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

Category: LNI Benefits (Page 9 of 21)

L&I Claim Retraining: The Importance of Good Retraining Plans

The Department of Labor and Industries (L&I) provides a variety of vocational services. The goal of L&I claim vocational services is to help work injury claimants resume continuous, successful, and gainful employment.

 

L&I claim retraining – Who is eligible?

Job retaining isn’t available to everyone. If you have a workers’ compensation claim in Washington State, you may be eligible for retraining if you meet certain conditions. First, you can no longer work at your job of injury. Second, you don’t possess skills to do work under your physical limitations. Finally, if you’re eligible for retraining, then time loss payments continue while you actively and successfully participate in retraining.

 

Retraining plans must be reasonable and appropriate

Retraining programs are a significant benefit following a work injury. However, in my opinion, for a retraining plan to be effective, it must be reasonable and appropriate. For starters, let me explain what I mean by reasonable and appropriate.

 

Reasonable: From my perspective, reasonable plans are within the aptitudes of work injury claimants. They are written for success and not repeated failure. Also, when submitting plans, there’s sufficient time for approval. Moreover, plans allow the work injury claimant to obtain the necessary books, hardware, and other supplies BEFORE the term begins. Good plans include provisions for any necessary educational accommodations. Furthermore, accommodations are pre-arranged and pre-approved with the educational facility. Finally, they are drafted based on recent information about program requirements and course offerings. The latter minimizes the likelihood of class unavailability or program changes.

 

Appropriate: In my opinion, appropriate plans provide a real chance to obtain work once the plan completes. Therefore, there must be actual demand and labor market. Additionally, the job must be something the work injury claimant can sustain in real life. Whenever possible, the plan should also involve a retraining goal that interests the work injury claimant.

 

 

The importance of good work retraining programs

It’s important for retraining plans to be reasonable so that injured workers succeed. Unreasonable plans have a very high likelihood of failure. For example, when plans exceed the aptitudes of a work injury claimant, they tend to fall behind, fail classes, and often must repeat classes. In fact, I’ve seen plans that include repeat classes in the coursework because of vocational counselor’s assumption the injured worker will fail the class the first time. This doesn’t inspire success. On the contrary. It makes work injury claimants feel defeated before they begin.

 

Another unreasonable issue is when work injury claimants don’t get the hardware, books, supplies or help they need until weeks into the term. By then, they are already behind and may not recover in time to achieve passing grades. In short, plans that are not reasonable make work injury claimants feel like they’ve been set up to fail. Reasonable plans, on the other hand, inspire success.

 

As a primary matter, any retraining goal must be physically appropriate for the work injury claimant. They need to be able to do the work with success and continuity. Beyond that, work injury claimants are far more likely to become successfully employees after retraining if they can obtain a job that satisfies them. The first step towards that goal is ensuring the retraining plan will enable workers to obtain a satisfying job. In my experience, there’s rarely anything more defeating than telling an injured worker they’ve lost a job they love to disability and have no choice but to do a job they hate. While the law does not require people to return to their pre-injury earning capacity, it also doesn’t require them to be miserable.

 

Personal experiences

In summary, plans that are reasonable and appropriate are likely to succeed. Plan success means achieving the goal of vocational services to help work injury claimants resume continuous, successful, and gainful employment. Retraining is an incredibly valuable benefit. For many, retraining is the only hope for returning to work. However, to achieve employability, for it to truly succeed, the plan must be reasonable and appropriate. Sadly, I don’t feel like we place enough emphasis on the importance of reasonable and appropriate retraining plans. While not universally true, I feel that stakeholders put more effort on pushing plans through approval than ensuring they’re reasonable and appropriate. I commend and thank the vocational rehabilitation counselors who actively work for reasonable and appropriate plans. Your work truly changes lives for the better!

 

Interestingly, Terry, my paralegal, was injured at his previous workplace and went through retraining under his workers’ compensation claim. That’s how he achieved his paralegal diploma. Recently, I asked him what retraining meant to him. He replied:

When I went through the plan development process, it was important to me that I found a plan that fit my aptitudes and physical restrictions. I needed my training program to provide me with the skills needed to safely support myself and my family in a new job. I was fearful that I would not be able to find this because early on in the process, I was being presented with options such as weeks-long office assistant that appeared to be within my physical restrictions, but very minimal in the job skills that would be acquired. If I had not been able to get in a program that was appropriate for my educational and physical situation, I would have likely ended up back in a labor-based job, risking further injury.

L&I Claim in Washington State: How does it work?

L&I claim benefits and workers’ compensation claim rules vary from state to state. L&I claim in Washington State follows the requirements of the Industrial Insurance Act. Here, in Washington State, the goal is to provide benefits to people with a work injury claim and their dependents.

 

Labor and Industries (L&I)

The Department of Labor and Industries (L&I) is the Washington State agency that administers these benefits. Consequently, it’s L&I’s job to determine the benefits to provide in every workers’ compensation claim. Generally, employers and employees statewide pay workers’ compensation insurance premiums out of every paycheck. For state-funded work injury claims, L&I pays benefits out of the premiums they collect throughout the year. Overall, when I think about all available L&I claim benefits,  I group them into categories: treatment, wage replacement, vocational, and closing.

 

L&I claim medical treatment

L&I must authorize treatment that is “necessary and proper” for any condition that relates to the work injury claim. In essence, “necessary and proper” typically refers to diagnostic, curative, or rehabilitative treatment. Moreover, L&I does not consider purely palliative treatment as necessary and proper under the law. L&I uses a third party called Comagine to help determine whether treatment fits the definition. Usually, treatment continues until the work injury claimant gets to maximum medical improvement. That’s when medical providers say the person with the work injury is as good as they are going to get.

 

Wage replacement in workers’ compensation claims

Employers can opt to keep the work injury victim on salary while they recover. However, in many cases employers don’t do this. Then, if the work injury claimant can’t work or has reduced earning capacity, they may be entitled to wage replacement benefits. Explicitly, these include time loss compensation or loss of earning power. Realistically, L&I pays time loss compensation if the work injury claimant is temporarily incapable of working while recovering. This is referred to as being “temporarily totally disabled”.

 

L&I pays time loss compensation benefits at base rate of 60% of the work injury claimant’s wages at the time of injury. Loss of earning power benefits are paid when the work injury victim can work to some extent while recovering but has at least 5% reduction in earnings.

 

L&I claim vocational benefits

Surprisingly, many people don’t realize that vocational services are part of their L&I claim benefits package. Personally, I think that  vocational benefits are particularly important for work injury claimants. Many workers need retraining to get back to work. In particular, this is often the case for people that work physical jobs after they suffer a work injury. Often, their work injury results in permanent physical limitations. When this happens, L&I can authorize and cover the costs of retraining for up to two years. Finally, L&I assigns a vocational counselor to oversee the entire process.

 

Closing L&I claim

Are there L&I claim benefits during claim closure? Yes! Many people are surprised to learn that L&I pays certain benefits when their workers’ compensation claim closes. In fact, L&I provides benefits at claim closure whenever the injured person has permanent measurable residuals. Many times, the person having the work injury is capable of working (despite the residuals). For compensation, they should get a permanent partial disability award (PPD award). The PPD is a monetary award. L&I bases the PPD award amount on the permanent disability that they can measure. More correctly, a competent medical provider is responsible for measuring the level of disability.

 

Sometimes, the person that suffered an injury at work is no longer capable of working. In such instances, we refer to them as “permanently totally disabled”. L&I places such injured people on an L&I pension when their claim closes. The value of L&I pension benefits is comparable to time loss compensation benefits. However, L&I pays pension benefits monthly for the remainder of the work injury victim’s life. That’s true as long as they remain permanently and totally disabled.

 

The role of a workers’ compensation attorney in Washington State

An L&I attorney or workers’ compensation attorney like me has several roles. For one, L&I attorneys ensure that L&I and insurance companies provide work injury claimants the benefits they deserve under the law. Furthermore, L&I issues orders or notice of decision letters regularly. These decisions are very important. They often contain entitlement to benefits. In many cases, people with L&I claim disagree with L&I’s decision. Therefore, they can protest or appeal the decision. Many times, the likelihood of success can be much higher with the help of an L&I attorney.

Kept-on-Salary: Employers Misuse the Program After a Work Injury in Washington State

The Department of Labor and Industries (L&I) has many initiatives and incentives. For employers, L&I designs incentive programs to help mitigate premium increases due to L&I claim costs. One program encourages employers to keep workers on salary after a work injury or workplace disease while they recover. Generally, when employees are unable to work after a workplace injury, we refer to them as “temporarily and totally disabled”. During that time, they are eligible for time-loss compensation benefits.

 

What is kept-on-salary in your L&I claim?

L&I pays time-loss compensation at a base rate of 60% of the work injury claimant’s wages at the time of injury. However, for self-insured employers, the employer insurance company makes these payments. Then, in some cases, the employer insurance premiums under L&I or their insurance provider might increase. L&I gives employers the option to keep employees on salary. Therefore, employers can continue to pay the employee after a work accident. Consequently, during that period the employer doesn’t pay time-loss, and their premiums don’t increase.

 

Keeping a person on salary after a work accident or work injury means that the employer continues to pay salary and benefits as before. Here, employers must make consistent payments on certain pay-dates and pay periods without interruption. There are several payments that don’t fall under kept-on-salary. For example, holiday pay, vacation pay, sick leave or bereavement pay do not count. Also, shared leave, severance pay, and paid time off do not constitute kept-on-salary. If an employer decides to reduce or stop benefits, they must report to L&I immediately. In fact, the employer must tells L&I that it’ll keep a work injury claimant on salary. When they do, L&I sends the employer a letter explaining all the relevant rules.

 

The kept-on-salary program in reality

Many people with a workers’ compensation claim that call my office tell me about their experience. Unfortunately, I frequently see employers misusing the kept-on-salary program. Whether the misuse is intentional or accidental, it often has serious negative consequences for people after a work injury. In detail, I mainly encounter four common kept-on-salary problems. The first issue is when employers tell the work injury victim that they must first use sick time and paid time off or vacation. Often, this happens early in the L&I claim process before workers even think to speak with a workers’ compensation attorney about their workers’ comp claim. The second misuse is when the employer reduces the work injury claimant’s payments to minimum wage. In some cases, they discontinue paying for certain benefits like healthcare. Sometimes, it’s because the person injured at work is not accruing work hours.

 

Next, the third common problem is when the employer changes their mind and stops payments. When this happens, I see employers make one payment on schedule and then fail to make next payments. Many times, they don’t give the work injury victim any notice in advance. Also, employers often don’t report this to L&I. Eventually, after getting nowhere with the employer, the work injury claimant may ask L&I to pay time-loss. However, there may be additional delays while L&I verifies that the employer is not keeping the worker on salary. This can result in significant delays in payment. On occasion, this cycle happens repeatedly throughout the workers’ compensation claim administration process. Finally, the fourth common misuse is failing to make payments on certain pay periods.  When this happens, the person that suffered the injury at work is unable to predict when they’ll get payments. It’s incredibly stressful.

 

Personal opinion and notes

I don’t take issue with L&I creating incentive programs for employers. On the contrary. These incentive programs make a lot of sense and we need more of them. However, I certainly have a big problem when these programs are detriment to people with a work injury claim. Many individuals that suffer an injury at work have so much to worry about. For example, their recovery, financials, caring for their family, among many other concerns. They should not have to wonder whether they will receive their next payment while they can’t work.

 

If you have a workers’ compensation claim and you encounter challenges while you’re kept on salary, you should notify your L&I claim manager right away. You can also pick up the phone and consult with an L&I attorney. Be safe and be well. I wish all work injury claimants a speedy recovery and quick return to work.

 

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