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

Category: Claim Settlement (Page 3 of 7)

What Is the Best Outcome for My L&I claim?

Work injury claimants frequently ask me about their L&I claim outcome. Following a work injury, most people with a workers’ compensation claim want to get the best outcome possible. With L&I claims, there are certain benefits available. However, from my perspective, the best outcome is securing the appropriate benefits. Furthermore, the appropriate benefits vary and depend on the facts of each workman’s comp claim. Below is a breakdown of circumstances and possible claim outcome.

 

Benefits in L&I claims

Generally, the first step in your claim is for the Department of Labor and Industries (L&I) to allow your claim. Then, there are several benefits available once the claim is allowed. Medical treatment is perhaps the most important benefits. On top, there are financial benefits such as time loss compensation, loss of earning power benefits (LEP), and permanent partial disability award. After that, there are vocational benefits, claim pension, and in some cases a comprehensive claim settlement.

 

What is the best outcome for my L&I claim?

Considering the above benefits, let’s explore several scenarios and possible outcomes. For example, what is the best outcome for an injured worker who makes full recovery and has no permanent loss of function? Most likely, the best outcome is to ensure that L&I pays all treatment costs and the appropriate time loss or loss of earning power benefits while the claim is open.

 

Now, let’s consider the following case. What’s the best outcome for workers with permanent measurable loss of function that can return to their job of injury? Or to another job for which they already have the necessary skills? Here, the best outcome is probably to ensure that L&I pays all treatment costs, as well as time-loss or LEP. Additionally, when the claim closes, L&I should rate the work injury claimant for permanent partial disability (PPD). The rating should be done by a competent medical professional. Finally, the rating will result in a monetary permanent partial disability payout.

 

Best L&I claim outcome for workers that need retraining

In the cases we described above, the work injury claimant can return to work without retraining. However, what is the best outcome for someone who has permanent measurable residuals but needs retraining to return to work? Likely, the best outcome is to ensure payment for treatment costs, and proper payments for time-loss and LEP benefits. However, in this case, it’s imperative to ensure that the work injury claimant receives vocational services while the claim is open. In fact, L&I can provide up to two years of vocational retraining under the claim. Then, assuming retraining is successful, L&I should rate the injured worker for PPD at claim closure. In turn, the worker should receive the proper PPD payment.

 

 

Best L&I claim outcome for workers that cannot return to work

Next, there are workers’ comp claim cases where the work injury claimant cannot return to work. For these situations, people ask: What’s the best outcome for someone with permanent loss of body function who may or may not be capable of working? Here, as before, we need to ensure that L&I covers treatment, medical costs, and PPD or LEP payouts. Then, ask yourself if you’re 50 years old (or older), and if you may not return to work as a result of your work injury or workplace disease. If the answer is Yes, then you should consider a comprehensive settlement. Usually, this type of workers’ comp claim settlement results in a larger payout than PPD alone.

 

Finally, what’s the best outcome for a work injury claimant who has such significant permanent loss of function that they will never be capable of working again? First, we need to ensure that treatment costs, time-loss, and LEP are all paid. However, if a person is so disabled that they are permanently incapable of working, they should probably receive a L&I claim pension. An L&I pensions is frequently considered the most significant monetary benefit in L&I claims. It’s roughly equivalent to receiving time loss for the remainder of your life, or as long as the inability to work continues.

 

Closing remarks

Obviously, there are a variety of potential outcomes in workers’ compensation claims. To determine the best outcome, you must carefully assess the facts and circumstances of your workers’ compensation claim. Every claim is different. The unique scenarios and conditions for each individual claim will dictate its best outcome.

 

L&I Claim Appeal Cost in Washington State

The Department of Labor and Industries (L&I) administers your workers’ compensation claim in Washington State. They decide what benefits work injury claimants can get. During your L&I claim (or self-insured employer claim), the department issues many decisions. Eventually, whenever you receive one, you can appeal the L&I claim decision. Furthermore, any party that disagrees with L&I’s decision can appeal to the Board of Industrial Insurance Appeals (BIIA).

 

Cost of BIIA appeal and the burden of proof

The BIIA is its own state agency and it’s completely separate from L&I. The BIIA reviews L&I decisions and acts like a court to decide the case. In fact, the BIIA decides the case according to the law. Here, the appealing party carries the burden of proving that L&I’s decision is wrong. In most cases, meeting the burden of proof requires testimony from expert witnesses. Usually, expert witnesses charge fees for testifying in BIIA proceedings. We refer to these fees as “costs of appeal”. Many times, these costs are significant.

 

People with a work injury claim are often upset when they learn about the cost of appeals. This is understandable. After all, most people don’t have thousands of dollars to cover costs. As a result, people might look for alternatives. In some cases, the issue at hand is primarily medical. When that’s the case, clients regularly ask me: “Can’t we just submit the medical records instead?”. The short answer is almost always: “No”.

 

L&I claim appeal and BIIA hearing procedure

In BIIA hearings, expert witnesses such as doctors must appear in person and testify. The BIIA will not allow notes, letters, reports or other documents into evidence if the other party objects to them. Practically, these kinds of documents are considered “hearsay”. Any reasonable attorney would object to them. Therefore, expert witnesses must testify when the issues under appeal involve benefits like:

 

My job as a workers’ compensation attorney

A big part of my job is helping work injury claimants decide for themselves whether the costs justify the benefits. However, in my experience, these decisions aren’t a simple cost-versus-benefit analysis. After suffering an injury at work, people have so much they have to consider. Deciding whether to proceed with an appeal is often one of the most difficult decisions they have to make.

 

Claim closure – What does claim closure mean?

People with an L&I claim in Washington State tend to have lots of questions about claim closure. Some of the most common questions I get are: Why is my claim closed? What does closure mean? What if my condition gets worse after my workers’ compensation claim closes? Did I get everything I was supposed to? What if I disagree with L&I closing my claim?

 

Every L&I claim is unique

Every work injury and workman’s comp claim are unique. As a result, people have different questions about their specific situation. Therefore, it’s very difficult to give general answers that apply to everyone. Sure, there are some high-level pieces of information that apply to all. However, a general answer might not fit your L&I claim circumstances. Either way, it’s always a good idea to consult with an L&I attorney or a workers’ compensation attorney before your claim closure becomes final.

 

My claim closed – What does closure mean?

The Department of Labor and Industries (L&I) closes claims after treatment completes and after they determine your return to work or employability status. Once a workers’ comp claim closes, work injury claimants cannot receive any more benefits under the claim. Specifically, your L&I claim no longer pays for medical treatment and medication. Furthermore, L&I stops paying benefits like time loss compensation and loss of eating power (LEP). Finally, L&I stops providing services such as vocational counseling or guidance. However, if L&I decides you are permanently and totally disabled, you will receive monthly L&I claim pension benefits after the claim closes.

 

What if my condition gets worse after my claim closed?

The most common concern I hear from clients is about worsening medical condition. Here, there are some good news – You can reopen an L&I claim! To do it, you must show objective worsening that relate to the medical conditions under your L&I claim. Practically speaking, you must show that you need further medical treatment. Alternatively, you can show that your disability is worse than before. Then, there are slightly different rules for mental health conditions. For example, with mental health claims, objective worsening isn’t a prerequisite. Yet, it’s still mandatory to have an expert medical opinion on worsening before L&I reopens your claim.

 

If you reopen your workers’ compensation claim after 7 years, then you might be able to receive all types of benefits. After 7 years, you can still reopen your L&I claim, but only for medical treatment. Even then, you can ask the L&I Director to exercise discretion and grant additional benefits.

 

Did I get everything I deserve?

This is the most challenging claim closure question to answer. Every work injury has different circumstances. Consequently, there are different benefits under every claim. Benefits can include medical treatment, time loss compensation, and loss of earning power. There can also be vocational services and retraining benefits. Sometimes, permanent partial disability awards and permanent total disability might apply. If you’re not sure you received the benefits you deserve, you should speak with a workers’ compensation attorney.

 

What if I disagree with closing my claim?

Many work injury victims disagree with their workers’ comp claim closure. If you are one of them, you must protest L&I’s decision within 60 days. However, if L&I affirms its decision, you can submit an appeal to the Board of Industrial Insurance Appeals (BIIA). If you do, make sure you have strong medical (and sometimes vocational) evidence to show that claim closure is wrong.

 

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