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

Category: LNI Benefits (Page 15 of 21)

L&I Workers Compensation Claim and the Kept-on-Salary Benefit

People that can’t work because of their industrial work injury or occupational disease in Washington State can receive time-loss compensation benefits. Single people with no dependents sometime struggle because the time-loss compensation rate is 60% of what they were making at the time of the work injury. However, keep in mind that you don’t pay taxes on time-loss compensation benefits under a workers’ compensation claim. In other words, when calculating your taxable income, L&I claim payments aren’t taxable. The purpose of this article to explain similar benefits such as kept-on-salary.

 

L&I claim and time-loss compensation benefits

Time-loss compensation benefits are vital for work injury claimants. At the same time, many employers are very frustrated by this benefit.  They are frustrated because L&I rates go up when their employees receive time-loss checks. Businesses often argue that it’s unfair. In response, L&I created several incentive programs to help employers keep their rates down.

 

I don’t have a problem with the Department of Labor and Industries (L&I) working to keep employer L&I rates down.  However, I am incredibly critical of L&I’s application of their incentive programs. From my standpoint, I strongly believe that L&I gives employer-incentives way too easily without appropriate oversight or enforcement.  As a result, workplace injury victims are being punished while employers are rewarded for unfair use of incentives.

 

The L&I Kept-on-Salary incentive program for employers

One incentive that works well for employers (and not so well for people with a workers’ compensation claim, especially with self-insured employer) is called Kept-on-Salary (KOS). Like its name, the idea is that a person that suffers work injury continues to receive regular paychecks, even when they can’t work. If you search online, you can find several articles about KOS that help employers reduce their L&I rates and save money.  However, there isn’t any information on the L&I website for the Kept-on-Salary program.

 

Despite having no information for work injury claimants, the Kept-on-Salary plan is available. In fact, it’s governed by RCW 51.32.090 and RCW 49.46.210. Under these rules and regulations, if a work injury claimant is under the Kept-on-Salary program, then they are not getting time-loss compensation payments.

 

How does Kept on Salary work in L&I claims in Washington State?

In short, if a work injury claimant is on kept on salary, it means that the employer continues to pay the worker. However, the employer must meet several conditions:

  • The injured worker shall receive a total of all wages (i.e., form all employers and jobs) as of the date of their work injury. This includes absolutely all payments that the work injury claimant was getting before. Even after-hours or jobs outside the scope of his or her work hours with the employer of injury.
  • The wages must include the benefits that the worker had prior to the work injury. Specifically, payments include healthcare benefits, housing (when applicable), fuel expenses and reimbursement, and so on. On top, it must include tips, shift-change or overtime pay, bonuses, and all other expense and benefits.
  • The employer can deduct certain amounts to comply with state or federal law. However, the employer cannot make any other deductions.
  • The employer must pay wages on a regular schedule at least once a month.

  

Employers misusing the Kept-on-Salary incentive

Employers can’t mandate workers to use benefits they earned over time such as vacation, sick leave or paid time off, to keep from paying time-loss compensation. Therefore, if an employer is making you take time off or vacation and doesn’t pay for that time, then you’re not under the Kept-on-Salary plan. This is one aspect of the program that employers can abuse. After all, L&I relies on employers to report if the L&I claim worker is on KOS.

 

Practically speaking, the problem is the shocking lack of remedy for people with a workers’ compensation claim. Employers can easily abuse this benefit because there are no real penalties or oversight. More explicitly, L&I does not seem to actively check the facts or the reliability and consistency of employer reports.

 

The reality of the Kept-on-Salary program

In my experience, employers are often not adhering to KOS requirements.  I cannot tell you how many times I’ve had to collect evidence to prove the employer is not meeting the requirements.  The process tends to be long, drawn out, and incredibly stressful for people trying to move their L&I claim.

 

In conclusion, incentives to help employers to reduce L&I rates make some sense.  However, L&I needs to do a much better job to ensure that those incentives do not have a punitive impact on people that suffer a work injury.

L&I Claim Retraining and Vocational Services: The Office Careers Saga Continues

I previously posted about the investigative reporting by Susannah Frame at King 5 regarding the Office Careers retraining program. Yesterday, the Department of Labor and Industries (L&I) publicly announced a moratorium on Office Careers retraining plans in L&I claims.

 

L&I retraining services put a hold on Office Careers

L&I published a news release and stated that: “Effective immediately, L&I is instituting a moratorium on approving any new retraining plans for Office Careers. This will remain in effect pending the results of our audit and/or the Workforce Board investigation. We will announce any changes to this process”.

 

In my experience, when L&I sends work injury claimants to ineffective retraining programs, it puts injured workers in a no-win situation. The person going through his or her L&I claim has to choose between:
(1) Participating in a program that’s not going to help their career;
(2) Reaching a workers’ compensation claim settlement for far less than appropriate; or
(3) Mounting an expensive legal battle to prove that L&I made a wrong decision.
Therefore, I’m thrilled that King 5 News brought this issue to light.

 

An opportunity for L&I vocational retraining

As a workers’ compensation attorney and L&I attorney representing people that were hurt at work, this chain of events gave me a lot to think about. My conclusion is that this is an opportunity for L&I to reform the culture surrounding vocational retraining in L&I claims. Currently, it appears that L&I places greater value on achieving determinations that injured workers are employable. Instead, I expect L&I to focus on having work injury claimants return to work successfully.

 

Someone saying that you’re employable is not the same as being employed. It’s also not the same as being able to maintain that employment successfully over time. If L&I wants to support a successful retraining program in L&I claims, then they must shift their culture.
They must place a greater value on retraining plans that actually make injured workers employable.

 

What’s a successful L&I claim outcome?

I’ve been thinking about this time and time again. I honestly don’t know how L&I defines a successful claim outcome. However, I suspect it includes a limited duration of disability and paying less money on an L&I claim. In my world, a successful outcome is one where an injured worker makes the best recovery possible. A successful outcome is one where a work injury client maintains a sense of financial security despite having sustained a life altering industrial injury or occupational disease.

 

L&I can do the right thing

An injured worker that’s abandoned, based upon an administrative decision that looks good on paper, is not a successful outcome. No matter how you look at it. I strongly encourage L&I to take this opportunity to do the right thing. Reform the culture. Celebrate truly successful claim outcomes. Stop incentivizing practices, behaviors, programs, policies, and a culture that does nothing but place injured workers in a no-win situation.

L&I Claim Travel Reimbursement

If you have a work injury claim, such as a workers’ compensation claim or L&I claim, then you can see any medical provider you choose. The only requirement is that the medical provider must be a member of the Medical Provider Network or MPN. For work injury claimants living in rural places or remote areas, finding a provider in the MPN can mean extensive travel. The good news is that L&I provides travel reimbursement in some cases.

 

How to get travel reimbursement for my workers’ compensation claim?

Under certain circumstances, the Department of Labor and Industries (L&I) will reimburse injured workers for travel to medical appointments. However, you must meet three criteria in order to get reimbursement for your travels. If you think that you meet all the requirements, then you should fill a travel reimbursement form. Once you complete the form, be sure to submit it to your claim manager.

 

First, the medical provider must be more than 15 miles away from the residence of the work injury claimant. Second, there can’t be any other available providers that have closer offices. Third, you must get pre-authorization for the reimbursement from your L&I claim manager. Furthermore, it is important to note that you can get reimbursements for mileage, toll road payments, and parking fees in excess of $10.

 

What do I need to do to get travel reimbursement from L&I?

On its face, travel reimbursement seems like a relatively simple and a valuable benefit for people with L&I claim. Clearly, it’s an excellent benefit for people with a work injury that incur extraordinary travel expenses for treatment. However, practically speaking, it is rather challenging to successfully receive travel reimbursement.

 

One of the most frustrating problems is when a workers’ compensation claim manager questions the need for travel. In my experience, this happens all the time when work injury claimants need to change their medical provider in the middle of an L&I claim. Nearly all medical providers are reluctant to become the attending physician for an older L&I claim. Therefore, people with existing claims often need to travel afar to find a doctor that is willing to see them.

 

L&I claim travel reimbursement form and pre-authorization

In many cases, before authorizing travel reimbursement, some L&I claim managers require us to produce a journal showing that we tried to find a provider within 15 miles of the worker’s residence. Despite the frustration, once we submit the journal to the claim manager, the claim manager usually authorizes the reimbursement.

 

Another common frustration I encounter all the time is when work injury claimants are unaware of the travel reimbursement requirements. It’s common for me to speak with people with a workers’ compensation claim who completely gave up on the reimbursement process. Usually, they give up because they either don’t understand or don’t seem to meet the requirements. The most frequent mistake I see is failing to get pre-authorization. Interestingly, in most cases it’s because they do not fill out the travel reimbursement form correctly. However, having done this so many times, it is fairly easy to correct these errors.

 

Takeaways and final notes

In summary, if you got hurt at work and you have a workers’ compensation claim or L&I claim, if you travel to medical appointments, then you can (and should) get travel reimbursement. Remember, to get travel reimbursement and eliminate unnecessary frustration, make sure you know the requirements, fill the form above, and ask for pre-authorization from your claim manager.

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