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

Category: Claim Settlement (Page 2 of 7)

Closing L&I Claim: Do I Need an Attorney?

I get calls from work injury claimants often. The #1 reason they call is because their L&I claim is closing. Also, the same goes for self-insured employer claims in Washington State. L&I claim closure can be very stressful. To help, I put together this checklist below. You can use it to check for any red flags. If there are some, I strongly recommend you consult with a workers’ compensation attorney.


L&I claim closure and maximum medical improvement (MMI)

Your L&I claim cannot close before you reach maximum medical improvement. Again, the same applies to self-insured employers. Maximum medical improvement is sometimes calls medical fixity. You achieve it when there’s nothing more that doctors can do for you. Unfortunately, it doesn’t mean you’re healed. In short, it means that doctors don’t think you’ll get better with more medical treatment. Yet, many times, it’s unclear if you’re at maximum medical improvement. After all, it’s a doctor’s opinion. Therefore, it’s possible your claim is closing while your medical provider thinks you need more treatment. If that’s so, then it’s a red flag. You definitely want to contact an attorney.


Future employment issues

L&I must address future employment concerns before a claim can close. For example, if you have total disability. That’s one example where L&I can’t just close the claim. At very least, they have to pay for your disability. Total disability means you have physical or mental impairment. It impacts your ability to find or maintain a job. Any type of job within your skills. Not only the job at the time of your work injury. However, total disability doesn’t mean you’re helpless.


L&I has to evaluate and decide if you’re employable. For that, they consider your age, education, skills, and training. They also consider your experience and any previous limitations. Furthermore, they take into account limitations from your work injury. One way for L&I to resolve total disability is with L&I pension. Therefore, you should think if you have total disability. If you do, and if your claim is closing without pension, then call an attorney.


Permanent partial disability

We refer to permanent partial disability as PPD. Some work injuries or occupational diseases cause permanent conditions. For example, a loss of body function can be permanent. L&I has methods to assess your level of PPD. On top, there are several evaluation techniques. For assessments, a PPD rating medical expert must examine you. Many times, an IME performs the PPD rating. Other times, the attending provider can perform the PPD rating. After the rating, L&I decides the amount of your PPD award. One red flag is when you have permanent limitations without PPD rating. Or, when your rating seems low considering your symptoms. Another red flag is when you don’t receive a PPD award. Finally, it’s possible that some doctors disagree with your PPD rating. All these cases are red flags. It’s important you talk to an attorney.



Unresolved problems in your L&I claim

Some L&I claims start to close when there are ongoing issues. That’s a red flag. For example, closing a claim while there are time-loss compensation payment problems. On top, closing a claim with outstanding medical bills. And so on. You know your claim. You can tell if there are any lingering issues. If there are, then it’s critical to resolve them before the claim closes.


L&I claim closing when it should

There are plenty of cases with no red flags. Very often, L&I claim closure is appropriate. However, improper claim closure is also common. When you L&I claim closes, then L&I sends you a letter. If your claim closed and you didn’t receive a letter, then you must speak with an attorney. Usually, the closing letter contains a payment order or notice of decision. After that, the decision becomes final in 60 days. This means you have 60 days to protest or appeal. Personally, I always think it’s a good idea to talk to an L&I attorney if your claim is closing. You can always receive free information and tips that can help.


Reopening L&I claim

Say your L&I claim closes inappropriately. Now, you can appeal and fight claim closure. If successful, L&I will keep the claim open and work to resolve the remaining issues. However, say your claim closes after they fix all remaining problems. In this case, you can still reopen your L&I claim in the future under certain circumstances.


Reopen L&I claim after it closes

These are certain requirements for reopening a claim. They are:

1) There must be an aggravation. This means that a condition in your claim got worse. More explicitly, for physical conditions, there must be objective medical findings. A doctor has to determine that your work injury condition deteriorated. In addition, you must show some medical tests to support the doctor’s opinion.

2) The aggravation requires more medical treatment or justifies higher disability rating.

3) The aggravation occurs between two specific dates. The first date is when the claim closed. It can also be the last date when L&I denied an application for reopening. Then, the second one is the most recent reopening application date.


Reopening due to new medical conditions

Sometimes, L&I can reopen a claim when a doctor finds new conditions. The conditions must relate to the workplace injury or work illness. This is true even if the condition wasn’t known prior to claim closure.


The 7 year L&I claim reopening rule

Many work injury claimants reopen a claim within 7 years of claim closure. If that’s the case, all L&I claim benefits may be available after reopening. This includes medical treatment, time loss compensation, and loss of earning power. On top, it includes increase in PPD, and even L&I pension benefits. But, if you reopen a claim after 7 years, you can only get more treatment. Unless the director of L&I grants you other benefit under their discretion.


PPD Rating in L&I Claims (and Why Most Doctors Won’t Do It)

After a workplace injury or work illness, some people are left with some sort of permanent disability. In legal terms, we call it permanent measurable residuals. Usually, these work injury claimants are eligible to a permanent partial disability award (or PPD award in short). To get it, the worker must undergo PPD rating. The PPD rating is done by a doctor. It’s a way for the doctor to measure the level of disability. Time-wise, the Department of Labor and Industries (L&I) performs PPD rating and provides the PPD award when an L&I claim closes. Furthermore, the same goes for self-insured employers and insurance companies, like Sedgewick.


PPD rating

L&I doesn’t decide the amount of the PPD award arbitrarily. In fact, it’s based on PPD rating and the L&I PPD award schedule. First, your L&I claim doctor must consider the area of the body involving the work injury or industrial disease. The body parts in question determine the methods they are going to use to decide the PPD rating. Here, there are 2 different categories.


If the industrial injury or workplace illness affects a body part that doctors can amputate, then doctors base the PPD award on the American Medical Association guides. However, if amputation is not an option, then the doctors base the PPD award on various categories in the Washington Administrative Code (WAC).



PPD award amount

The PPD award schedule is the official term for calculating the PPD payout. The monetary amount of the PPD award depends on the PPD rating. For reference, L&I maintains a PPD awards table. The table shows the payment amount versus the PPD rating decision. Interestingly, the award rate also depends on the date of the work injury (or the manifestation date for a workplace disease). Once the L&I doctor makes the PPD rating, L&I looks up the award schedule to find the PPD award value. Furthermore, additional information about this process can be found under the PPD section of the L&I website.


I’ve been representing work injury claimants for many years. Over time, I came to realize that many L&I attending doctors don’t do PPD ratings. Consequently, when your L&I claim is getting ready to close, L&I usually sends you to an independent medical exam (IME). There, the IME panel confirms your maximum medical improvement and gives a PPD rating. However, the methods for finding the PPD rating are relatively straightforward and simple. Therefore, I’m confused as to why more attending doctors don’t provide PPD ratings regularly.


Recommendations and personal thoughts

Personally, I think (and hope) that many more attending providers should perform PPD ratings. First, in general, attending doctors are in the best position to know their patients’ permanent residuals. Hence, it should be fairly simple for them to determine the appropriate rating method and measurements. Second, it would allow work injury claimants to feel more confident that their PPD rating and compensation are fair and proper. I get so many calls from injured workers who are concerned that IME providers didn’t take accurate measurements. Unsurprisingly, PPD readings by attending physicians are bound to limit these types of concerns. Finally, if more attending doctors perform PPD ratings, we wouldn’t need so many IME doctors and appointments. That way, we can keep L&I claim costs down. Moreover, we could reach L&I claim closure more quickly and efficiently, once workers reach maximum medical improvement (assuming no further vocational issues).


I often ask L&I doctors why they don’t perform PPD ratings. Sadly, the most common answer I get is that they don’t feel competent and lack training. For me, it seems that this is a relatively easy problem to fix. All we need is little education, some training, and someone within the L&I ranks with enough energy to push for change.

Consulting with L&I Attorney in Washington State: Don’t Wait Too Long!

Many L&I attorneys in Washington State that represent work injury claimants offer free consultation. Personally, I’d much rather talk to a work injury claimant early in the claim. For me, it’s far better to tell people they don’t need an attorney rather than wait until their work injury claim gets completely out of control. Therefore, I think it’s a good idea to schedule an L&I attorney consultation whenever you feel there are red flags in your workers’ compensation claim. This applies to both L&I claim matters or self-insured employer claim as with a Sedgewick claim (and others).


L&I attorney – Should I consult with one?

If you have an upcoming consultation with a workers’ compensation attorney, you can take steps to make it more productive. Explicitly, these steps include preparing for the meeting, answering questions that the attorney asks you, and listening carefully with an open mind. The first step is to prepare for the L&I attorney consultation. Often, a free consultation with a workers’ compensation lawyer is approximately 30 minutes long. Therefore, the L&I lawyer needs to collect important information in a short time. To help, make sure to equip yourself with basic information. For example, your claim number, date of injury, and current claim status. It’ll help the L&I attorney get information quickly. That way, you and the attorney can spend most of the consultation discussing more pertinent issues.


L&I attorney consultation and answering questions

In my experience, work injury claimants often want to describe the abuses they experience in their L&I claim. For instance, people often complain about poor communication, excessive delays, and employer misconduct. Furthermore, many people are upset about negative or aggressive comments from their treatment provider, claim manager, and vocational counselor. L&I claims are hard for everyone. I know. We see these misbehaviors towards injured workers all the time. However, is this the best use of your consultation time while speaking to an L&I attorney?



Remember, the main goal of the L&I claim consultation is to identify legal issues that need attention. By far, the easiest way to do it is to ask work injury claimants very specific questions. Make sure you’re carefully listening to every question. Then, provide complete but concise answers to enable the L&I attorney to cover more issues. This way, it’ll help the attorney make a better assessment regarding representation.


Speaking with an lawyer while keeping an open mind

Unfortunately, there’s a lot of misinformation out there regarding L&I claims. It’s difficult for people after a workplace injury to digest the fact that things may be different than they thought. However, you must remember that the Industrial Insurance Act provides many benefits and protection after a workplace injury or work sickness.


An L&I attorney with proven experience will be looking at your claim from all angles. The goal for a good workers’ comp attorney is to ensure that the system is treating you fairly after your workplace injury. Therefore, it’s important to maintain an open mind. Do not get upset with new information or questions. Answer questions directly, and the best of your ability. Things aren’t always exactly as you expect them. Recall, the attorney’s job is to help you. Therefore, be open and let the L&I attorney find the best way to navigate the conversation.


L&I claim consultation – Get ready

In summary, I strongly believe that it’s a good idea to consult with a workers’ compensation lawyer any time you have concerns. If you don’t understand what’s happening in you claim, or if something is going wrong, then call an L&I attorney. Most worker’s comp attorneys offer free consultations. However, it’s important for consultations to be efficient. For that, be sure to prepare for your consultation by following these simple steps:

  • Don’t wait too long to speak to an L&I attorney
  • Come prepared with information such as claim number, date of injury, and claim status
  • Listen to the attorney’s questions
  • Answer the questions directly to make best use of your consultation time
  • Listen and keep an open mind
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