Category: LNI Benefits (Page 19 of 21)

Workers Compensation Claim Structured Settlement

Workers’ Compensation Claims and Structured Settlement

Have you ever heard the term “structured settlement” as it relates to workers’ compensation claims or L&I claims? Ever wondered if it might make sense for your case?

The Stages of an L&I claim or Self-Insured Employer Workers’ Compensation Claim

I often describe claims as having three phases:

(1) The open and active phase. This is when a claim is open and the injured worker is actively receiving treatment. Here, the goal of the treatment is to cure their condition or improve the overall level of disability;

(2) The employability determination phase. In this stage there is an assessment of the injured worker’s ability to return to work given their permanent limitations;

(3) Claim closure. I usually tell people that all claims must close (with a few very rare exceptions). However, the main question is how they close.

Workers’ Compensation Claim Closure

Typically, claims close in one of three ways:

(a) Simple claim closure. In this case, the injured worker completely recovers and returns to work at the job of injury;

(b) Permanent partial disability (PPD) claim closure. This is when an injured worker fails to make a complete recovery but is capable of working; and

(c) Total permanent disability claim closure. This happens when an injured worker is permanently incapable of returning to work.

The description above covers most common cases phases of L&I claims and workers’ compensation cases. However, in general, there is another option for claim resolution through a structured settlement or CRSSA. The Department of Labor and Industries (L&I) describes structured settlement as an alternative to monthly time-loss benefits. Under this outcome, the injured worker and L&I agree to a sum of money that is received as a series of payments over a relatively short period of time. It’s important to note that medical benefits may continue for industrially related conditions.

Conditions and Requirements

Certain additional conditions apply for structured settlement. If you are an injured worker over 50 years old, and you have an accepted claim that is at least 180 days old, then you may qualify. Under the right circumstances, a structured settlement can be a very satisfying way of resolving a claim more expeditiously. From my experience, structured settlements make sense for injured workers who have become frustrated or tired of the claim process. They are also suitable for injured workers who have alternative sources of income, and have concrete plans for their financial future.

In my opinion, however, injured workers should never enter into a structured settlement because they are frustrated or desperate to resolve a claim. Injured workers should never feel like a structured settlement is their only option. It is only one of many options available under the Industrial Insurance Act and it may involve giving up other benefits. I strongly urge injured workers to consult with an experienced workers’ compensation attorney before agreeing to a structured settlement. In addition, you must remember that before it becomes final, the Board of Industrial Insurance Appeals (BIIA or Board) must review and approve the terms of the structured settlement.

Additional Resources

If you are looking for additional information, you can check out the following L&I flow chart. This chart can help injured workers better understand the various steps and process. Also, keep in mind that following Board approval, there is a 30-day revocation period in which any party may revoke consent to the settlement for any reason. L&I will continue to administer the claim and provide benefits during the time the Board reviews the structured settlement. Claim administration and benefits also continue with the 30-day revocation period.

Reopening L&I Claim or Self-Insured Employer Claim

/ L&I attorney / 14 Comments

You may have heard that L&I claims can be reopened after they close. This is true, but there are a few important things to remember regarding claim reopening.

Reopening an L&I claim

First, you can reopen a claim any time following claim closure for additional medical treatment. However, for an injured worker to receive additional monetary benefits such as time-loss compensation, loss of earning power benefits, increased permanent partial disability or permanent and total disability, the claim must be reopened within 7 years of the original claim closure. After 7 years, if you reopen a claim, then L&I will only provide medical treatment. The only exception is when the Director of L&I exercises discretion to grant additional benefits.

Second, the reopening of a claim is not guaranteed. If an injured worker or provider believes that a claim should be reopened for whatever reason, a reopening application must be filed documenting the basis for reopening. L&I will carefully evaluate the evidence to determine whether reopening is appropriate. If L&I feels that it is not appropriate, reopening of the claim will be denied. Like any decision, the decision to deny reopening can be protested or appealed for physical conditions.

Conditions to reopen a workers’ compensation claim

For the reopening of a claim to be granted there must be an objective worsening of a claim related condition between the time the claim last closed and the time the application to reopen is filed. In workers’ compensation, we refer to these dates as the terminal dates. The first terminal date is the date of the most recent claim closure. The second terminal date is the date the application to reopen is filed. Findings of disability that can be seen, felt, or measured by an examining physician are called objective findings.

Therefore, whether there has been an objective worsening of claim related conditions between the relevant terminal dates often involves a comparison of the objective medical findings at or around each of the two dates. However, if L&I denies an application to reopen, a medical opinion regarding the objective worsening will be required to prove that the decision to deny reopening was incorrect.

Conclusions and recommendations

If you want to reopen your L&I claim, you should have your current findings and compare them to the objective findings from the time of most recent claim closure. It is also important that your medical provider clearly explains in what ways there has been an objective worsening. Non-physical conditions such as mental health conditions do not require objective worsening for reopening to be granted. These kinds of conditions inherently cannot be seen, felt or measured. However, for reopening to be granted, a medical opinion concerning worsening of the non-physical condition between terminal dates will still be necessary.

Preferred Worker Program for Injured Workers in Washington State

/ L&I attorney / 0 Comments

Have you ever heard the term Preferred Worker as it relates to injured workers and L&I or self-insured workers’ compensation claims? The preferred worker program is a return to work incentive program offered by L&I that benefits both employers and injured workers.

Preferred Workers Program in L&I workers’ compensation cases

Pursuant to WAC 296-16-110, under this program, L&I may certify an injured worker who has permanent medical restrictions as a “preferred worker“. This certification enables an employer to receive financial incentives when they hire the injured worker for a medically-approved, long-term job. Moreover, an injured worker certified as a “preferred worker” can use that status to make themselves a more competitive hire.

Benefits for employers

Employers who create a safe, long-term, medically appropriate job for a preferred worker become eligible for significant benefits including:
1) Reimbursements including 50% of the base wages paid to the preferred worker, for up to 66 days or up to $10,000 within a consecutive 24-month period;
2) Up to $2500 for tools and equipment; and
3) Up to $400 for worker clothing;
In addition to these reimbursements, the employer may become eligible for an additional incentive payment of 10% of the worker’s wages or $10,000 (whichever is less) after 12 months of continuous employment of the preferred worker. On top, hiring a preferred worker also comes with premium incentives: L&I will pay or reimburse the cost of a new claim filed within the certification period with no penalty on the business.

Preferred Worker Program: Tips for injured workers

If you are an injured worker trying to return to the workforce, be sure to ask your vocational counselor whether you qualify for “preferred worker” certification. If you are certified, the Department of Labor and Industries (L&I) will provide you with a letter confirming your certification. You will also receive a brochure you can present to prospective employers to educate them on all the benefits available when they hire a preferred worker.

If you are an employer interested in learning more about the incentives for hiring preferred workers, the L&I website has lots of information. L&I resources include informational webinar, the documents required to apply for the incentives, and an “apply here” link to apply online through the Secure Access Washington portal.

Conclusions and takeaways

Under the right circumstances, the preferred worker program can be very beneficial for injured workers returning to work and for accommodating employers. However, one significant shortcoming of the preferred worker program is that certification is only granted to injured workers who have a state funded claim. Injured workers of self-insured employers are not currently eligible for preferred worker certification. In my opinion this is a grave injustice to self-insured injured workers and I am currently exploring avenues for correcting this inequity.