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

Nerve Damage and Pain in L&I Claim: Numbness and Tingling as Symptoms

There are many ways for workers to suffer nerve damage in a work injury or work-related disease. For example, when nerve trauma or nerve compression occurs in a workplace injury, it can lead to nerve pain and damage. Another example is a work injury that pinches spinal nerves at the root. Such an injury can cause radiculopathy, which is a type of neuropathy. Furthermore, a workplace injury that crushes the nerve endings may cause peripheral nerve damage. Peripheral nerve damage can also come from diseases such as carpal tunnel syndrome (CTS) and autoimmune disorders.

 

Radiculopathy in L&I Claim

Radiculopathy is a common type of nerve damage in work injury and industrial disease workers’ compensation claims. The symptoms occur when a nerve root in the spine is pinched. Many times, radiculopathy can occur in the upper part (or neck part) of the spine, called the cervical region. It can also happen in the middle back, which we refer to as the thoracic region. On top, it can occur in the low back, also known as the lumbar and sacral regions.

 

Symptoms of radiculopathy include weakness, numbness or tingling. However, different individuals might feel the symptoms in different parts of their body. It all depends on the spinal region and location of the pinch. One well know form of radiculopathy is Sciatica. People often describe sciatica as shooting pains, numbness or tingling down one leg or both legs. Workers experience this type of radiculopathy when the nerves are pinched in the low back.

 

Peripheral neuropathy in workers’ compensation claim settings

Peripheral neuropathy is a different kind of nerve pain and damage. It doesn’t originate from the spinal nerve root. Peripheral nerves transmit information between the brain and other parts of the body. Moreover, our senses depend on peripheral nerves. For example, they help us feel when something is cold, hot, or sharp. Peripheral nerves are made of fibers. Interestingly, they are insulated by body tissue. They are fragile and they can experience damage easily.

 

When damage occurs, it impacts the communication between the brain and other body parts. For instance, if the damage is to motor nerves, it can cause difficulty controlling movements or uncontrollable muscle spasm. On top, if the damage is to sensory nerves, it can make it difficult to sense pain or to walk. In addition, it can be difficult to maintain balance or perceive temperature changes. Finally, when the damage is to autonomic nerves, it might impact subconscious functions like blood pressure, breathing, body temperature regulation, and digestion.

 

In particular, Carpal Tunnel Syndrome is a common work disease that involves peripheral nerve damage. Here, when the peripheral nerves in the wrist and forearm suffer inflammation, then people feel numbness, tingling or burning in their hands and fingers.

 

Work injury as cause for nerve damage and pain

You’d expect that it’ll be easy to figure out if a workplace injury or industrial disease causes nerve damage or pain. However, there are many non-occupational factors and conditions that can cause nerve problems. For one, diabetes and alcohol abuse are common causes of peripheral neuropathy. Many non-occupational autoimmune disorders also cause neuropathy. Consequently, it can be very difficult to determine the cause of nerve pain or damage. To complicate matters, people might have a preexisting disease like diabetes before their work injury or workplace illness.

 

Neuropathy in IME exams

Recently, I noticed a new trend. Independent Medical Examiners (IMEs) say that neuropathy is from non-work or non-occupational causes. Also, they say the other causes are genetic factors like gender, or diabetes and alcohol use. I don’t dispute these other factors cause neuropathy. Yet, I think they are taking the easy way out. More explicitly, they are using other conditions too often as convenient excuse for L&I or self-insured employers to avoid covering neuropathy in L&I claims.

 

When this happens, you must get a clear picture of the work injury claimant’s preexisting health. For that, you must order records from primary care providers or specialists that treated preexisting conditions. In fact, little time and effort collecting this data can go a long way. It can help medical providers formulate a more accurate opinion regarding causation. Sometimes, prior health records show neuropathy before the work injury or workplace disease. However, in many cases there are no previous records or symptoms.

 

The opinion of a workers’ compensation attorney

Very often, there are no documents or medical history that show prior symptoms. In such cases, it helps us show that symptoms stem, on a more-probably-than-not basis, from the work injury. Furthermore, when there’s objective medical evidence showing that symptoms  relate to the work injury or disease, then it’s even more likely that a causal connection exists.

 

Neuropathy is a serious condition. It requires knowledgeable treatment to help eliminate long term issues. When the Department of Labor and Industries (L&I) or self-insured employers deny coverage, it can be a major setback for work injury claimants. It can seriously hinder their recovery. Therefore, it’s important to make sure that the causal connection to the work injury or work-related illness is well-documented, to try and prevent treatment delays.

L&I Claim and Independent Medical Exam (IME) Providers from Out of State

Recently, I’ve been very busy wrapping up litigation in several cases. The litigation was before the Board of Industrial Insurance Appeals (known as BIIA or Board in short). The appeals in question were filed by work injury clients, which I represent. In general, an L&I claim appeal is filed after we receive an L&I claim decision that we disagree with.

 

L&I claim appeal: Testimony and cross examination

During litigation, I present evidence supporting the appeals on behalf of my clients. The evidence is primarily testimony from medical and vocational expert witnesses. Generally speaking, we present expert testimony by deposition. Therefore, it can take months before all the testimony is complete. In this case, it took us over 3 months.

 

The Department of Labor and Industries (L&I) and self-insured employers have their own expert witnesses. As these workers’ compensation claim appeal cases were winding down, I’ve been busy with cross examination. Cross-exam is my chance to ask them questions. Interestingly, most of the medical witnesses in recent cases were L&I claim IME providers.

 

L&I claim IME doctors from outside Washington State

Let’s focus on the 3 most recent depositions of L&I claim IME providers. Surprisingly, I found out that all 3 are not from Washington State. In fact, none of them ever treated patients in Washington State. The only reason they have a license to practice medicine here is to do IME exams for a workers’ compensation claim.

 

They testified that they fly here for a week, once every four or five weeks. When they come, they spend four to six days performing IME examinations for work injury claims. These providers do anywhere from 2 to 10 IME exams each day. On average, they run 6 examinations per day. Furthermore, L&I and self-insured employers usually ask for their opinion and testimony to support their position. They rarely (if ever) testify to support work injury victims.

 

L&I workgroup to evaluate IME procedures

In March 2020, new legislation prompted L&I to create a workgroup and evaluate the IME process. For one, the workgroup was supposed to figure out how to retain more in-state physicians for IME exams. On top, they tried to develop strategies to reduce the number of IME tests in L&I claims. Moreover, they were going to consider the work injury claimant’s rights as they relate to an IME. The workgroup mandate expired December 31, 2020.

 

Frankly, I don’t know the results of the workgroup efforts. However, I’m glad the legislature acknowledged the need to address these issues. Like me, every workers’ compensation attorney knows that IME exams are necessary in a workman’s comp claim. Yet, as an L&I attorney representing people after a work injury, I often question the “independent” nature of the exam. In fact, some practitioners refuse to call them “independent”.

 

My personal take

I find it hard to accept that IME exams are independent. I mean, we rarely see IME tests that are favorable to work injury claimants. Also, the costs of these medical examinations are disconcerting. For example, I recently reviewed an IME bill for more than $2000 for one time evaluation and record review. No wonder doctors from other states get their license in Washington State and fly out to do these exams.

 

I hope the L&I workgroup made some good progress regarding IME procedures. I’m also hopeful that we’ll see improvements for more fairness towards work injury claim clients. Personally, I’d like to see L&I reduce the excessive costs associated with these kinds of examinations. Finally, I wish L&I succeeds in recruiting more Washington State doctors and other providers to help with L&I claim matters.

 

Workers’ Compensation Claim: The Importance of Objective Medical Findings

Objective medical findings are very important in every L&I claim and workers’ compensation claim. The Department of Labor and Industries (L&I) distinguishes between objective and subjective findings. For example, when a work injury claimant describes their symptoms, that falls under subjective findings. However, medical exam results where a treatment provider can see, feel, or measure, are objective.

 

L&I claim time-loss certification

L&I requires objective findings before they can provide certain benefits. This fact applies to both work injury and industrial disease. One example is time loss compensation benefits. You must certify time-loss before L&I can remit payments. To certify time-loss, a treating provider must complete an activity prescription form (APF). Then, the provider should attach chart notes to document their findings. In fact, the APF contains a mandatory section asking providers to list “measurable objective findings”. Here, examples include things like positive x-rays, swelling, muscle atrophy, and range of motion.

 

Objective medical findings in an L&I claim

I frequently investigate L&I claims for work injury victims that are not getting time loss payments. Very often, I discover it’s because they didn’t identify objective medical findings. Sometimes, it’s an oversight that anyone can correct easily. Other times, it’s because there are no objective findings.

 

In reality, some provides have their own definition for “objective”. In more troubling cases, L&I denies x-Ray or MRI exams that would objectify the worker’s complaints. Either way, I think it’s extremely important to identify objective medical findings and communicate them to L&I clearly. In fact, I routinely help my clients ensure that providers submit objective findings to L&I.

 

Reliance on objective findings

Personally, I find that many work injury claimants struggle to understand the concept of objective medical findings. Many believe that since they are in pain, then it’s enough for them to describe the pain. Unfortunately, pain is a subjective complaint. Therefore, it’s absolutely critical for treatment providers to identify underlying objective medical findings that explain the source of the pain.  Furthermore, under the law, if there are objective findings, then medical providers may also consider subjective complaints when deciding things like whether a person can go back to work.

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