Category: LNI Benefits (Page 5 of 21)

What Happens If I Suffer a Work Injury While Working a Light-Duty Job?

If a worker has an L&I claim, then their employer might offer them light duty work. However, a light-duty job offer must be valid. Work injury claimants who refuse valid light duty work can no longer receive wage replacement benefits. These benefits include time loss compensation and loss of earning power benefits.

What is a valid light duty job offer?

There are many types of light-duty jobs. Yet, under the workers’ compensation claim system in Washington State, there are special considerations. More specifically, a light duty job offer is valid if it meets 5 criteria:

(1) The job must be with the employer of injury.

(2) The employer must send the job description (sometimes called job analysis) to the attending provider and the injured worker.

(3) The attending provider must approve the job.

(4) The employer has to provide a written job offer to the work injury claimant. The offer needs to include a reasonable start date.

(5) The employer must reinstate health care benefits at the same level as of the time of injury. One exception is when there’s a superseding agreement in place.

Workers’ concerns regarding light duty jobs

Some work injury claimants are nervous about doing light duty work. Personally, I regularly encounter 2 common concerns. First, there’s a fear of needing to perform work beyond the worker’s limitations. These limitations are set by the attending provider. Then, there’s a second concern – suffering another workplace injury while working light duty.

The first concern is easy to address. Employers cannot ask workers to do something that’s not in the job description. Remember, the attending provider approved the job description based on the worker’s limitations. Therefore, when this happens, the light duty job is no longer valid.

Suffering a work injury while working a light duty job

The second concern is not so simple. Unfortunately, in real life, work accidents do happen during light duty work. And then, when they do, they cause additional frustration and stress.

It’s important for workers to understand how to handle work injuries while working a light duty job. Here, there are different options and scenarios. One scenario pertains to temporary light duty jobs. The other applies to permanent light duty work. If you suffer a work injury while working a temporary or transitional light duty job, then you have coverage under your original L&I claim. However, for permanent jobs, you need to file a new workman’s comp claim.

Which conditions and benefits belong to what work injury?

Either way, the new work injury will likely complicate your claim. That’s because it’ll interrupt medical appointments and chart notes in the original claim. It also depends on the body area and the nature of the second injury. Many times, it can be hard to keep conditions and symptoms separate from the original injury.

In addition, it can be difficult to determine benefits. Do benefits apply under the original L&I claim? Or under the second work injury claim? Or both? Administratively, it can be very messy. Therefore, it’s important for workers and medical providers to be precise. In statements, in medical reports, and in all other documents.

Light-duty work injury can impact benefits

Another important point is the impact on financial benefits. Interestingly, your wage rate under the original claim and the new claim may not be the same. In the first case, the new work injury is under the original L&I claim. Here, the wage rate from the original claim applies. If the worker is receiving loss of earning power payments when the light duty injury occurs, then L&I will factor those benefits to wage rate calculations. Moreover, if the light duty injury means the worker can no longer work, then L&I will pay time loss compensation. Of course, as always, the worker must certify time loss with the attending provider.

The second case is when the light duty injury prompts a new claim. Here, L&I uses the wages of the light duty job to calculate benefits for the new claim. This holds true even when the light duty job pays less than the original job. When this happens, it’s incredibly frustrating for work injury claimants.

Some takeaways

To summarize, fear of re-injury at work isn’t a valid reason for declining a valid light duty job offer. Injuries that happen while working light are no fun! There are several ways to handle those injuries. They depend on whether the light duty work is temporary or permanent.

As always, the very best thing for workers and employers is to take all possible precautions. Do what you can to eliminate workplace injuries. However, if a light duty work injury occurs, then L&I is going to cover it. The coverage might be under the original claim or under a new workman’s comp claim.

Late L&I Claim Filing: What Happens If I Delay Or Wait Long to File an L&I Claim?

/ L&I attorney / 3 Comments

People regularly call my office asking for advice about their L&I claim. Many times, they ask about common mistakes. More correctly, they want to know what mistakes to avoid. By far, the biggest mistake I see is when work injury claimants wait too long to file their claim. In the legal setting, we refer to it as “delayed claim filing”.

Do not delay your L&I claim filing

If you wait and delay claim filing, it can cause many issues. The most significant issue is – raising red flags for L&I and claims administrators. It’s unclear to them if your claim is even valid. I mean, if the claim is legitimate, then why wait so long to file? However, there are other problems with filing late. Follow-on issues include insurance coverage problems, delay in medical treatment, and difficulties in obtaining benefits.

By law, you have one year from the date of your work injury to file a claim. For an occupational disease (OD) claim – the limit is 2 years. In OD claims, the clock starts ticking when a medical professional notifies you (in writing) about your occupational disease.

Is your L&I claim valid?

Just because you have one to two years to file a claim, it doesn’t mean it’s wise to wait that long. If you wait, you’ll have to face claim validity questions. In my experience, this happens almost every time when employees don’t file a workers’ comp claim right away. It doesn’t matter if you wait one month or eleven months. Every time, filing delays call into question whether there was an injury in the first place.

Naturally, you can expect any logical person who suffers an injury to get immediate medical attention and file an L&I claim right away. That’s the though-process that claim managers follow. On average, out of ten claims that L&I rejects, at least eight involve filing delays.

Good reasons for waiting to file a workers’ compensation claim

Sometimes, work injury claimants have good reasons for filing late. Common reasons I see frequently include:

1) Not wanting to upset the employer;

2) Thinking the injury is minor and will resolve on its own; and

3) Begin afraid of the workers’ compensation claim system.

All these reasons are very understandable. They make sense. However, it’s best to not delay. None of these reasons are worth risking L&I claim rejection. Therefore, it’s best to report your injuries right away. Even if they are minor work injuries. It’s important to seek immediate medical attention and file a workman’s compensation claim promptly. Even if the injury turns out to be minor. It’s far better to have a claim than to litigate later after claim-rejection.

Filing a claim late can result in insurance coverage issues

Another common problem with waiting too long to file a claim is insurance coverage. Sometimes, when workers have an accident on the job or develop a workplace illness, they get medical attention right away. However, they may use private insurance to cover the treatment rather than filing a claim. Initially, it might seem easier and less burdensome. But later, it can cause confusion and complication. Especially if you file a claim afterwards.

Private insurance carriers aren’t happy when they learn they’ve been covering treatment for a work injury. After all, L&I or self-insured employers are responsible for workplace injury insurance coverage. Moreover, L&I or the self-insurer won’t have the medical records for your early treatment. Later in the process, they may disregard your early treatment when deciding to allow (or reject) the claim. Finally, switching billing from private insurance to workers compensation can create headaches for medical providers. Filing a claim without delay avoids these kinds of issues.

Medical treatment delays after a late L&I claim filing

Filing late can also mean treatment delays. These delays can occur when there are questions concerning the validity of the claim. For example, if L&I rejects your claim, you might have to file an appeal. After that, the appeal litigation process can take a long time. In fact, it may take more than a year to get a final decision. Even if they allow the claim without litigation, there’s still a risk of other delays. For example, treatment delay when switching between insurance carriers. Again, filing a claim without delay can dramatically reduce the likelihood of unnecessary delays.

Getting workers compensation benefits after filing a claim late

Work injury claimants can receive a variety of benefits. Medical treatment is one. However, there are many others. For example, wage replacement benefits such as time loss compensation or loss of earning power benefits, or vocational services. Securing these benefits can be challenging regardless of when you file the claim. In addition, if you file late, then you must obtain these benefits retroactively. However, it’s always difficult to obtain retroactive benefits. Sometimes it’s even impossible. This is another reason why workers must file an L&I claim right away.

Conclusions

In summary, there are many reasons for filing a workers’ compensation claim right away. Avoid delays and don’t wait long. It doesn’t matter what your reasons might be. There’s high likelihood of running into claim problems later. It’s not worth it. You must always submit an incident report at work. Then, go see a medical provider and explain your work injury or work-related condition. Medical providers will have the appropriate accident report forms. On top, they will complete and handle the provider’s initial report.

L&I Surveillance: I Think I’m Being Watched – What Should I do?

/ L&I attorney / 0 Comments

Surveillance in an L&I claim is relatively common. In fact, work injury claimants encounter surveillance in both self-insured claims and state-funded L&I claims. It isn’t against the law. Private investigators usually conduct the surveillance. Moreover, they know exactly what they can and cannot do under the law.

Willful misrepresentation in a workers’ compensation claim

The Department of Labor and Industries (L&I) is the administrator for state-funded claims. Here, surveillance is more likely to occur after someone reports fraud relating to a work injury claim. For example, when a person receives workers’ compensation benefits but appears able to work. Another example is when the injured worker is working while collecting time loss compensation.

Under the Industrial Insurance Act, there is no such thing as fraud. There’s only willful misrepresentation. The relevant law for willful misrepresentation is RCW 51.32.240. In short, it’s willful misrepresentation to receive payments or other benefits in greater amounts than a person deserves. Simply put, it refers to making a false statement, misrepresentation, omission, or concealment of facts to deliberately obtain or increase benefits. Moreover, it also includes willful failure to disclose work-type activities.

L&I claim surveillance

Fraud isn’t part of the workers’ comp ecosystem in Washington State. However, the word “fraud” is a trigger to describe people that abuse or take advantage of the system. In fact, L&I encourages the public to report potential fraud. L&I takes these reports very seriously. For one, they built an entire fraud investigation unit. There, investigators frequently take statements and conduct surveillance. Hence, one of the easiest ways to “avoid” surveillance is to not give L&I reasons to suspect you.

Still, I’ve seen cases where people file reports against work injury claimants even when they’ve done nothing fraudulent. Luckily, surveillance in these instances reveals nothing more than workers trying to get through everyday life the best they can. Of course, I’ve also seen surveillance showing that an injured worker is lying about their injuries and limitations. I’m always very disheartened when I see blatant willful misrepresentation. This kind of behavior negatively impacts all workplace injury claimants.

Self-insured claims and surveillance

With self-insurance, there’s a third-party administrator (TPA) that manages the claim. In my experience, surveillance occurs much more frequently in self-insured claims. What’s more, third-party admins can request surveillance even when there’s no accusation of fraud. Many times, the surveillance is useless. Usually, the film shows workers doing nothing more than struggling to get in and out of cars. Or attending appointments and spending a lot of time at home. Consequently, we only find out about the surveillance later during the discovery phase when the case goes to litigation.

Workers’ compensation surveillance and bias

However, sometimes injured workers are surveilled doing normal things. For example, going for walks, grocery shopping, and taking out the garbage. I commonly watch tapes showing workers doing yard work, attending family outings, going out to eat, or walking their dog. Sometimes, attorneys or claim administrators share the footage with treating doctors and independent medical examiners (IME). They do it to demonstrate that the work injury claimant is more physically capable than they lead on.

Depending on the film, this can be very effective in getting doctors to ease up or even remove physical restrictions. Sometimes this is very appropriate. Yet, many times the surveillance video doesn’t present a complete picture. Often, it shows things out of context. This typically leads to significant disagreements and litigation. There’s no easy way to prevent surveillance in self-insured claims. Therefore, it’s always best to ensure that you are being open and truthful. Describe your abilities and limitations to doctors honestly.

Takeaways and final notes

To summarize, surveillance is a standard practice in L&I claims. It’s legal and it happens all the time. It’s common in both self-insured and state-funded claims. When surveillance reveals behavior that’s consistent with doctors’ reports, then nothing will come of it. However, there are cases when a work injury claimant engages in activity beyond what they report. In such instances, the claim manager will likely use the footage to terminate benefits. In particularly egregious cases, claim handlers will use the surveillance records to push for willful misrepresentation charges.

If you suffer an injury at work and have a claim – it’s best to assume that someone is watching you. Therefore, your outward behavior must match your reports. Finally, it’s important to be honest. Describe your workplace injury and limitations honestly to doctors. Report the injury conditions in simple words the best way you can and you’ll be fine.