Workers Compensation - Washington

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

Month: July 2019

Complex Regional Pain Syndrome (CRPS) in L&I Workers’ Compensation Claims

In workers’ compensation we see all kinds of work injuries and occupational diseases resulting in various medical diagnoses. These things are never easy, no matter what the diagnosis. However, some conditions seem to have a straighter claim path than others. Complex Regional Pain Syndrome (CRPS), for one, is a diagnosis that often leads to an irregular and challenging claim path.

 

L&I treatment guideline for CRPS

It seems that CRPS is a somewhat controversial diagnosis. The medical community is still working to better understand the condition. However, L&I does recognize CRPS as a medical diagnosis and has a treatment guideline for it. According to L&I, there are two sub-types of CRPS. Type I is what used to be called RSD, while type II used to be called Causalgia. The central difference between CRPS type I and type II is that type II occurs following a known peripheral nerve injury. On the other hand, type I occurs in the absence of any known nerve injury.

 

CRPS is a relatively uncommon condition. Also, it is not necessarily the right diagnosis for individuals with widespread pain in an extremity. Typically, true CRPS develops within 2 months of an injury in a single extremity. Symptoms include burning pain and severe pain caused by something that is typically not painful (such as a breeze or very light touch). Other symptoms are swelling, irregular or asymmetrical temperature and color of the limb, irregular or asymmetrical sweating of the limb, and skin, nail and hair changes in the impacted limb. While not required, a three-phase bone scan with a characteristic pattern of abnormality can help confirm the diagnosis.

 

Challenges with Complex Regional Pain Syndrome

One of the reasons I think CRPS becomes so challenging in workers’ compensation is because it is best treated early. Unfortunately, there are often many administrative claim related hurdles to be crossed before the condition is accepted. Consequently, early detection and treatment might not occur. CRPS is difficult because it produces extreme pain.

 

It makes it difficult for those who suffered a work injury to use the impacted limb. However, inactivity only worsens the condition. Therefore, studies have shown that early mobilization of a limb following an injury or surgery can help prevent CRPS. Yet, if symptoms do occur, the most effective treatment is early pain control and mobilization or restoring physical function. According to L&I, individuals with CRPS “must commit themselves to physical restoration on a 24-hour per day basis”. This is not an easy feat to accomplish.

 

L&I has divided treatment into six-week phases and will authorize a maximum of three phases. The first phase should include up to 5 sympathetic blocks to help control pain. The second phase should include up to 3 sympathetic blocks to help control pain. An additional 3 blocks may be authorized in the third phase as well. In addition to pain control through sympathetic blocks, the treatment phases should also include therapy and other pain control. The goal of therapy is physical restoration of function. The pain control is so that the injured worker can participate in therapy more fully.

 

Conclusions

In my experience the Department prefers for CRPS treatment phases to be carried out through a SIMP program (i.e., Structured Intensive Multidisciplinary Program). However, there are a limited number of SIMP programs throughout the State. It is not always practical for an injured worker to travel to a SIMP program for up to 18 weeks of treatment. In these cases, it can be quite difficult to coordinate treatment recommendations and authorizations efficiently.

 

I believe that L&I is actively trying to improve this process. I can attest firsthand to the fact that the Medical Director’s office often becomes very involved in CRPS. The goal seems to be to help treatment providers stay on track in moving these claims forward and reducing the long term disabling effects of the condition. However, the fact remains that claims involving CRPS are often irregular and challenging. More information about CRPS and the L&I Medical Treatment Guidelines can be found on the L&I website.

Super Lawyers award for Workmans Comp and Workers Comp law

Let’s face it, attorneys are gluttons for positive attention. Knowing our affection for positive recognition, numerous awards varying in objective legitimacy have been developed to recognize “top” attorneys. As a result, most attorneys are used to receiving numerous award letters throughout the year. Usually these awards require some sort of membership or other fee to be paid before the award is officially conveyed. Consequently, I’ve become quite jaded regarding awards for lawyers and question the legitimacy of most.

 

Each year, Super Lawyers recognizes the top lawyers in Washington through a patented multi-phase selection process. The process requires attorneys to nominate their peers. In turn, Super Lawyers performs independent research and peer evaluation. According to Super Lawyers, the Washington attorneys who receive the highest point totals during the selection process are further recognized in Washington Super Lawyers Top Lists. Super Lawyers, within the legal community, is one of the more widely accepted and recognized awards conveyed on attorneys.

 

With that, I am pleased to share that I have been named a 2019 Super Lawyer’s Rising Star in Washington State. I previously received this award in 2013, 2014, 2015, and 2016. After a two-year break, I’m happy to again be recognized as a top workers’ compensation attorney. Thank you to my peers who nominated me. And, thank you to my clients who trust me to assist them as they navigate their L&I work injury and workers comp claims.

New rules for self-insured employers help L&I govern workers’ compensation claims in Washington State

Many employers in Washington State pay workers’ compensation insurance premiums to the Department of Labor and Industries (or L&I in short). Washington State supports and backs L&I. However, some employers choose to go with private workers’ compensation insurance provider. Such an employer is referred to as a self-insured employer.

 

Who manages self-insured workers’ compensation claims?

If you were injured at work or developed an occupational disease while working for a self-insured employer, then your claim is administered by a third-party. However, L&I still oversees the entire claim administration process. L&I often uses administrative codes to help its employees govern and oversee self-insured claims.

 

New rules help L&I oversee workers’ compensation claims

Effective today, July 1, 2019, the administration code WAC 296-15-425 governs self-insurer communication standards. What does that mean? It means that under this WAC code, self-insurers are now required to communicate with injured workers about certain decisions in writing using L&I templates.

 

Self-insurers must use L&I templates to communicate with injured workers within 5 days of taking action to:

1. Calculate an injured workers wage rate (form F207-227-000);
2. Start, stop or deny compensation benefits (form F207-224-000 and form F207-225-000);
3. Accept or deny a contended condition (form F207-220-000 and form F207-221-000);
4. Authorize or deny treatment (form F207-226-000); and/or
5. Assess an underpayment or overpayment of benefits (form F207-223-000 and form F207-222-000).

 

Why is this important? Is it good for injured workers?

This step is incredibly helpful because templates are designed to ensure timely and accurate delivery of claim decisions. The templates also promote efficient claim processing to protect injured workers and streamline L&I’s regulatory oversight. The templates inform injured workers of the action being taken and provide them with information about their right to dispute decisions. If an injured worker disputes a self-insurer decision within 60 days, L&I will intervene and issue an order to resolve the dispute. However, the Department’s decision may always be appealed to the Board of Industrial Insurance Appeals (BIIA) if either party disagrees with it.

 

If a self-insurer makes a decision and there is no dispute, then L&I will not intervene. While WAC 296-15-425 changes the process for how self-insurers communicate with injured workers, it does not change the reactionary process for injured workers. Just like any claim-related decision, it is important for injured workers to review claim decisions carefully. After that, it is extremely important to dispute any decision with which they do not agree in a timely manner.