Workers’ compensation is a vital program for the safety and health of our workforce in Washington State. It is relatively straight forward, and the Industrial Insurance Act governs the Workers’ Compensation system. However, in my experience, most people don’t really know how the system works.
Understanding workers’ compensation claims and L&I claims
Here are seven of the most common misconceptions about workers’ compensation claims.
Medical provider – Work injury claimants must see the doctor that the employer or L&I chooses
If you had an injury at work, you can see any provider that you choose. It doesn’t have to be the provider that the Department of Labor and Industries (L&I) or the employer say you should see. If the provider is a member of the Medical Provider Network or MPN. There are thousands of providers in the MPN. In fact, there is a good chance your primary care provider is a member of the MPN. Here is more information about the MPN and finding a doctor for your L&I claim.
L&I claim settlement – Injured workers get workers’ compensation claim settlement at the end of the claim
Technically, this is not true. People with work injury may or may not receive an L&I claim settlement at the end of their claim. Many work injury claimants receive what is called a Permanent Partial Disability or PPD award at the end of their claim. The award is based on the PPD rating. However, this isn’t a settlement and there is no guarantee that you will receive this award.
Employment – A PPD award will impact future employment
Some individuals with a work injury claim have concerns about PPD and PPD ratings. They think that rating means branding or labeling them as “disabled”. In turn, many believe it will impact their chances to find work in the future. This isn’t necessarily true. As an injured worker, the most important thing is for you to not exceed your permanent limitations in any future employment. Additionally, you don’t have to disclose your PPD award when seeking employment in the future.
Job of injury – The employer must hold your job or cannot terminate you
Employers cannot to retaliate when someone files a workers’ compensation claim. However, they are not obligated to keep a person’s job while they are off work due to a work injury or occupational disease.
Attorney fees – L&I covers the cost of a workers’ compensation attorney
Unfortunately, this is not accurate. Workers’ compensation attorneys work on a contingent fee basis. By law, fees are taken as a percentage of the monetary award that a work injury claimant receives under their L&I claim. There is one exception where a judge may award attorney fees.
Filing lawsuit against employer – You can sue L&I, the employer, or the claim manager for wrongdoing
This is false. As frustrating as workers’ compensation claims can be, there is no legal option for suing L&I, employers, or third-party administrators. In other words, it doesn’t matter how L&I, or your employer handle your claim. You cannot sue them for it.
Maximum medical improvement means L&I will close your claim
When some work injury claimants reach maximum medical improvement or MMI, their claims can close. However, this isn’t always true because some claims can remain open even after treatment is complete. Remember, if you reach maximum medical improvement and you are unable to return to work, you may still be eligible for vocational training services. Finally, vocational retraining can take up to two years.
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My claim covered lumbar , cervical and mental health but my claim manger would pay sometimes the mental health or deny it on and off . I have severe anxiety., depression bc of my injury . It became so severe I decided to act on my thoughts of suicide .but before I did , I cried every day sometimes all day . My pain level was out of control , I had options , surgery but I didn’t want surgery bc of what happened to my first surgery . Long story short . One day I decided or I was thinking their was no way out , couldn’t even walk they day w out severe pain went down to a near by lake w my gun . I sat their put bullets in it then I put different kind went back and forth then I had it all ready then an auto drove behind me , I waited for them to leave but they didn’t . They were making all kinds of noise. Then the next thing I know the police surrounded me . I thought I had been alone this entire time . But in fact there had been an investigator following me Lni had hired an investigator. I felt even more shame knowing I had a man seeing my every move while I was going to end my life . He ended up saving my life , I am very thankful for that now . Then this investigator took 2 photos off my fb , one of me wearing platform shoes , platform shoes are for people that have lumbar back pain, 2nd photo me and my daughter on a snow mobile in -35 weather ( one photo showed temp) I was wearing no gear as my daughter and everyone else was in the other photos but claim manger said I was snow mobiling . Yes if you don’t know about temp -35 , no gear you would know I wasn’t riding . We did go in a little circle bc sun was hitting snow then lens when we taking photos the circle was a little circle maybe 5 secs but again their was a video of me and what I was driving and it definitely was not a snow mobile or anything like it , it was a little truck but claim manger forgot to mention that . Oh one more thing that was in the report , the investigator mentioned I could be a property manger he was guessing , his guess was wrong but still put his input , my daughter is 16 she is a trans , we live in a little town where they don’t like people that are gay , she is bullied , hit on ect my daughter wanted a car and I could not afford to get her one and she was scared to work in our little town . She came up w an idea to rent her room and sometimes the office . She would save and buy herself a car . She set up an account w airbnb her name , her ID , she did everything . When she had guest sometimes I did talk to them made them feel welcome . The Lni claim manger said I worked , it was my airbnb. The claim manger already had all the paper work from airbnb showing it was not mine it was my daughters . It wasn’t about the money bc it was very minimal. If it was mine I would have reported no big deal . Lni told airbnb or someone told airbnb that Cynthia was under 18 yrs of age . So they closed her airbnb down . A couple months later I told my daughter I would put my name and my info on airbnb so she could get her car . She finally got her car . The claim manger took my suicide video and gave it to a orthopedic ime dr , then the claim manger took my photo’s and airbnb and gave it to ime psychiatrist . If the claim manger gave the correct video surveillance to the correct ime dr ( the suicide to the IME psychiatrist) and the complete and not just clips of the videos to the orthopedic ime . I don’t believe the ime psychiatrist would have cleared me to work full time , or the orthopedic ime would have cleared me to work full time . This claim manger stated I am a fraud but in fact he is . He knew what he was doing when he sent the videos to the wrong dr . This claim manger knows what kind of state of mind I am and also he watched videos of my good days and my bad days of my physical condition. . He seen it w his own eyes in the video. Then a few days ago I read a note to my therapist from the claim manger stating sharlotte grocery shops but in fact I had already given my therapist all my weekly invoices from the company that brings me my groceries for the past 4 years . Weekly I have my groceries delivered bc the pain and the anxiety of going into a store . This claim manger lies. He had not one video or photo of me shopping bc I never shop . This claim manger cut me off for absolutely no reason. My last surgery was a 3 level fusion on my lumbar 2/17/2023 before that I had a hip replacement bc of my foot drop but since my hip replacement we have been really working on my foot drop thank god . months has past , my attorneys has asked for the videos of the investigation but still to this day no video . The claim manger cut of my pay 3/3/23 , I have no money no job , no one wants to hire me it’s been years since I worked , my body is broken , mentally I am broken . LNI are not for their workers they are against them . I thought about suicide when I received the notice from the claim manger , I have fought hard , every day I fight to be here . What was that claim manger thinking just finished watching me try to end my life then turn around issues I am good mentally send her to work let’s cut her pay off , let’s see if she will kill herself . This claim manger should Not be in the chair he is in. This is my review I give a zero star to the claim manger .
Thank you for sharing your story, I can’t imagine it was easy to do that. I hope that your benefits will be reinstated very soon so that you can continue working towards a more complete recovery and an improved quality of life, both physically and emotionally.
I’m very concerned and bothered by L&I’s deceptive behavior.
I got knocked in the head by a patient at DSHS, and L&I told me they would send me to providers for treatment. They even write on letters “Thank you for treating this patient.” Fast forward 1.5 years later, and they state they don’t pay for treatment, and the doctors did nothing to diagnose or help anything. They’re just there to minimize and/or dismiss the claims for LNI.
L&I also never told me about Vocational Counselors, about retraining, and they never addressed my neurological and spine issues when I told them about it. And every other LNI employee I talk to says something difference from what other LNI employees say, so there’s clearly intentional misrepresentation / obfuscation going on.
Is there really no way to sue them for negligence?
You cannot sue L&I for negligence. As an injured worker you are entitled to certain benefits based on the law and facts of your case. From what you’ve reported, it sounds like you may need better advocacy to ensure you are understanding the claim process and getting the benefits you are entitled too. This is precisely what attorneys like me do for the work injury claimants we represent. You’re welcome to call for a free consultation if you’d like to discuss this further.
I started having lower back pain working construction to the point I could no longer work a full schedule (6+ years at same washington employer). I seen a doctor on my own accord because I wasn’t aware of occupational disease being a viable option. Anyways the doctor wrote me a note saying that I would not be able to work a full schedule and after a couple months I was fired for not being able to work a full schedule. It was then I was informed by a coworker that I should file a occupational disease claim (this being the first time i knew such thing existed). By this time I had already had an MRI and was set to start physical therapy and meet with a back surgeon. Once I filed I was told I was no longer allowed to keep seeing my old medical staff or I wouldn’t be reimbursed because they were not in the L and I network. At the same time I was also told I couldn’t start seeing a doctor in their network until my claim was approved. I was sent paperwork to fill out which had the wrong date when asking what all doctors I seen before I filed. Instead of my filing date or simply saying “from the date you filed” they put the date of the first time I started seeing a doctor about my back. I called my case manager and told her this didn’t make sense because that was the date I started seeing a doctor for my back. So why are you asking what doctor I seen for my back before than? She just said something like “I know it doesn’t make sense but we have to ask”. So I said do I leave it blank than and just sign it? She said yes so that’s what I did. Then some time passes and they resend those same papers and I call my claim manager and ask why and she said basically it was a mistake and not to worry about it and that a decision was going to be made that following Monday. I made sure I was very clear so nothing would cause anymore delay and asked “so you have everything you need?”. She said she did and I thought that was that. Well after not hearing anything from the time a decision was suppose to be made I wanted to be patient and give them time to get things in order as I knew if I was rejected they would have to let me know In a timely manner. After about 6 weeks I called and asked what the status on my case is and they said they couldn’t make a decision because they are waiting for my doctor to fill out a form they sent him. I asked why was I told they had everything they needed if this is the case? While speaking to my case managers manager all but begging to see a doctor for my back pain she told me “my back hurts and I work every day”. She then went on to tell me that they were sending me to see a IME for a second opinion. It all made sense why i was being given the run around when the attitude of management is to mock people in desperate need of help. This was the same time that my personal insurance expired leaving me no option. A week or so later they resent the same paperwork from before with the now corrected date asking what doctors ive seen before i filed. My unemployment has ran out a long time ago and I’m now penniless and homeless with severe pack pain waiting for my IME appointment. I am really struggling with how this is all legal. Washington state acts like they are dumbfounded as what to do to help the homeless population and alleviate the problem yet its policies create homelessness. Had L and I just given me a yes or no in a timely fashion I could have kept seeing my own doctors. Instead they told me they were going to give me a yes or no then didn’t and began dragging out my case knowing that the average person can’t go a year with no income. It’s truly evil what they are doing.
I find it surprising that you can invest in hiring workers’ comp legal experts to file for a claim after getting involved in a workplace accident. I have a friend who talked about his colleague who is suffering from a hand injury after visiting their warehouse. I should talk to him about finding these legal experts if they haven’t yet.
Not sure what you mean by “invest”. By law, every workers’ compensation attorney in Washington State works under a contingency fee agreement. Workers do not pay attorney fees. The attorney fees are taken out of what the attorney secures for the injured worker.