Category: LNI Benefits (Page 16 of 21)

How to Increase Your L&I Claim Time Loss Compensation or Loss of Earning Power Benefits

Did you know that you can apply for a change of circumstance to increase your wage rate under your workers’ compensation claim in Washington State? When you do, they have to redo your L&I time loss calculation. The same applies with loss of earning payments. In short, if you’re getting time-loss compensation from L&I, or Loss of Earning Power checks, it can help increase your payments.

Calculating wages for L&I time-loss and wage benefits in your claim

People that have a workers’ compensation claim for a work injury typically receive L&I claim benefits such as time-loss compensation benefits (TLC) or loss of earning power benefits (LEP). This fact applies to people with an L&I claim that are administered by the Department of Labor and Industries (L&I). And, it also holds true for people that have a workers’ compensation claim with a self-insured employer, which is administered by a third-party administrator (TPA). In short, we refer to these benefits as wage replacement benefits, because they compensate the work injury claimant for lost wages while he or she are trying to recover from their workplace injury.

The entity that administers the claim (L&I or the TPA) must be able to determine the appropriate monthly wages. This is required in order to pay the correct amount for wage replacement benefits. According to RCW 51.08.178, monthly wages includes the injured worker’s hourly rate (or salary) at their normal work pattern at the time of injury. It must also include board, housing, fuel or other consideration of a similar nature. For example:
1) Bonuses received in the preceding 12 months;
2) The value of employer-paid healthcare benefits if the employer stopped paying for healthcare insurance coverage; and
3) Tips reported to the employer for federal income tax purposes.

How to protest or appeal a wage order?

The Industrial Insurance Act mandates L&I claim administrators to compute wages in a “fair and reasonable” manner. Here, when the claim administrator determines the wages, L&I usually issues a written L&I order decision called “wage order”. The order outlines the wage rate computation. Like other L&I orders, the wage order becomes final and binding after 60 days. However, just like other orders, you can protest or appeal it.

If you are an injured worker and you received a wage order, it is very important to review it carefully for accuracy. If it’s not correct, you must send a written protest or appeal and file it in time. Again, you must send your protest within 60 days to have L&I correct the wage computation. Once the wage under your L&I claim becomes final, the wage order cannot be changed even if it is wrong. Finally, it’s important to note that the only exception to this rule is when there’s a “change of circumstance”.

What is change of circumstance under a workers’ compensation claim?

Under RCW 51.28.040, injured workers can apply for change of circumstance after a wage order has become final and binding. One of the most common events that constitutes a valid change of circumstance is when an employer stops providing healthcare benefits.

Often, employers will continue healthcare insurance coverage for work injury claimants after opening an L&I claim. While the employer pays your healthcare coverage, it is not appropriate to include the value of healthcare benefits in the wage rate computation. However, when the employer stops paying, then a change of circumstance occurs. Therefore, if your employer stopped paying for healthcare coverage, you should file for change of circumstance. Consequently, L&I will include the value of your healthcare insurance in your wage rate calculation.

L&I time-loss calculation: Legal notes and personal experiences

In general, if the facts of your L&I claim warrant an adjustment or increase, it will apply to benefits paid up to 60 days prior to when the application for change of circumstance was filed. An inaccuracy in the original computation does not constitute a valid change of circumstance. There must be some material change that occurred after the fact.

Most workplace injury claimants I talk to are not aware that they can file a change of circumstance. Sadly, it is very common for me to discover that injured workers weren’t paid years of increased benefits because they didn’t apply for change of circumstance when the change originally occurred. Filing an application for change of circumstance is relatively easy. All you need to do is send a written request to your L&I claim manager asking for an adjustment. In this letter, you should explain the change that occurred and provide the relevant details.

L&I Claim Notices: Notice of Decision, Payment Order

/ L&I attorney / 10 Comments

Workers’ compensation claims can be overwhelming. Recently, I’ve consulted with several injured workers who have been completely overwhelmed with their claims. As a result, they started avoiding claim related documents. Among those, are L&I notice of decision letters. You must not ignore those.

Dealing with L&I claim orders and communications

Some work injury claimants I talk to no longer open their mail because it was causing them too much anxiety. I call this the “ostrich approach”. Just like an ostrich, burying its head in the sand, injured workers with a work injury claim who avoid claim-related communication don’t see the danger that is coming. They may miss critical deadlines, which in turn, can cause permanent harm to their workers compensation claim.

The Department of Labor and Industries (L&I) has the obligation to administer work injury claims. Similarly, claimants have the right to challenge L&I decisions that they believe are a mistake. However, work injury claimants only have 60 days to challenge and protest an L&I decision. If you do not file a request for reconsideration within 60 days, then you essentially waive your right to challenge L&I.

Remember, L&I makes mistakes. There’s no question about it. But, like it or not, it’s your job to be on top of things. In other words, if you don’t appeal an L&I decision, their mistake becomes final and binding under the law, no matter how wrong it may be.

L&I notice of decision

When L&I makes a decision concerning an issue in an L&I claim, they must notify the injured worker. In fact, they have to send something called a written order. Usually, these decisions are titled “NOTICE OF DECISION”. Here is what one that comes from L&I looks like:

L&I payment order

Sometimes L&I makes unfavorable decisions in what they title “PAYMENT ORDERS”. You would think something called a payment order would be a favorable decision issuing a payment. It isn’t uncommon for L&I to make a decision denying time-loss compensation or closing a claim in a decision called “PAYMENT ORDER”. Here is an example:

Can I protest a notice of decision or payment order?

Whether a decision is a NOTICE OF DECISION, PAYMENT ORDER, or has some other label, it’s’ easy to tell if you have the right to protest. For that, you can refer to the bottom of the decision letter and read it carefully. For example, it will look something like this:

In some cases, work injury claimants protest a decision. Then, after some time goes by, L&I affirms its previous determination. When this is the case, the notice of appeal rights looks as follows:

Monitor your L&I claim

If you have a work injury claim or L&I claim, the most important thing you can do is to pay attention to notices. You can protect yourself and protect your workers compensation claim by protesting or challenging L&I’s mistakes on time. There is nothing more heartbreaking for me than being contacted by an injured worker who disagrees with an L&I decision after they waited too long to dispute a decision.

Don’t be overwhelmed by your claim. If your claim and the associated correspondence is causing you too much anxiety, contact an experienced attorney who can help alleviate your anxiety. Your attorney will receive all the communications directly. They will oversee your claim and ensure that the Department’s mistakes are challenged on time.

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

/ L&I attorney / 12 Comments

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.