Category: LNI Benefits (Page 3 of 21)

Workers’ Compensation Vocational Rehabilitation – Who Gets Them and Why?

After a work injury, some workers may no longer be employable. To address this, the Department of Labor and Industries (L&I) can provide workers’ compensation vocational rehabilitation services. However, L&I doesn’t have to offer vocational rehabilitation. In fact, it’s up to L&I to choose who gets these services.

Who gets workers’ compensation vocational rehabilitation benefits?

In Washington State, the Industrial Insurance Act governs the workers’ compensation system. Under the law, some workers’ compensation benefits are entitlements. What does that mean? It means that L&I must provide these L&I claim benefits to workers when they meet certain conditions. For example, if a worker has temporary total disability, then L&I must provide time-loss compensation.

Another example is when workers require medical treatment. After a workplace injury, L&I must provide proper treatment for conditions that relate to the work injury. Whenever a work injury claimant has permanent partial disability, L&I must give a PPD award. However, if workers are unable to return to work, nothing mandates L&I to provide vocational rehabilitation services.

Who decides to give L&I vocational rehabilitation services?

There are many types of vocational services under an L&I claim. Early return-to-work in one example. Vocational retraining and vocational counseling are also important services. However, all workers’ compensation vocational rehabilitation benefits are discretionary. L&I decides who receives vocational services and who doesn’t.

Yet, on many occasions, L&I does provide workers’ compensation vocational rehabilitation. Interestingly, it’s up to the Director of L&I to decide who receives them. Although, on occasion, the Director of L&I can designate others to assist with these decisions.

Why does L&I provide vocational services?

If there’s no requirement for L&I to offer vocational services – why do they provide them? That’s a good question. The answer is – it boils down to cost. Say that L&I doesn’t provide vocational services to a work injury claimant. Then, ask yourself: Can the worker go back to work without receiving vocational benefits? If the answer is No, and if L&I denied vocational services, then L&I may be on the hook to provide them with an L&I pension.

L&I awards a workers’ compensation pension when the worker has permanent total disability. In fact, a workman’s compensation pension is one of L&I’s most significant monetary benefits. It’s a lifetime annuity. With an L&I pension, L&I pays the worker twice per month, for life. Therefore, it’s very costly (to L&I). Consequently, vocational benefits are one way for L&I to ensure employability. By doing so, L&I can avoid long term disability and pension payments.

What can I do if L&I doesn’t provide vocational services?

However, L&I sometimes declines vocational benefits. Unfortunately, if L&I decides to not award vocational rehab services, it’s nearly impossible to reverse their determination. The only way to change the decision is to prove that the Director of L&I abused their discretion. Then, to prove abuse of discretion, you must show that no reasonable person would make the same decision.

What if I receive workers’ comp vocational rehab services?

Some workers end up receiving vocational benefits from L&I. If you are one of those workplace injury claimants, then I strongly recommend you follow the below.

First, if you want to return to work and you receive vocational benefits – be thankful. Some L&I vocational programs are very good! In fact, my office often hires paralegals straight out of retraining programs.

Second, you must cooperate with your vocational service providers. Here, cooperation means you must meet with your vocational counselor and adhere to their guidance. You’ll have to provide them your education history and work experience. Moreover, they’ll expect you to collaborate and explore options to return to work.

Final takeaways

You must cooperate with vocational services. If you fail to cooperate, then L&I can suspend all benefits under your L&I claim. Don’t do it. It’s not worth it. Navigating the vocational process can be simple. However, in some cases, it can also feel confusing, hostile, and scary.

From my perspective, the most important thing is to fully engage in the process. If you want to return to work, then give it all you got. Workers’ compensation vocational rehabilitation can be an incredible benefit. Take full advantage of it. Pay attention to what’s happening around you. Track the actions and various recommendations throughout the vocational process.

Finally, as always, problem can arise along the way. For some, the vocational process seems hostile. For others, there can be lack of transparency. If that’s the case, it’s always a good idea to speak with a workers’ compensation attorney.

My L&I Claim Doctor Says I Need to Lose Weight Before Surgery: Does L&I Cover Weight Loss Treatment?

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The Department of Labor and Industries (L&I) covers medical treatment after a work injury or occupational disease. For treatment, L&I accepts certain conditions. Typically, L&I doesn’t cover conditions that do not relate to the workplace injury. However, in some cases, L&I allows temporary treatment of “unrelated conditions”. Specifically, when unrelated conditions prevent recovery from an accepted condition. In fact, L&I allows medical treatment of an unrelated condition as “aid-to-recovery”. Therefore, workers can sometimes receive treatment for obesity or being overweight. L&I considers this an unrelated condition.

L&I weight loss coverage

If you weigh too much, it can hold back your recovery after a work injury. For example, when your injuries involve weight-bearing muscles and joints. Explicit examples include foot injuries, ankles, knees, and hips. Additionally, excess weight can make it challenging to attend rehab treatments. Many times, overweight workers find it difficult to undergo physical therapy. Also, a diagnosis of obesity can delay surgery. This is until weight drops to appropriate levels. Hence, if obesity is a roadblock to recovery, then L&I may cover weight loss treatment.

Criteria for weight loss treatment

A worker must meet certain criteria for L&I to allow weight loss treatment. These criteria include:

1) The worker is “severely obese” with BMI of 35 or more.

2) Obesity is the main barrier to recovery. It’s preventing the worker from making progress on their L&I claim accepted conditions.

3) Weight loss is necessary to allow further treatment, surgery, physical rehabilitation, or returning to work.

How to get L&I pre-authorization for weight loss treatment

L&I requires several steps to pursue weight treatment coverage. First, the worker must request weight loss treatment. Here, L&I must pre-authorize the treatment. Otherwise, L&I will not pay for treatment expenses. To receive pre-authorization, your L&I doctor or attending provider needs to:

Notify L&I or the self-insured employer of the worker’s weight and level of function before the injury. Also, your provider must explain how your weight impacts treatment and recovery.
Describe the medical need for L&I obesity treatment. This includes tests, consultations, or diagnostic studies.
If appropriate, your L&I doctor can request nutrition counseling. A Certified Dietician or Certified Registered Dietician Nutritionist are available.

Unfortunately, L&I won’t approve many popular weight loss methods. Specifically, L&I regularly denies coverage of:

Weight loss surgery, drugs, or medication.
Certain programs or special foods that include meals, supplements, and vitamins.
Cookbooks and educational materials.
Exercise programs and exercise equipment.
Food scales and bathroom scales.

Developing a weight loss treatment plan

Next, L&I requires a plan before they can grant the pre-authorization. In state-funded claims, the L&I claim manager will draft a treatment authorization letter. This letter documents the terms of the plan. Work injury claimants must sign the authorization letter. This way, everyone agrees on the terms of the weight loss plan from the start. Therefore, work injury claimants and their providers must develop a treatment plan and specify:

a) How much weight the worker must lose.

b) Time estimate to complete the weight loss process.

c) The diet and exercise plan or the weight loss plan and methods.

d) The medical provider’s plan for monitoring progress.

e) Plans for documenting weekly weigh-ins.

f) Counseling and education from trained staff as appropriate.

Keeping the L&I authorization for weight loss active

L&I authorizes weight loss treatment in 90-day increments. However, work injury claimants must follow additional requirements to keep the authorization active. These requirements include:

i) Losing at least 5 pounds every 6 weeks.

ii) Attending weekly treatment sessions.

iii) Complying with the treatment plan.

iv) Checking in with the attending provider at least every 30 days.

v) Having the program coordinator sign a weekly weigh-in sheet.

vi) Sending the L&I claims manager the weekly weigh-in sheets.

It’s very important for the attending provider to see the worker every 30 days (or less). Also, the provider must notify the L&I claims manager if:

1) The work injury claimant reaches the weight goal.

2) Weight is no longer a barrier to treatment.

3) If the worker isn’t meeting their weight loss goals.

4) The work injury claimant isn’t cooperating with the treatment plan.

When will my L&I weight loss coverage end?

L&I coverage for weight loss treatment can end. One reasons for ending the coverage is when the work injury claimant reaches the weight goal. A second reason is if the worker’s obesity no longer impedes their recovery. Furthermore, another scenario is when the worker fails to drop the 5-pound minimum requirement over 6 weeks. Finally, L&I can end the treatment authorization if the worker isn’t cooperating with the plan.

Personally, I’ve seen good success with L&I weight loss treatments. Yet, the treatment is very bare-bones and basic. L&I uses mainstream programs, such as Weight Watchers or Noom. However, most plans come down to food modifications and calories deficits.

Concerns for workers receiving weight loss treatment

Due to work injuries, workers rarely take part in exercise programs. Although, walking exercises can be a successful and an integral part of L&I weight loss plans. Also, carefully designed strength training can be very beneficial.

In reality, the public nature of this L&I program can be frustrating to workers. Weight loss is often a very personal experience. Therefore, it can get extremely unpleasant having so many people monitoring your weight loss progress. Weekly weigh-ins can be stressful and demoralizing. Particularly, if the worker is having trouble meeting the mandatory weight loss goals.

Summary and conclusions

That said, L&I coverage for weight loss treatment is a huge benefit. Without it, excess weight can hinder recovery and stall the L&I claim indefinitely. Even worse, it can result in suspension of L&I benefits. In conclusion, there are some issues with these weight loss programs. However, they’re still an incredible benefit within the L&I claim process.

L&I Attorney Fees: Costs and Benefits for Injured Workers

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If you’re a work injury claimant, you may need to hire a workers compensation attorney. In Washington State, we sometimes use the term L&I attorney instead. If you’re concerned about L&I attorney fees – you’re not alone. The cost of hiring an L&I attorney can be stressful for workers. In fact, some people wait too long to reach out to a workers compensation attorney. Most workers worry about the cost. I wish I could say that attorney fees aren’t a concern. Unfortunately, that isn’t true. The law allows workman’s comp attorneys to receive reasonable attorney fees for their services. However, the law also sets the limits for what they can charge.

Managing your L&I attorney fees and cost

In Washington State, the Industrial Insurance Act has rules regarding fees. And, these rules make it easier for workers to manage their L&I attorney fees. Specifically, these rules include:

1) Mandatory contingent fees

2) Fixed fee percentages for structured settlements (CRSSA)

3) L&I attorney fee and cost reimbursements for Superior Court appeals.

Below, let’s go over the 3 rules and how they affect your L&I claim benefits.

Contingent fee as one form of L&I attorney fees

Outside the workers’ compensation setting, most attorneys charge a retainer. The retainer is an upfront fee. Clients pay the retainer before receiving legal services. After that, clients typically pay an hourly rate. In contrast, a workers compensation attorney doesn’t charge a retainer. Similarly, an L&I attorney fee isn’t hourly. In fact, under RCW 51.52.120, the law allows a workers compensation attorney to charge a reasonable “contingent fee”. This fee is up to 30% of the monetary benefits that an L&I attorney gets for his or her client. So, a workers compensation attorney doesn’t collect fees unless the worker receives payments from L&I. Namely, these L&I monetary benefit payments include:

a) Time-loss compensation benefits

b) Loss of earning power benefits

c) Permanent partial disability (L&I PPD) awards

d) Permanent total disability or L&I pension benefits.

Again, the 30% contingent fee comes out of these benefits. That is, after the L&I attorney helped their client secure them. Obviously, sharing a percentage of these benefits can cause significant stress. However, contingent fees are best in a worker compensation claim. Why? Because they ensure that the worker and the L&I attorney both have “skin in the game”. The L&I attorney doesn’t receive payments until the worker also receives them. Most importantly, contingent L&I attorney fees ensure that workers have early access to legal representation.

L&I claim resolution settlement agreements & fixed fee

Claim Resolution Settlement Agreement (CRSA) is a new way of resolving L&I claims. It’s the “new version” of CRSSA. Here, instead of continuing with the L&I claim, the worker and L&I decide on a monetary settlement. In short, the worker gives up the claim. In exchange, L&I pays the worker to walk away. So, let’s say an L&I attorney secures a CRSA. Then, under RCW 51.52.120(3), the L&I attorney fee for securing the CRSA is 15%.

Superior court appeals

Workers can appeal L&I decisions. Appeals take place at the Board of Industrial Insurance Appeals (i.e., the Board). First, let’s go over the steps of the Board appeal process. If the matter goes to a full hearing, the Board judge will issue a Proposed Decision & Order. Then, any party that disagrees with the decision can file a Petition for Review. Next, the Board will either deny or grant the petition. Finally, the Board will issue a Decision and Order.

Either party can disagree with any of these Board rulings. Therefore, either party can file an appeal to Superior Court for a Bench trial or Jury trial. In a Superior Court appeal, the law presumes the Board’s decision is correct. Hence, the appealing party has the burden of proof. Now, let’s discuss how this affects your L&I attorney fees.

L&I attorneys fee and cost reimbursement in successful Superior Court appeal

If successful, under RCW 51.52.130, the Superior Court may award L&I attorney fees and costs. To clarify, this means L&I or the self-insured employer will reimburse the worker for their workers compensation attorney fees. Put another way, the law will award attorney fees if Superior Court does 2 things. First, if Superior Court reverses or modifies the Board decision. And second, when Superior Court grants more relief to a work injury claimant.

Furthermore, trial witnesses cost money. Especially when it comes to medical testimony. The Court may waive these witness fees upon a successful outcome. Therefore, winning a Superior Court appeal can have many benefits. And that’s on top of securing your L&I benefits. However, remember, reimbursements only apply in successful Superior Court appeals. In contrast, fee and cost waivers aren’t available when working with L&I or the Board. It’s only available when an L&I attorney litigates your claim in Superior Court.

Takeaways and final remarks

In summary, work injury claimants may need to hire an L&I attorney, resulting in fees. Contingent attorney fees will be a percentage of the monetary L&I benefits. For percentages, L&I attorney fee will always be 30% or less. In CRSA, the law limits the fee percentage to 15%. Typically, L&I and self-insured employers aren’t responsible for paying your L&I attorney fees. However, a worker may make a successful appeal to Superior Court. There, the Superior Court may order L&I or the self-insured employer to pay attorney fees and costs.