Workers Compensation - Washington

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

Month: November 2019

Find a doctor for an L&I claim in Washington State

Every workers compensation claim in Washington State must have an attending provider, which is sometimes referred to as the attending physician or attending doctor. Whether you have a state-funded L&I claim or a workers comp claim with a self-insured employer, you must have an attending physician on the record. This attending doctor sees you regularly throughout your L&I claim and is primarily responsible for medical opinions supporting your entitlement to benefits. These benefits include both medical treatment and coverage, as well as monetary benefits such as time loss compensation. Moreover, the attending physician is usually the person who makes referrals to other treating doctors and specialists.

 

The L&I Medical Provider Network (MPN)

The Department of Labor and Industries (L&I) maintains a list of attending physicians. This list is called the Medical Provider Network or MPN in short. Looking at the list, you’ll see that there are LOTS of doctors on the Medical Provider Network. Some are local and reside here in Washington State and serve patients in your area. Others are out-of-state doctors that serve work injury victims that got hurt in Washington State and later moved out of state.

 

If you got injured at work in Washington State, you can choose your own primary doctor for your L&I claim. Here, the only rule is that your doctor must be a member of the Medical Provider Network. Also, when your attending physician refers you to other doctors and specialists, with very rare exceptions, all those other treating providers must also be part of the medical network. These include physicians, surgeons, chiropractors, naturopathic physicians, podiatric physicians, ARNP providers, PA-C physicians, dentists, optometrists, and so on.

 

Challenges finding a medical provider for your L&I claim

The MPN was enacted by the legislature in 2011. It was implemented and later launched by L&I in 2013. Since then, I have seen a significant increase in difficulties for work injury claimants to find an attending physician. Some challenges that we regularly see at our office include:
(a) Trouble finding willing MPN attending providers in a location reasonably close to the injured worker;
(b) Inability to find a new attending provider if the prior attending provider is no longer available for whatever reason; and
(c) Difficulty finding an attending provider willing to take over if the claim is more than a few months old.

 

The reason for these challenges (in my opinion) is because L&I claims are time consuming, they are riddled with challenges, and they are not lucrative. Being an attending provider is very time consuming. As a doctor, you have to examine the injured worker roughly every 30 days. On top, you must also complete regular administrative paperwork like the Activity Prescription Form or APF. You must also respond to inquiries from the claim manager and vocational counselor. If a work injury claimant has an attorney, the doctors are likely to get inquiries from their workers compensation law firm as well. If that’s not enough, doctors have to complete the relevant paperwork outside clinical practice hours.

 

Being a medical doctor on a claim is time consuming

Being an AP is tough. Members of the MPN are required to follow strict treatment guidelines that L&I says are evidence-based best practices. These requirements limit a provider’s ability to exercise their own knowledge and expertise in formulating opinions and making recommendations. However, claims are contentious. Medical providers often find themselves unable to move a claim forward due to legal disputes. Sometimes, attending doctors must provide a testimony in a deposition to help resolve the dispute. All these activities take time away from other aspects of their medical practice.

 

Finally, while I’m not an expert on rates, I frequently hear medical doctors complain that L&I pay rates are very low. So, combining the extra time and frustration providers put into these claims, they also get paid at a bottom dollar rate. Consequently, I’ve seen some good doctors still willing to help and take on L&I claim cases, but they limit the number of L&I patients they treat at any given time.

 

L&I is not helping

Since the MPN was launched in 2013, I’ve seen L&I do nothing to help incentivize medical providers to treat injured workers. Furthermore, L&I makes injured workers jump through hoops before willing to assist in finding a willing attending provider. I represent many injured workers currently looking for a new attending provider because their previous doctor recently retired. With claims that are years old, it’s nearly impossible to find willing attending physicians in the Medical Provider Network.

 

Finding a doctor for an L&I claim can be tough

The first step in obtaining a new attending provider is using the L&I Find a Doc search to identify potential providers. At first, the prospects look promising. For example, searching all providers within 15 miles of our Port Orchard office yields 1,819 options. Removing specialties such as dentistry, we still see 617 providers in general practice, orthopedics, internal medicine, occupational medicine and the like. With 617 options to choose from, you’d think it would be easy to find a willing provider. I can tell you from first-hand experience – it is extremely difficult, daunting, and disheartening.

 

Injured workers must call the providers to determine if the doctor is willing to see them. In most cases, the answer is a simple No. However, before saying no, some providers ask for medical records or access to review the claim file on Claims and Account Center (CAC). In those cases, it can take weeks to get an answer. Usually, this process continues for months.

 

In our office, we ask our clients to maintain a journal to document the providers they call, when they call, and the provider’s response. In several cases, we have clients who called hundreds of providers without any success. During that time, the Department is often threatening to terminate benefits.

 

Conclusions and final notes

L&I requires that injured workers have an attending physician. Yet, L&I fails to adequately incentivize or encourage medical providers to take on workers’ compensation claims. As an L&I attorney representing work injury claimants in Washington State, it makes the life of my clients very difficult. It’s hard for injured workers to find doctors that are willing to see them. And, throughout this entire process and struggle, L&I almost always threatens to terminate benefits.

 

Workers compensation attorneys like me report these issues with the MPN all the time. However, when an injured worker asks L&I for help to find a doctor for a claim, L&I forces the work injury claimant to prove they aren’t able to find a doctor on their own. This is just another example of how L&I is not making injured workers a priority.

L&I claim for head injury and traumatic brain injuries (TBI) in Washington State

As an L&I attorney representing injured workers, I see all kinds of work injuries and specific problems that arise. That includes L&I claims for head injury and L&I claim issues for traumatic brain injuries (TBI). Workers compensation clients suffering from head injury or brain injury can be very difficult to work with. But often, they are also the ones that need my help the most.

 

What is a traumatic brain injury?

The CDC defines TBI as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury“. The CDC reports that everyone is at risk for TBI. However, children and the elderly are particularly vulnerable. TBI is considered a serious public health concern resulting in death and disability for thousands yearly. Not all bumps, blows, or jolts to the head result in a TBI. However, if a TBI does occur it can vary in severity from mild to severe.

 

Mild TBI cases, often referred to as a simple concussion, usually resolve fairly quickly. More severe cases may involve extended periods of unconsciousness or amnesia following the injury. According to the CDC, TBI symptoms may affect a person’s ability to think, ability to remember, and their physical well-being. Furthermore, it can also affect one’s emotions, mood and sleep. Some symptoms may appear quickly. Others may take days or even months to appear.

 

L&I claim for head injuries or brain injury

An L&I claim for TBI or head injury can be a very challenging case. In fact, as an L&I attorney, these cases are probably the most challenging ones I handle. This is due to a variety of things:

(1) The symptoms are largely subjective – There isn’t much objective medical evidence available to support the extent of the injury.

(2) Head injuries are often accompanied by physical injuries impacting other parts of the body. Those other injuries often take priority, and the head injury is overlooked.

(3) Significant efforts are being made to research and understand head injuries, especially related to professional athletes. However, in L&I claims and workers’ compensation setting there seem to be significant medical delays in TBI diagnosis and treatment.

(4) Fourth, it seems to me that there is an institutional resistance within the L&I claim administration system to accepting and authorizing necessary and proper treatment for TBI.

(5) Finally, due to the nature of the injury itself, clients who have suffered TBI are often difficult to work with.

 

Subjectivity in L&I claims for head or brain injury

In the L&I workers’ compensation system, if the work injury claimant makes statements or complaints to a medical provider, then those statements are considered subjective. On the other hand, objective findings of disability are those that a medical provider can see, feel or measure. It is widely acknowledged that mental health conditions such as depression and anxiety lack objectivity. Most other injuries in the L&I claim system require objective evidence to substantiate the extent of disability. Head injuries and TBI are complicated because it is a physical injury, but the extent can’t be seen, felt, or measured.

 

Usually, a TBI diagnosis is based on the worker’s description of how the injury occurred and their subjective symptom complaints. Common symptom complaints that I see all the time include difficulty thinking clearly, headaches, blurred vision, irritability, and sadness. Other symptoms include excessive sleeping, difficulty sleeping, noise sensitivity, concentration problems, problems remembering, lack of energy, nervousness, anxiety, and dizziness. Doctors simply cannot objectively verify these symptom complaints. Especially when the onset may be days or months following the injury.

 

Lack of Priority for L&I claims for TBI

TBI generally occurs from a blow to the head, or a jolt or a bump. Consequently, it is not uncommon for other physical injuries to occur in addition to the head injury. For example, someone may have fallen from a ladder breaking their arm and hitting their head. In most cases, the initial medical treatment is so focused on the arm injury that the head injury is ignored or overlooked. If the worker was working alone, they may not recall whether they lost consciousness. In fact, they may have significant difficulty recalling the details of the injury entirely.

 

According to the CDC, TBI symptoms are challenging to sort out. It is not uncommon for symptoms to be overlooked by the person injured, their family, friends, and even doctors. I have seen many severe TBI diagnosis made long after the original work injury. In my experience, this creates difficulty for getting the condition accepted under the claim.

 

L&I claim for head injury often result in medical delays

From my experience as an L&I attorney, it seems that many of the providers within the Department’s Medical Provider Network (MPN) overlook the importance of making an early and accurate TBI diagnosis. There seems to be a lack of urgency in making appropriate referrals for TBI diagnosis and treatment.

 

For example, I have seen cases where a blow to the head has been reported as the primary injury and wasn’t referred for MRI for more than a year. I’ve also seen work injury victims discharged from medical care and released to return to work without restriction, based on resolution of their other physical injuries, despite having numerous ongoing symptoms consistent with TBI. Unsurprisingly, the lack of attentive medical care leaves work injury claimants, who are already struggling with the symptoms of their TBI, feeling scared, hopeless, and angry.

 

Institutional Resistance within the Department of Labor and Industries (L&I)

From my perspective, L&I claim administrators tend to view the conditions causally related to an injury very narrowly. Generally, the administrator accepts the initial diagnosis on the accident report. It can be very difficult to add another condition to the claim later.

 

In some head injury and TBI cases, the initial diagnosis may include “concussion”. However, it is not uncommon for the head injury not to be reported at all on the initial paperwork. If the person suffering a work injury develops symptoms, or if the TBI diagnoses appears sometime later, then adding the condition to the L&I claim is often met with administrative resistance.

 

L&I attorney dealing with TBI work injury clients

As I’ve already noted, there are many symptoms for TBI. Side effects such as difficulty thinking clearly, irritability, sadness, and concentration problems, can be very challenging. Other issues such as problems remembering, nervousness, and anxiety, don’t make things easier. Add these kinds of symptoms to the normal stress of a workplace injury including financial instability and recovery uncertainty – clients who have suffered a TBI are often challenging to represent.

 

In my experience, they have good days and bad days. They aren’t always good at recalling past conversations, keeping appointments, or following through with requests. But I am always reminded that these are the people that need me the most. And I never discount this fact. On the positive side, our office has vast experience representing injured workers who have suffered a TBI. Because we understand the symptoms and their impact on our clients, we always do our best to help those clients understand the current status, difficulties, and needs of their claim.

 

L&I attorney and TBI workers compensation claims – additional resources

Remember, just because TBI claims are difficult does not mean they are impossible. The good news is that TBI is a condition that’s undergoing significant research by the medical community, professional athletic organizations, and the CDC. Every year it seems that new developments are made, to better understand the diagnosis and treatment. In fact, the CDC has several resources available related to TBI. One of those resources is the “Acute Concussion Evaluation” or ACE forms available for medical providers. The CDC also has a program called “HEADS UP” designed to help parents, sports and school coaches, as well as health care providers minimize and respond to the risk of TBI.

 

If you suspect that you, a friend, or family member sustained a TBI in a workplace injury, I would encourage you to review the helpful Brain Injury Basics information on the CDC website. If a TBI is complicating your workers’ compensation claim, don’t delay in consulting with an experienced L&I attorney who can help you understand your rights and determine if you need representation. You must ensure you receive appropriate benefits in such a challenging claim and difficult times.

The new L&I website and L&I claim portal

The Department of Labor and Industries (L&I) has revamped its website and the new site is now available publicly. You can have a look at https://www.lni.wa.gov/. According to L&I, the goal is for the new site to be more accessible with simplified and mobile friendly navigation, as well as larger and more readable fonts. Other goals include easier access to sign in to secure online services, and a clean and streamlined look.

 

The new L&I website: Updates and changes

While the website address has not changed, they have restructured some internal pages. Because of that, the L&I news release indicates users may have to update bookmarks and favorites. For Spanish-speaking work injury claimants, L&I says that its Spanish website is still up and running. As of the time of this writing, the links to the Spanish L&I claim site are broken and are not working, as are other sections of the site. However, the English site still contains help links for people with limited English language abilities.

 

If you follow my posts, you know I use the L&I website all the time. In my opinion, it is filled with useful information, news bulletins, and important links. For this reason I’ve been both eager and apprehensive for this website upgrade. Today I spent some time exploring the new site. I’m not surprised to discover that it is going to take me a while to get good at using the new site. On the old site, I regularly used the search feature to find specific forms, data, or to research aspects of claim administration. I am a little concerned that the search feature on the new site isn’t as efficient as the old site. I’m also concerned that many of the old information and links are no longer available on the new L&I website.

 

Searching for L&I forms and links

For example, as a test I searched for both WSF (which is the term for Work Status Form) and WVF (for Work Verification Form). It is a very common form that our injured worker clients fill and file all the time with L&I to keep their time-loss benefits going for their L&I claim. Unfortunately, for both “content” and “forms & publications”, the new site did not return any results. When I searched for Work Status Form, it returned over 800 results. The form wasn’t one of the top results. Finally, I put my search term “Work Status Form” in quotes. Alas, that returned 3 results, one of which was the form.

 

Therefore, for the record, this is the new link for the Work Status Form. Another important form, the Activity Prescription Form (or APF) can be found in this APF link. This simple exercise suggests that it is going to take time before anyone will be able to effectively navigate the new website. I have to say that they did succeed to make the site look clean with streamlined content. Also, it did work well on mobile.

 

L&I claim and Account Center

For the L&I Claim and Account Center portal, where anyone can view the status of an L&I claim, there hasn’t seem to be any changes for right now. However, the link for Claims and Accounts Center has changed and it is now https://secure.lni.wa.gov/home/.

 

L&I is accepting questions, comments and concerns about the new site. Here, feedback can be submitted to WebFeedback@Lni.wa.gov. I think that injured workers and people with L&I claims should spend some time to go over the site and provide feedback. As it stands right now, while new and exciting, the fact remains that older links are not working and a lot of great information that was there before is no longer available.