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

Office Careers retraining program in L&I claims is under investigation

Last night, there was a news broadcast on King 5 News regarding a vocational retraining program called Office Careers. This program has been approved by the Department of Labor and Industries (L&I) for a while. Since then, the local workers’ compensation community has been a buzz.

 

The Office Careers news report

According to the investigation, L&I paid millions of dollars over time to this unaccredited retraining facility without any proof of success. As a workers’ compensation attorney representing work injury claimants in Washington State, I am thrilled to see that this issue is finally exposed. In my experience, Office Careers is the “go-to” program that vocational counselors select to retrain some of the most disabled and challenging injured workers.

 

Why do vocational counselors like Office Careers?

As I see it, Office Career has become the default vocational retraining program. In my opinion, it’s because they claim to provide job retraining after a work injury that anyone can pass. However, it’s because they provide injured workers with the bare minimum marketable skills (at best). As a result, the people retrained after a work injury might be able to obtain basic minimum wage office assistant type work.

 

At first glance, the program seems ideal for injured workers living in more remote areas. That’s because Office Careers offers an entirely online retraining program. This eliminates the challenges and hassle of finding an onsite retraining program within a reasonable distance of the injured worker’s home.

 

Personal experience with the Office Careers retraining program

My client, who wishes to remain anonymous, was watching the news report the other day and gave me permission to share the following information. L&I said that this client is capable of retraining at Office Careers back in October 2018, through her L&I claim. I submitted a dispute to L&I arguing that my client lacked the aptitudes to succeed in the program. Moreover, I explained that the injured worker was being set up for defeat and failure. Here, my rational was that this work injury client has already undergone aptitude testing and received very low scores.

 

In this case, it was pretty obvious that the injured worker would need additional time and assistance to complete a GED before moving on to the program with Office Careers. Despite my arguments, L&I approved the retraining plan. My client started a GED program at a local institution but struggled to pass the testing to obtain the GED certificate. The vocational counselor wasn’t happy with the lack of progress from the local GED program. Because of this, the vocational counselor pushed for a plan modification that would involve the GED course and a general clerical course though Office Careers.

 

From in-class GED program to Office Careers

In the plan modification report, the vocational counselor stated that: “Office Careers provides the GED training and has Spanish and English-speaking instructors to assist [the work injury claimant] in passing the test”. Despite my client’s lack of success in a local in-class GED program, L&I approved the modification. Under the plan modification, Office Careers would collect over $17,000 in tuition. The injured worker started the program at Office Careers in September 2019.

 

Within the first three weeks Office Careers wrote a progress report indicating that “it might not be feasible in the timeframe of this program to prepare [the injured worker adequately] to succeed at GED” due to the worker’s low scores. It was known that the injured worker had learning disabilities. It was evident that my work injury client had only a 6th grade educational level prior to starting retraining. In a progress report from December 2019, Office Careers stated that it is “hoped that a person starting GED training (or equivalent) starts the process with at least an 8th grade understanding as a starting point”. The injured worker continued to struggle with the retraining program even though they put forth their best efforts to succeed.

 

What’s next in this L&I claim?

Ironically, today my office received a vocational closing report indicating that this work injury claimant cannot benefit from the retraining program. Consequently, they are discontinuing my client’s vocational retraining services. We knew that this determination was coming. However, it doesn’t lessen the devastating impact on this injured worker.

 

This process has been exhausting and demoralizing. It has done nothing to benefit an injured worker trying desperately to recover from a devastating industrial injury. We applaud the sharp investigative reporters at King 5 News for bringing this issue to light. And, we pray that this news will create a wave that will change the attitude towards retraining services that genuinely benefit injured workers.

L&I claim travel reimbursement

If you have a work injury claim, such as a workers’ compensation claim or L&I claim, then you can see any medical provider you choose. The only requirement is that the medical provider must be a member of the Medical Provider Network or MPN. For work injury claimants living in rural places or remote areas, finding a provider in the MPN can mean extensive travel.

 

How to get travel reimbursement for my workers’ compensation claim?

Under certain circumstances, the Department of Labor and Industries (L&I) will reimburse injured workers for travel to medical appointments. However, you must meet three criteria in order to get reimbursement for your travels. If you think that you meet all the requirements, then you should fill a travel reimbursement form. Once you complete the form, be sure to submit it to your claim manager.

 

First, the medical provider must be more than 15 miles away from the residence of the work injury claimant. Second, there can’t be any other available providers that have closer offices. Third, you must get pre-authorization for the reimbursement from your L&I claim manager. Furthermore, it is important to note that you can get reimbursements for mileage, toll road payments, and parking fees in excess of $10.

 

What do I need to do to get travel reimbursement from L&I?

On its face, travel reimbursement seems like a relatively simple and a valuable benefit for people with L&I claim. Clearly, it’s an excellent benefit for people with a work injury that incur extraordinary travel expenses for treatment. However, practically speaking, it is rather challenging to successfully receive travel reimbursement.

 

One of the most frustrating problems is when a workers’ compensation claim manager questions the need for travel. In my experience, this happens all the time when work injury claimants need to change their medical provider in the middle of an L&I claim. Nearly all medical providers are reluctant to become the attending physician for an older L&I claim. Therefore, people with existing claims often need to travel afar to find a doctor that is willing to see them.

 

L&I claim travel reimbursement form and pre-authorization

In many cases, before authorizing travel reimbursement, some L&I claim managers require us to produce a journal showing that we tried to find a provider within 15 miles of the worker’s residence. Despite the frustration, once we submit the journal to the claim manager, the claim manager usually authorizes the reimbursement.

 

Another common frustration I encounter all the time is when work injury claimants are unaware of the travel reimbursement requirements. It’s common for me to speak with people with a workers’ compensation claim who completely gave up on the reimbursement process. Usually, they give up because they either don’t understand or don’t seem to meet the requirements. The most frequent mistake I see is failing to get pre-authorization. Interestingly, in most cases it’s because they do not fill out the travel reimbursement form correctly. However, having done this so many times, it is fairly easy to correct these errors.

 

Takeaways and final notes

In summary, if you got hurt at work and you have a workers’ compensation claim or L&I claim, if you travel to medical appointments, then you can (and should) get travel reimbursement. Remember, to get travel reimbursement and eliminate unnecessary frustration, make sure you know the requirements, fill the form above, and ask for pre-authorization from your claim manager.

How to increase your L&I claim time loss compensation or loss of earning power benefits

Did you know that you can apply for a change of circumstance to increase your wage rate under your workers’ compensation claim in Washington State?

 

Calculating wages for monetary benefits under your L&I claim

People that have a workers’ compensation claim for a work injury typically receive L&I claim benefits such as time-loss compensation benefits (TLC) or loss of earning power benefits (LEP). This fact applies to people with an L&I claim that are administered by the Department of Labor and Industries (L&I). And, it also holds true for people that have a workers’ compensation claim with a self-insured employer, which is administered by a third-party administrator (TPA). In short, we refer to these benefits as wage replacement benefits, because they compensate the work injury claimant for lost wages while he or she are trying to recover from their workplace injury.

 

The entity that administers the claim (L&I or the TPA) must be able to determine the appropriate monthly wages. This is required in order to pay the correct amount for wage replacement benefits. According to RCW 51.08.178, monthly wages includes the injured worker’s hourly rate (or salary) at their normal work pattern at the time of injury. It must also include board, housing, fuel or other consideration of a similar nature. For example:
1) Bonuses received in the preceding 12 months;
2) The value of employer-paid healthcare benefits if the employer stopped paying for healthcare insurance coverage; and
3) Tips reported to the employer for federal income tax purposes.

 

How to protest or appeal a wage order?

The Industrial Insurance Act mandates L&I claim administrators to compute wages in a “fair and reasonable” manner. Here, when the claim administrator determines the wages, L&I usually issues a written L&I order decision called “wage order”. The order outlines the wage rate computation. Like other L&I orders, the wage order becomes final and binding after 60 days. However, just like other orders, you can protest or appeal it.

 

If you are an injured worker and you received a wage order, it is very important to review it carefully for accuracy. If it’s not correct, you must send a written protest or appeal and file it in time. Again, you must send your protest within 60 days to have L&I correct the wage computation. Once the wage under your L&I claim becomes final, the wage order cannot be changed even if it is wrong. Finally, it’s important to note that the only exception to this rule is when there’s a “change of circumstance”.

 

What is change of circumstance under a workers’ compensation claim?

Under RCW 51.28.040, injured workers can apply for change of circumstance after a wage order has become final and binding. One of the most common events that constitutes a valid change of circumstance is when an employer stops providing healthcare benefits.

 

Often, employers will continue healthcare insurance coverage for work injury claimants after opening an L&I claim. While the employer pays your healthcare coverage, it is not appropriate to include the value of healthcare benefits in the wage rate computation. However, when the employer stops paying, then a change of circumstance occurs. Therefore, if your employer stopped paying for healthcare coverage, you should file for change of circumstance. Consequently, L&I will include the value of your healthcare insurance in your wage rate calculation.

 

Legal notes and personal experiences

In general, if the facts of your L&I claim warrant an adjustment or increase, it will apply to benefits paid up to 60 days prior to when the application for change of circumstance was filed. An inaccuracy in the original computation does not constitute a valid change of circumstance. There must be some material change that occurred after the fact.

 

Most workplace injury claimants I talk to are not aware that they can file a change of circumstance. Sadly, it is very common for me to discover that injured workers weren’t paid years of increased benefits because they didn’t apply for change of circumstance when the change originally occurred. Filing an application for change of circumstance is relatively easy. All you need to do is send a written request to your L&I claim manager asking for an adjustment. In this letter, you should explain the change that occurred and provide the relevant details.

 

IME exam in L&I claims in Washington State

The Department of Labor and Industries (L&I) sometimes requires injured workers to attend Independent Medical Examinations or IME. In many cases, L&I asks work injury claimants to attend an IME in order to help L&I make claim-related decisions. From L&I’s perspective, an IME provides objective medical-legal examination for the purpose of establishing medical findings, opinions and conclusions about an injured worker’s physical condition.

 

IME tests in L&I claim appeals

It’s important to note that IME exams can only be performed medical examiners that are pre-approved by L&I. Fundamentally, I don’t share L&I’s perspective on IME examinations. When I represent work injury plaintiffs in appeals before the Board of Industrial Insurance Appeals (BIIA), often L&I medical arguments rely on IME opinion. In fact, it is very common for me to cross examine the same seven or eight IME doctors repeatedly.

 

IME panels in Washington State

There are several panel corporations that provide IME services to L&I. These include Sunrise Medical, Objective Medical Assessments Corporation (OMAC), Central Seattle Panel of Consultants, Medical Consultants Network (MCN), and others. Interestingly, most of the examiners who perform IME tests are contracted with more than one of these panels. In other words, having a variety of panels offering IME tests does not result in a greater variety of examiners.

 

IME exams are inherently biased and unfair

On occasion I’m surprised by the outcome of an IME. However, more often I predict the outcome before the examination even occurs. There are several reasons for this. L&I argues that IME tests are an objective process. I’ve had IME doctors testify that they are in the best position to provide opinions to L&I because they have no stake in the outcome. Whether these providers want to admit it or not, they have a bias in favor of L&I.

 

The Department of Labor and Industries controls the process and procedure of every IME from start to finish. For one, L&I sets the ground rules for these examinations. Moreover, as mentioned earlier, the examiners must be approved by L&I. In addition, examiners are mandated to follow the Medical Examiner’s Handbook written by L&I.

 

IME examiners are asked to answer specific questions given to them by the claim manager. Typically, along with the questions presented to IME doctors, the claim manager usually provides claim related information. This information can include the status of the claim, the L&I claim accepted conditions and the contested conditions. The IME examiner reviews the medical records provided by L&I and is paid according to fee schedules dictated by L&I. Finally, the examiner must produce a report in accordance with L&I timelines.

 

IME exams from the viewpoint of injured workers

In my experience, injured workers who are required to attend an IME rarely feel that the process is unbiased and objective. For example, a work injury claimant has no choice when it comes to the IME doctor. In addition, the date and time of the IME exam is set by L&I. Then, if there are any scheduling conflicts for the injured worker, he or she must ask for permission from the claim manger to reschedule.

 

Frequently, injured workers feel attacked and judged by the IME examiners. It’s very common for work injury plaintiffs to report that the examiners seem to ignore what they are saying. Consequently, the IME process leaves work injury claimants feeling frustrated, insecure, and unheard. People that suffer a work injury contact me all the time to inquire about representation. Many times, they call me because they have been scheduled for an IME, or recently attended an IME. As a result, they are concerned about the future of their claim.

 

IME notes from an L&I attorney

In my opinion, there are many legitimate reasons for which L&I needs outside, impartial medical opinions to help resolve L&I claim issues. However, I don’t believe that the current IME process is fair. I also don’t feel that the current format of IME examinations accomplishes the goals of the Industrial Insurance Act.

 

L&I claim notices: Notice of Decision, Payment Order

Workers’ compensation claims can be overwhelming. Recently, I’ve consulted with several injured workers who have been completely overwhelmed with their claims. As a result, they started avoiding claim related documents.

 

Dealing with L&I claim orders and communications

Some work injury claimants I talk to no longer open their mail because it was causing them too much anxiety. I call this the “ostrich approach”. Just like an ostrich, burying its head in the sand, injured workers with a work injury claim who avoid claim-related communication don’t see the danger that is coming. They may miss critical deadlines, which in turn, can cause permanent harm to their workers compensation claim.

The Department of Labor and Industries (L&I) has the obligation to administer work injury claims. Similarly, claimants have the right to challenge L&I decisions that they believe are a mistake. However, work injury claimants only have 60 days to challenge and protest an L&I decision. If you do not file a request for reconsideration within 60 days, then you essentially waive your right to challenge L&I.

Remember, L&I makes mistakes. There’s no question about it. But, like it or not, it’s your job to be on top of things. In other words, if you don’t appeal an L&I decision, their mistake becomes final and binding under the law, no matter how wrong it may be.

 

L&I decision

When L&I makes a decision concerning an issue in an L&I claim, they must notify the injured worker. In fact, they have to send something called a written order. Usually, these decisions are titled “NOTICE OF DECISION”. Here is what one that comes from L&I looks like:

 

L-and-I Notice Of Decision

 

L&I payment order

Sometimes L&I makes unfavorable decisions in what they title “PAYMENT ORDERS”. You would think something called a payment order would be a favorable decision issuing a payment. It isn’t uncommon for L&I to make a decision denying time-loss compensation or closing a claim in a decision called “PAYMENT ORDER”. Here is an example:

 

L&I Payment Order

 

Can I protest a notice of decision or payment order?

Whether a decision is a NOTICE OF DECISION, PAYMENT ORDER, or has some other label, it’s’ easy to tell if you have the right to protest. For that, you can refer to the bottom of the decision letter and read it carefully. For example, it will look something like this:

 

L&I protest order

 

In some cases, work injury claimants protest a decision. Then, after some time goes by,  L&I affirms its previous determination. When this is the case, the notice of appeal rights looks as follows:

 

L&I Notice Of Appeal

 

Monitor your L&I claim

If you have a work injury claim or L&I claim, the most important thing you can do is to pay attention to notices. You can protect yourself and protect your workers compensation claim by protesting or challenging L&I’s mistakes on time. There is nothing more heartbreaking for me than being contacted by an injured worker who disagrees with an L&I decision after they waited too long to dispute a decision.

Don’t be overwhelmed by your claim. If your claim and the associated correspondence is causing you too much anxiety, contact an experienced attorney who can help alleviate your anxiety. Your attorney will receive all the communications directly. They will oversee your claim and ensure that the Department’s mistakes are challenged on time.

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