to-work goal. Previously, similar programs seem to follow a “one-size-fits-all” approach. Now, I genuinely believe that work injury claimants will perform much better because the program addresses their individual needs.

However, I’m concerned that this guideline falls short of meeting the intent and purpose of the Industrial Insurance Act. Specifically when it comes to this part:

“to protect injured workers, to provide them with sure and certain relief for their injuries, and to reduce to a minimum their suffering and economic harm.”

With this in mind, I feel strong disheartening when I read the definition of “work disability” in the draft guideline:

“Work Disability is a concept describing the overall societal context of why workers may have continued disability. This model includes the personal aspects (like physical injury and coping strategies of the worker) and places them within a framework of the larger healthcare, legislative and workplace systems; all of which have impact on the benefits, incentives and decision-making for RTW options. Ultimately, these factors influence the worker to make a decision on when, or if, they RTW. Addressing these factors is part of a worker’s recovery and when particular barriers to recovery are identified, efforts can be made to address and work toward satisfactory solutions. This requires proper messaging from all providers about the nature of work disability and methods to foster patient engagement.”

 

Concerns and opinion

First, this definition isn’t consistent with the legal definition of total disability. Beyond that, it demonstrates one of the biggest challenges work injury claimants face during L&I claims. Explicitly, having their pain complaints taken seriously. Sure, pain is a subjective complaint. Workers’ compensation laws require at least one objective finding to support the extent of a work injury claimant’s physical disability. However, treatment providers are not required to rely solely on objective findings.

Guidelines like this should do a better job in helping treatment providers understand how to appropriately acknowledge and validate work injury claimant pain complaints. Being in pain doesn’t mean that a person doesn’t want to get back to work. It also doesn’t mean they think of themselves as disabled. Moreover, in my experience, if you treat people after an injury at work as if their pain is driven by disability conviction, return to work avoidance, or secondary gain – that’s the best way to destroy the provider-patient relationship. Consequently, there’s a very good chance that their treatment will fail.

 

Claim closure – What does claim closure mean?

People with an L&I claim in Washington State tend to have lots of questions about claim closure. Some of the most common questions I get are: What does closure mean? What if my condition gets worse after my workers’ compensation claim closes? Did I get everything I was supposed to? What if I disagree with L&I closing my claim?

 

Every L&I claim is unique

Every work injury and workman’s comp claim are unique. As a result, people have different questions about their specific situation. Therefore, it’s very difficult to give general answers that apply to everyone. Sure, there are some high-level pieces of information that apply to all. However, a general answer might not fit your L&I claim circumstances. Either way, it’s always a good idea to consult with an L&I attorney or a workers’ compensation attorney before your claim closure becomes final.

 

What does closure mean?

The Department of Labor and Industries (L&I) closes claims after treatment completes and after they determine your return to work or employability status. Once a workers’ comp claim closes, work injury claimants cannot receive any more benefits under the claim. Specifically, your L&I claim no longer pays for medical treatment and medication. Furthermore, L&I stops paying benefits like time loss compensation and loss of eating power (LEP). Finally, L&I stops providing services such as vocational counseling or guidance. However, if L&I decides you are permanently and totally disabled, you will receive monthly L&I claim pension benefits after the claim closes.

 

What if my condition gets worse after my claim closes?

The most common concern I hear from clients is about worsening medical condition. Here, there are some good news – You can reopen an L&I claim! To do it, you must show objective worsening that relate to the medical conditions under your L&I claim. Practically speaking, you must show that you need further medical treatment. Alternatively, you can show that your disability is worse than before. Then, there are slightly different rules for mental health conditions. For example, with mental health claims, objective worsening isn’t a prerequisite. Yet, it’s still mandatory to have an expert medical opinion on worsening before L&I reopens your claim.

 

If you reopen your workers’ compensation claim after 7 years, then you might be able to receive all types of benefits. After 7 years, you can still reopen your L&I claim, but only for medical treatment. Even then, you can ask the L&I Director to exercise discretion and grant additional benefits.

 

Did I get everything I deserve?

This is the most challenging claim closure question to answer. Every work injury has different circumstances. Consequently, there are different benefits under every claim. Benefits can include medical treatment, time loss compensation, and loss of earning power. There can also be vocational services and retraining benefits. Sometimes, permanent partial disability awards and permanent total disability might apply. If you’re not sure you received the benefits you deserve, you should speak with a workers’ compensation attorney.

 

What if I disagree with closing my claim?

Many work injury victims disagree with their workers’ comp claim closure. If you are one of them, you must protest L&I’s decision within 60 days. However, if L&I affirms its decision, you can submit an appeal to the Board of Industrial Insurance Appeals (BIIA). If you do, make sure you have strong medical (and sometimes vocational) evidence to show that claim closure is wrong.

 

L&I Claim in Washington State: How does it work?

L&I claim benefits and workers’ compensation claim rules vary from state to state. L&I claim in Washington State follows the requirements of the Industrial Insurance Act. Here, in Washington State, the goal is to provide benefits to people with a work injury claim and their dependents.

 

Labor and Industries (L&I)

The Department of Labor and Industries (L&I) is the Washington State agency that administers these benefits. Consequently, it’s L&I’s job to determine the benefits to provide in every workers’ compensation claim. Generally, employers and employees statewide pay workers’ compensation insurance premiums out of every paycheck. For state-funded work injury claims, L&I pays benefits out of the premiums they collect throughout the year. Overall, when I think about all available L&I claim benefits,  I group them into categories: treatment, wage replacement, vocational, and closing.

 

L&I claim medical treatment

L&I must authorize treatment that is “necessary and proper” for any condition that relates to the work injury claim. In essence, “necessary and proper” typically refers to diagnostic, curative, or rehabilitative treatment. Moreover, L&I does not consider purely palliative treatment as necessary and proper under the law. L&I uses a third party called Comagine to help determine whether treatment fits the definition. Usually, treatment continues until the work injury claimant gets to maximum medical improvement. That’s when medical providers say the person with the work injury is as good as they are going to get.

 

Wage replacement in workers’ compensation claims

Employers can opt to keep the work injury victim on salary while they recover. However, in many cases employers don’t do this. Then, if the work injury claimant can’t work or has reduced earning capacity, they may be entitled to wage replacement benefits. Explicitly, these include time loss compensation or loss of earning power. Realistically, L&I pays time loss compensation if the work injury claimant is temporarily incapable of working while recovering. This is referred to as being “temporarily totally disabled”.

 

L&I pays time loss compensation benefits at base rate of 60% of the work injury claimant’s wages at the time of injury. Loss of earning power benefits are paid when the work injury victim can work to some extent while recovering but has at least 5% reduction in earnings.

 

L&I claim vocational benefits

Surprisingly, many people don’t realize that vocational services are part of their L&I claim benefits package. Personally, I think that  vocational benefits are particularly important for work injury claimants. Many workers need retraining to get back to work. In particular, this is often the case for people that work physical jobs after they suffer a work injury. Often, their work injury results in permanent physical limitations. When this happens, L&I can authorize and cover the costs of retraining for up to two years. Finally, L&I assigns a vocational counselor to oversee the entire process.

 

Closing L&I claim

Are there L&I claim benefits during claim closure? Yes! Many people are surprised to learn that L&I pays certain benefits when their workers’ compensation claim closes. In fact, L&I provides benefits at claim closure whenever the injured person has permanent measurable residuals. Many times, the person having the work injury is capable of working (despite the residuals). For compensation, they should get a permanent partial disability award (PPD award). The PPD is a monetary award. L&I bases the PPD award amount on the permanent disability that they can measure. More correctly, a competent medical provider is responsible for measuring the level of disability.

 

Sometimes, the person that suffered an injury at work is no longer capable of working. In such instances, we refer to them as “permanently totally disabled”. L&I places such injured people on an L&I pension when their claim closes. The value of L&I pension benefits is comparable to time loss compensation benefits. However, L&I pays pension benefits monthly for the remainder of the work injury victim’s life. That’s true as long as they remain permanently and totally disabled.

 

The role of a workers’ compensation attorney in Washington State

An L&I attorney or workers’ compensation attorney like me has several roles. For one, L&I attorneys ensure that L&I and insurance companies provide work injury claimants the benefits they deserve under the law. Furthermore, L&I issues orders or notice of decision letters regularly. These decisions are very important. They often contain entitlement to benefits. In many cases, people with L&I claim disagree with L&I’s decision. Therefore, they can protest or appeal the decision. Many times, the likelihood of success can be much higher with the help of an L&I attorney.

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