Category: Claim Settlement (Page 6 of 7)

What Does My L&I Claim Worth? An Overview of Workers Compensation Claim Benefits

What’s the value of my L&I claim? What’s my workers’ compensation case worth? I get these questions all the time. And, my answer is always the same: “It depends”. For a better answer, it’s important to review the value of your L&I claim benefits.

What is the value of my workers’ compensation claim?

Knowing the value of your workers’ compensation claim or L&I claim in Washington State is tough. Calculating it isn’t easy. Remember- first you have to file your claim. Then, if the Department of Labor and Industries (L&I) allows it, you may receive various L&I claim benefits. Some of these benefits have a monetary value. Furthermore, the value is unique to each L&I claim because every claim is different.

The purpose of this article is to help you figure out the potential value of all available benefits. Remember, there’s no one-size-fits-all answer. There is no formula to calculate the exact value of your workers’ compensation claim. But, if you want to get a rough estimate, you can sum up the total value of all L&I claim benefits.

L&I claim benefits: Medical treatment

It’s very difficult to put a dollar amount on the value of medical treatment. For many, and in my opinion as well, it is invaluable. Generally, if your claim has been allowed, then L&I (or the self-insured employer) will cover your medical bills and expenses. That is, so long that the treatment is for conditions that relate to your work injury claim.

It is important to keep in mind that certain treatment recommendations must go through an authorization process. However, once you receive authorization, then L&I will cover your treatment 100%. This means that there are no out-of-pocket expenses. For example, co-pays or deductibles. It’s also reassuring knowing that you have a path to medical recovery. It’s always good to know that L&I will cover your medical bills for your L&I claim treatment.

Time-Loss Compensating – a key benefit

Say that you have an L&I claim. Also, say that L&I already allowed your claim. In addition, let’s assume that you’re unable to work. Then, you are eligible for monetary wage replacement benefits. Time loss compensation (TLC) is one such benefit. It’s what you get when you are temporarily incapable of working.

Your time loss wage rate is based on what you were making at the time you got injured at work. A single male of female individual with no dependents receives 60% of their wage. For time-loss calculations, take the 60% at the time you got hurt on the job. If you are married or have children, then you’ll receive a higher percentage.

Loss of Earning Power under an L&I claim

In some cases, after a work injury, some people are still able to work with limitations. For example, some work injury claimants can work less hours than before. Others might perform a light duty job that pays less than their job of injury. If you can after your injury, and your new salary is lower than before – you’ll receive compensation for lost wages.

Loss of Earning Power (LEP) covers this situation. It’s an L&I benefit. L&I pays it when you’re doing limited work that results in 5% (or more) decrease in your wage-earning capacity. This is a significant monetary value in any workers compensation claim. The specific value varies from individual to individual. As explained earlier, it all depends on your earnings at the time of injury at work or occupational disease manifestation.

Vocational services in L&I workers compensation claims

Some people are permanently incapable of returning to your work. If you are one, you can be eligible for retraining. If L&I approves your retraining, they will pay for your retraining program for up to two years. The total cost is approximately $18,000. But that’s not all. In addition to the $18,000 cost of retraining, L&I will pay time-loss compensation benefits. L&I will pay it throughout your entire retraining program.

The topic of vocational services in workers compensation claims is very broad. It is also very complex. There are many steps and services. You can read about important topics relating to vocations services by following the resources below:
1) Option 1 vs Option 2
2) Vocational services plan development
3) Job analysis
as well as many others. You can also refer to the high-level summary of vocational services in L&I workers compensation claims.

Permanent Partial Disability in L&I claim

Permanent partial disability (PPD) refers to loss of bodily function because of a work injury or work illness. The degree to which you lose bodily function is what we call PPD rating. In this context, you have to go through a PPD rating exam by a qualified medical professional.

There are many rules in PPD rating exams. Say that your permanent condition if for parts of the body that can be amputated. For example, an arm or a leg. Here, the PPD rating is based on percentage of loss of function. Then, there are parts of the body that cannot be amputated. For instance, the spine or mental health disability. In such cases, the PPD rating is based on levels called “categories of impairment”. These categories, and other rules and guidelines, are available in the Washington Administrative Code (WAC).

Either way, a doctor will try to assess the loss of your body function. For that, the examining doctor compares your condition with the condition described in the categories. Then, the doctor selects the category that best describes your level of impairment. The monetary value of the PPD is based on a PPD award schedule. The PPD award schedule is available on the L&I website.

Permanent Total Disability is an important L&I benefit

Total disability is a physical or mental impairment that prevents you from working. Usually, medical professionals or vocational counselors decide if you can work. If your disability prevents you from returning to work in the foreseeable future – we refer to it as Total Disability. L&I considers it to be a permanent condition.

With total disability, you must obtain an opinion from a medical provider. The provider will establish the likelihood that your disability will continue to impact your ability to work in the future. If you are indeed permanently totally disabled (PTD), then you’ll probably receive a pension under your L&I claim.

Pension in L&I claims

An L&I pension means that you receive monthly payments for the remainder of your life. L&I will send you payments so long as you cannot, and do not, return to work. As before, your pension payments depend on the amount you were earning before the injury. The pension benefit provides a source of income for people with severe injuries that can never return to work.

Workers compensation LNI claim PPD rating

Permanent Partial Disability (PPD) rating in Workers’ Compensation and L&I claims

/ L&I attorney / 2 Comments

What’s my L&I claim case worth? I get this question all the time. The answer is always the same: It depends. One way to determine the value of a work injury L&I claim case is based on the Permanent Partial Disability or PPD award. And, the same holds true for a workers’ compensation claim with private insurance companies and self-insured employers.

What is Permanent Partial Disability or PPD?

PPD is a monetary award that some injured workers receive when L&I closes their claim. In short, if the injured worker has: (a) Reached maximum medical improvement; (b) Continues to experience permanent residuals from the industrial injury or occupational disease; and (c) Is still capable of working, then a PPD award may be appropriate.

PPD award rating is based upon medical evidence. When the body part involved in the work injury is one that cannot be amputated, the PPD rating usually uses categories of impairment from the Washington Administrative Code or Washington Administrative Code (WAC). However, if the body part could potentially be amputated, the PPD is rated according to criteria from the American Medical Association (AMA) Guides to the Valuation of Impairment.

Who can provide PPD rating for my claim?

Within the medical provider network or MPN, some providers feel comfortable and are willing to provide PPD ratings. Yet, others do not. Consequently, from my perspective, it is always ideal when the attending provider (AP) that’s assigned to the claim is willing to rate the PPD. This is because that provider usually has the best sense of the injured worker’s permanent residuals from the work injury.

If an AP does not do PPD ratings, they will usually refer the injured worker to a provider that does. Alternatively, they can request an Independent Medical Examination (IME).

How much is my right arm worth?

On a personal note, before you continue reading, please know that I’m very uncomfortable placing a monetary value on parts of the body. The human body is sacred. Body parts are priceless. However, this is the world and the reality we live in.

Injured workers often want to know what the monetary value of the PPD will be. It is important to know that the value is a set number that varies based upon the date of injury. L&I publishes a “Permanent Partial Disability Award Schedule” that lists PPD values based on the date of injury. For example, the value of a 10% right arm PPD for a person injured on December 31, 2015 is $12,004.04. Here, it’s because 100% of the value of an arm for a 2015 date of injury is $120,040.41. However, without a medical opinion rating the PPD, it is virtually impossible to estimate the dollars-and-cents value for the award.

Workers compensation LNI claims help and problems

Solving Problems and Overcoming Roadblocks in Your Workers’ Compensation or L&I Claim

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If you don’t succeed the first time, then you should try and try again. I think this should be the motto for injured workers dealing with their L&I claim as they navigate their workers compensation claim process and issues.

The Industrial Insurance Act (RCW 51) was created to provide “sure and certain” relief for people injured at work. However, this doesn’t mean that workers’ compensation claims go smoothly or without roadblocks. Far from it. In fact, much of what I do is figuring out the best way to navigate obstacles that arise in L&I claims and self-insured employer claims.

L&I and workers’ compensation claims are full of tough obstacles

Whether it is getting treatment authorized, a condition accepted, or finding resolution to a conflict that has arisen, problem solving is my job. I’ll be the first to admit that sometimes problem solving feels more like trial and error. This isn’t because I don’t know what I am doing. It is because over the years I’ve learned that there’s almost always more than one way to solve a workers’ compensation problem. The key is finding the most successful approach, which is usually based on the unique facts and circumstances of the case at hand.

One L&I case in particular

Explicitly, since October, I’ve been trying to solve a series of issues in one particular case. I’ve had difficult conversations with my own client. I’ve had even more difficult conversations with the Claim Manager at the Department of Labor and Industries (L&I). Moreover, I had some loud and rough calls with assistant attorney generals and their paralegals representing L&I.

While I was able to get my client on board with some aspects of my plan, other pieces remained an unresolved challenge. On no less than six separate occasions since October, my proposals were formally rejected. Each time, I went back to the drawing board to try and develop a plan that would succeed. I clearly am not allowed to disclose specific details about this case. However, I’m pleased to report that today I managed to successfully resolve all the remaining issues. Interestingly, the solution wasn’t much different than what I had proposed about ten months ago. Yet, this time around, I just needed to take the right approach, at the right time.

Personal notes

Today’s perseverance to try and try again really paid off. I secured time loss compensation benefits to an injured worker that desperately needed them. To satisfy their mounting debt, to make some urgent payments, and to get a brief temporary break. Equally important, we now have some much-needed breathing room. We are already preparing to tackle the next roadblock that we’re anticipating in this complicated L&I claim.