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

Category: LNI Benefits (Page 1 of 18)

L&I Survivor Benefits After Death: How Does L&I Survivor Pension and Other Benefits Work?

After a work injury or occupational disease, workers with permanent total disability can receive an L&I pension. An L&I pension is like a lifetime annuity. Workers receive pension payments every month. Moreover, L&I pension benefits continue for the life of the worker. Sometimes, work injury claimants ask what happens after they die. Does L&I provide survivor benefits? Are there L&I death benefits? Will their family members receive an L&I survivor pension? Or, can workers pass their L&I pension to their spouse or children? In general, the answer is Yes. However, every situation is different. It always depends on the facts and details.

 

L&I survivor benefits when death is not related to the L&I claim

Say that the Department of Labor and Industries (L&I) gives you an L&I pension. Additionally, at the time you receive the pension, say that you have a spouse or domestic partner. Then, L&I will provide you with survivor benefits options. In fact, L&I sends you a form so you can choose the L&I survivor benefits you want. The form explains all the different options. It also details the financial implications of each option.

 

You, the injured worker, can select your L&I survivor benefits. The most common options are:

(1) Full survivor benefits

(2) Partial survivor benefit

(3) No survivor benefits.

In other words, the pensioner can choose to have all, or a portion of their pension benefits pass on to their surviving spouse. These options apply when the pensioner dies from causes unrelated to their L&I claim. Furthermore, when death that is not related to the claim, you can only pass survivor benefits to your spouse (or partner). You cannot pass them to your children or dependents.

 

Option 1: Full L&I pension survivor benefits

Let’s say you choose full L&I survivor benefits. Furthermore, before death, you receive a certain pension amount every month. The surviving spouse or domestic partner continues to receive the same amount after you die. This option is good for the surviving spouse. However, this option usually results in the lowest monthly payout amount. That’s because L&I stretches your pension payments over the remaining life of both you and your spouse.

 

Option 3: Partial L&I survivor benefits 

Now let’s assume the injured worker chooses partial survivor benefits. As before, the pensioner receives a certain monthly payout during their lifetime. Upon death, the surviving spouse or domestic partner continues to receive approximately 50% of the pension. Here, again, the payments continue for the rest of the spouse’s life.

  

Option 2: No claim survivor benefits

Work injury claimants can decline L&I survivor benefits. In this case, the spouse must sign and notarize an L&I option form. The form acknowledges that they understand and agree to not receive benefits after the pensioner’s death. Importantly, this option typically results in highest monthly payout. That’s because L&I only pays the pension funds over the life of the pensioner.

 

Survivor benefits when death is claim-related

Sometimes, a work injury or occupational disease is the cause of death. We refer to these cases as fatal claims. Fatal claims can occur when a worker dies while on the job. However, they can also happen later. For example, when an L&I pensioner dies from claim-related conditions.

 

Legally speaking, L&I survivor pension benefits for work injury cases that result in death are usually straightforward. While tragic, in most such cases, the work injury is the cause of death. With fatal injuries on the job, employers must report them to L&I. Alternatively, they can report them to the Department of Occupational Safety and Health (DOSH) within 8 hours. DOSH will prepare a fatality memo. Also, under RCW 68.50.103, if the cause of death is uncertain, then they must order an autopsy.

 

If a worker receives L&I pension payments and dies later, then L&I survivor benefits can be more challenging. That’s because you must show causation. In other words, there must be medical evidence connecting the cause of death to the work injury or occupational disease. Typically, you’ll have to hire a medical expert. Sometimes, it’s even necessary to get an opinion from a forensic pathologist. This entire process can be sad and frustrating for survivors.

 

How to apply for L&I survivor benefits

Surviving beneficiaries who want to collect L&I survivor benefits must submit a beneficiary application. For work injury, they must submit the L&I survivor benefits application within one year from the date of the death. The rules for occupational disease deaths are different. For those, you must submit within two years of receiving notice from a physician that death was due to an occupational disease.

When applying, you’ll have to provide additional documents. These documents include:

1) Marriage certificate or declaration of domestic partnership

2) A copy of the death certificate

3) Birth certificate for dependent children

4) Letters of guardianship or custody orders (when applicable)

5) For children 18-22 years old – Proof of full-time enrollment in an accredited school.

 

What happens after L&I approves survivor benefits?

After L&I approves survivor benefits, L&I makes a one-time payment upon death. The amount of this immediate payment is 100% of the average monthly wage in Washington State. On top, L&I provides burial benefits up to %200 of the same average monthly wage. After that, L&I pays monthly survivor benefits when due. The amount of the monthly payments varies. In fact, it depends on who receives the L&I survivor benefits. The payout amounts are different for spouses, children, or other dependents.

 

L&I survivor benefits payments to a spouse, domestic partner, or children

The first category of payments is when the survivor is a spouse or a domestic partner. Here, the L&I claim entitles the survivor to receive 60% of the worker’s wages. Furthermore, for reference, L&I calculates the worker’s wages at the time of injury. On top, there’s a statutory maximum limit. If 60% of the wages is greater than the statutory maximum, then payments are capped at the limit.

 

Sometimes, worker’s that die in fatal claims leave behind children. With surviving children, L&I pays an additional 2% of wages per child. This extra benefit also has a maximum limit. Here, the limit is up to 10% of wages. That’s equivalent to paying survivor benefits for up to 5 children.

 

Survivor benefits and L&I survivor pension for other dependents

On occasion, there is no eligible spouse or domestic partner. Yet, there are surviving minor dependents. In these unfortunate situations, L&I pays monthly survivor benefits of 35% of wages. As before, L&I calculates the wage rate at the time of the work injury. Also, it’s important to note that L&I makes the payments to the guardian of the minor dependents. Plus, the fatal L&I claim pays an additional 15% for every additional child. Once again, this is up to a maximum limit. In this case, the limit is set at 65% of the injured worker’s wages. Finally, if there’s more than one child, then L&I divides claim benefits equally among them.

 

Moreover, an L&I claim resulting in the worker’s death pays out benefits to other recipients. However, these recipients only qualify if they depended on the worker’s earnings. For instance, dependents such as parents, grandparents, or grandchildren. These dependents can also be brothers, sisters, nieces, and nephews. Here, dependents may receive a benefit equal to 50% of the average monthly support during the year before the injury. This L&I benefit limit caps out at 65% of the worker’s wage. Or, at the maximum benefit level. Whichever is less.

 

When will my L&I survivor benefits end?

For dependents, L&I payments for survivor benefit may end. More explicitly, L&I stops payments when the dependency naturally ends, had the injury not occurred. Also, for minor dependents, their L&I survivor benefits end when they turn 18. If they are full-time students in an accredited school, then it’s when they turn 23.

 

For spouses, or domestic partners, the L&I survivor pension benefit is an annuity for life. However, L&I terminates benefits when the surviving spouse remarries. Similarly, L&I stops payments when the domestic partner enters another partnership. When this happens, the surviving spouse or partner has 2 options.

 

Option #1 – they can choose to receive a lump-sum settlement payment. Either 24 times the monthly compensation, or 50% of the remaining value of the pension. Whichever is less. Or, option #2 – they can decline the settlement. With option #2, the spouse maintains their right to reinstate L&I survivor pension benefits when the new relationship ends. For example, when the new marriage ends because of death or divorce. Or, when the new domestic partnership is over.

 

Conclusions

In summary, spouses, domestic partners and dependents may receive L&I survivor benefits. These benefits start upon the death of the work injury claimant who’s eligible for an L&I pension. L&I survivor benefits vary depending on the cause of death. Some benefits are appropriate when the death relates to the workers’ compensation claim. Other benefits apply regardless. Furthermore, the extent of the L&I survivor benefits varies depending on the status of surviving dependents.

 

It’s important to remember that survivors must file an application for benefits. It’s critical to file the application on time. One year for death after a work injury, and 2 years for occupational disease deaths. Unfortunately, if you don’t file on time, you’re giving up all your rights for benefits.

 

L&I Claim Protest: What Is It and Why It’s Important?

Many times, the Department of Labor and Industries (L&I) makes incorrect decisions. The same is true in self-insured claims. When this happens, it’s important to file a claim protest. If the L&I claim protest isn’t successful, we proceed to file an L&I claim appeal.

 

L&I claim protest versus claim appeal

Usually, L&I makes an initial decision. Then, to push back on the initial decision, we file an L&I claim protest. If L&I affirms its decision, we continue to file a claim appeal. A successful protest saves time, frustration, and costs. However, in my experience, the chances of winning an L&I claim protest are not good. Therefore, the purpose of this article is to review best-practices when filing an L&I claim protest.

 

Filing an L&I claim protest -in writing and on time

Under RCW 51.52.050, any party that disagrees with a decision can protest it. With every L&I decision, your rights to protest and appeal must be printed on the decision paper. And again, the same applies in self-insured employer claims.

 

A valid L&I claim protest must be in writing. Moreover, you have to file it on time. Workers have 60 days to file a claim protest from when you receive the decision. People often tell me they called their claims manager to disagree with the decision. However, a call to the claim manager is NOT a valid protest. You MUST file every protest with L&I. Even if the employer is self-insured. Sometimes, people accidentally send a written protest or appeal to the self-insured administrator (instead of L&I). Here, L&I considers the date the employer receives the filing as the date of receipt.

 

You must include supportive evidence in your L&I claim protest

Many L&I decisions involve medical determinations. For example, accepting or rejecting a medical condition. Other examples include causation of conditions and the need for further treatment. Finally, there’s also permanent partial disability ratings, and activity prescriptions.

 

If you’re protesting a medical decision, it’s important to have recent supportive medical records. Recent medical information is especially important if your attending medical provider disagrees with the decision. In fact, whenever this is the case, it’s important for L&I to review the recent medical opinion of the attending provider. Sometimes, it’s a different treating provider who feels that L&I’s decision is incorrect. Even if it isn’t the attending provider, you must provide this medical information to L&I. Unfortunately, without recent medical opinions showing that the decision is incorrect, you’re unlikely to prevail.

 

L&I protest for non-medical decisions

Many L&I decisions are for non-medical claim benefits. For instance, wage rate or offset dispute. As before, you’re more likely to win an L&I claim protest if you submit supportive evidence. Often, people are frustrated that the burden is on them. Workers have to track down relevant evidence and file it with the protest. I get it. I sympathize with this frustration. However, gathering and submitting supportive evidence is the best way to win an L&I protest.

 

To summarize, you must protest or appeal unfavorable L&I decisions. The most common convention is to protest an initial determination. While it can be difficult to win protests, you can increase your likelihood of success. Just follow 2 simple rules: (1) file your L&I claim protest in writing and on time; and (2) gather and submit evidence to support the protest.

 

The L&I Claim SIMP Program for Chronic Pain Management

Are you familiar with the SIMP program? SIMP is an abbreviation for Structured Intensive Multidisciplinary Program. More simply, it’s a chronic pain management program. L&I regularly refers work injury claimants to SIMP during L&I claims. In fact, L&I recommends SIMP for chronic pain when workers don’t respond to conservative care.

 

What is the SIMP program in L&I claims?

SIMP can be helpful when chronic pain interferes with your ability to work. Furthermore, SIMP is useful when work injury claimants develop dependency on pain medication. However, the program is a somewhat complex and expensive way to treat chronic pain.

 

The SIMP program is “structured”. That’s because workers receive care in a consistent manner. The care is regular and steady. It has a schedule for modules of assessment. In addition, it includes education, treatment, and follow up evaluations. During the program, caregivers custom-tailor plans to address specific treatment needs for workers.

 

Key parts of the L&I claim SIMP program for chronic pain

SIMP is also “intensive” because it requires 6-8 hours of daily treatment. The routine continues 5 days a week for up to 4 weeks. The program is also “multidisciplinary”: A team of providers with different yet complementary expertise provide the care. Moreover, providers address pain management in multiple ways. That includes traditional medicine, psychology, physical therapy, and occupational therapy.

 

Sometimes, the program also includes vocational services and nursing services. Finally, the “program” portion focuses on outcomes. To get there, the program offers coordination and goal-oriented processes. In fact, caregivers regularly measure and document the workers’ progress. Consequently, failure to make progress can result in discharge from the program.

 

Phases in the SIMP pain management program

If L&I approves a SIMP program, then 3 essential phases follow. The first phase is evaluation. The second phase is treatment. Then, the third is the follow up. Usually, Evaluation is a lengthy process. Program providers conduct a history review and physical exams. They evaluate the likelihood that the work injury claimant will benefit from the program. Plus, they develop a treatment plan during the evaluation. Upon completion, SIMP caregivers submit a report with their findings and recommendations.

 

After L&I approves the program, the work injury claimant enters the treatment phase. Treatment comprises several important components, which include:

  • Exercises
  • Cognitive behavioral therapy
  • Coordination of services
  • Education and skill development
  • Pain and function tracking
  • Ongoing assessment of unrelated conditions
  • Doing real or simulated work or daily functional tasks
  • Establishing return to work goals
  • Developing a discharge care plan.

When the plan completes, providers provide workers with a discharge report.

 

Finally, the Follow Up can last up to 6 months after treatment concludes. The goal of the follow-up phase is to reinforce pain management gains. On top, the follow-up supports return to work goals. Additionally, it helps identify setbacks or issues that require intervention.

 

Takeaways and conclusions

Work injury claimants must give good faith efforts to comply with SIMP treatment plans. After all, in theory, SIMP is ideal for treating complex chronic pain in L&I claims. However, there are ongoing debates as to whether such programs deliver on their promise.

 

Personally, as an attorney representing injured workers that regularly participate in SIMP, I see too few results. From my perspective, optimal outcomes on paper don’t match reality. I would like to see more attention and legitimacy to how workers feel about their own progress and symptoms. That said, SIMP is one of the only L&I-approved treatments for pain. That’s because pain is subjective. For that, I am grateful even if I don’t always agree with SIMP outcomes.

 

« Older posts