Workers Compensation - Washington

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

Month: August 2019

Permanent Partial Disability (PPD) rating in Workers’ Compensation and L&I claims

What’s my L&I claim case worth? I get this question all the time. The answer is always the same: It depends. One way to determine the value of a work injury L&I claim case is based on the Permanent Partial Disability or PPD award. And, the same holds true for a workers’ compensation claim with private insurance companies and self-insured employers.

 

What is Permanent Partial Disability or PPD?

PPD is a monetary award that some injured workers receive when L&I closes their claim. In short, if the injured worker has: (a) Reached maximum medical improvement; (b) Continues to experience permanent residuals from the industrial injury or occupational disease; and (c) Is still capable of working, then a PPD award may be appropriate.

 

PPD award rating is based upon medical evidence. When the body part involved in the work injury is one that cannot be amputated, the PPD rating usually uses categories of impairment from the Washington Administrative Code or Washington Administrative Code (WAC). However, if the body part could potentially be amputated, the PPD is rated according to criteria from the American Medical Association (AMA) Guides to the Valuation of Impairment.

 

Who can provide PPD rating for my claim?

Within the medical provider network or MPN, some providers feel comfortable and are willing to provide PPD ratings. Yet, others do not. Consequently, from my perspective, it is always ideal when the attending provider (AP) that’s assigned to the claim is willing to rate the PPD. This is because that provider usually has the best sense of the injured worker’s permanent residuals from the work injury.

 

If an AP does not do PPD ratings, they will usually refer the injured worker to a provider that does. Alternatively, they can request an Independent Medical Examination (IME).

 

How much is my right arm worth?

On a personal note, before you continue reading, please know that I’m very uncomfortable placing a monetary value on parts of the body. The human body is sacred. Body parts are priceless. However, this is the world and the reality we live in.

 

Injured workers often want to know what the monetary value of the PPD will be. It is important to know that the value is a set number that varies based upon the date of injury. L&I publishes a “Permanent Partial Disability Award Schedule”  that lists PPD values based on the date of injury. For example, the value of a 10% right arm PPD for a person injured on December 31, 2015 is $12,004.04. Here, it’s because 100% of the value of an arm for a 2015 date of injury is $120,040.41. However, without a medical opinion rating the PPD, it is virtually impossible to estimate the dollars-and-cents value for the award.

Solving problems and overcoming roadblocks in your workers’ compensation or L&I claim

If you don’t succeed the first time, then you should try and try again. I think this should be the motto for injured workers dealing with their L&I claim as they navigate their workers compensation claim process and issues.

 

The Industrial Insurance Act (RCW 51) was created to provide “sure and certain” relief for people injured at work. However, this doesn’t mean that workers’ compensation claims go smoothly or without roadblocks. Far from it. In fact, much of what I do is figuring out the best way to navigate obstacles that arise in L&I claims and self-insured employer claims.

 

L&I and workers’ compensation claims are full of tough obstacles

Whether it is getting treatment authorized, a condition accepted, or finding resolution to a conflict that has arisen, problem solving is my job. I’ll be the first to admit that sometimes problem solving feels more like trial and error. This isn’t because I don’t know what I am doing. It is because over the years I’ve learned that there’s almost always more than one way to solve a workers’ compensation problem. The key is finding the most successful approach, which is usually based on the unique facts and circumstances of the case at hand.

 

One L&I case in particular

Explicitly, since October, I’ve been trying to solve a series of issues in one particular case. I’ve had difficult conversations with my own client. I’ve had even more difficult conversations with the Claim Manager at the Department of Labor and Industries (L&I). Moreover, I had some loud and rough calls with assistant attorney generals and their paralegals representing L&I.

 

While I was able to get my client on board with some aspects of my plan, other pieces remained an unresolved challenge. On no less than six separate occasions since October, my proposals were formally rejected. Each time, I went back to the drawing board to try and develop a plan that would succeed. I clearly am not allowed to disclose specific details about this case. However, I’m pleased to report that today I managed to successfully resolve all the remaining issues. Interestingly, the solution wasn’t much different than what I had proposed about ten months ago. Yet, this time around, I just needed to take the right approach, at the right time.

 

Personal notes

Today’s perseverance to try and try again really paid off. I secured time loss compensation  benefits to an injured worker that desperately needed them. To satisfy their mounting debt, to make some urgent payments, and to get a brief temporary break. Equally important, we now have some much-needed breathing room. We are already preparing to tackle the next roadblock that we’re anticipating in this complicated L&I claim.

Work injury and workers’ compensation claims for minor workers under 18 years old

Not all workers are over 18 years old. Unfortunately, it is not uncommon for teenage workers to suffer from a workplace injury. Especially when school is out over the summer. Therefore, it is important to know that in Washington State, workers’ compensation claim and work injury coverage applies to all injured workers. No matter what age.

 

Work injury legal reference for teens and minors

Under RCW 51.04.070, people injured at work who are minors are considered sui juris. This is a fancy Latin legal term that means having the full legal capacity to act on your own behalf. So what does it mean? It means that if you had a work injury and you are under the age of 18, are entitled to your own workers’ compensation or L&I claim for benefits.

 

Important notes

However, there are some nuance. For example, if an injured worker is under 18 years of age and receives disability payments. Here, those payments are paid to the parent, guardian or legal custodian of the minor injured worker. If the parent, guardian or legal custodian gives written permission, L&I can make payments directly to the minor injured worker. Aside from this one caveat regarding disability payments, workers’ compensation claims for injured workers under the age of 18 are treated the same as all other claims.

L&I work injury claim programs: Incentivizing employers with Retrospective Rating Groups

Have you ever heard of the term Retrospective Rating? It is an incentive program that the Department of Labor and Industries (L&I) created for employers. Any employer with industrial insurance and in good standing can participate in Retrospective Ratings. Employers can do this individually or by joining a “Retro Group”. Through Retrospective Rating, employers can earn a partial refund of their workers’ compensation premiums by reducing workplace injuries and lowering the associated claim costs.

 

What is a Retrospective Rating Group?

Very simply, Retrospective Rating is a new way of calculating employer premiums for workers’ compensation. Here, premiums are calculated retrospectively after the fact. Coverage periods last for twelve months and may begin any calendar quarter. Roughly ten months after a coverage period ends, L&I reviews the actual experience and calculates a retrospective premium.

 

If the claims cost for the coverage year are below expectations, the employer or retro group earns a partial refund. The refund is the difference between the retro premium and the regular premium. If costs are higher than the regular premium, the employer or retro group may be penalized with an additional assessment.

 

Theory vs. Reality

This seems like a fair and equitable incentive program. After all, shouldn’t employers be rewarded for increasing safety and reducing work injuries and occupational diseases? If that is how this program really worked, it would have my full and most ardent support. Unfortunately, I think more effort is spent “lowering associated claim costs” than “reducing workplace injuries”.

 

Since Retrospective Rating came into existence, I have seen an increase in contentious relations between retrospective rating employers and groups, and work injury claimants. This often results in tension with return to work options, breakdowns in effective communication, contentiousness throughout claim administration, and increased litigation.

 

Personal notes and takeaways

I’m not opposed to incentivizing employers. Far from it. But, I think the Retrospective Rating program needs to be thoroughly re-evaluated to determine if it is accomplishing what it should. Reducing claim costs is important. But at what expense? Some food for thought…