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

Category: LNI Claim Appeal (Page 1 of 5)

Workers’ Compensation Attorney Fee and Costs in Washington State

People call me every day to consult about their workplace injury claim. Some of them are looking for representation. Almost always, attorney fees are a concern. The purpose of this article is to explain all L&I attorney fee considerations and costs.

 

Do I need an attorney after an injury at work?

Many work injury claimants can manage their claim on their own. Some people call it the “DIY” method. If you have an L&I claim, you don’t always need a workers’ compensation attorney. Moreover, the same applies to self-insured employer claims. Many people, especially with simple claims, can manage themselves just fine.

 

The Department of Labor and Industries (L&I) oversees all work injury claims in Washington State. Certain times, there are situations where you want to involve an L&I attorney. For example, when you have a claim appeal at the Board of Appeals. There are other cases where it’s best to have an attorney for your L&I claim. For instance, if your claim is complex, it’s probably best to let an attorney manage the claim.

 

Workers’ comp attorney fees are not like others

Many workers assume that L&I attorney fees are similar to other areas of law. If you ever dealt with other attorneys, then you probably know how they work. First, they charge you an initial retainer fee. Then, they bill a certain dollar amount for each hour of work. That’s not how it works with workers’ compensation attorneys.

 

Here, in Washington State, we have the Industrial Insurance Act. Under the act, work injury attorneys must work on a contingent fee basis. This means we get paid from the benefits we secure for our clients. In fact, we cannot charge on an hourly basis. It’s not allowed.

 

Maximum L&I attorney fee

By law, an L&I attorney can charge a reasonable contingent fee. In general, the fee cannot be more than 30% of the L&I benefits that we secure. For structured settlements or CRSA, the L&I settlement fee is 15%.

 

Some claimants think that if they win their case, then the other side will pay their workers’ comp attorney fee. That’s not true for board appeals. It’s also incorrect for benefits at the Department level. However, most workers’ compensation attorneys charge less than 30%. It mostly depends on the amount of work it takes to secure the benefits. In other words, if less work is required, then the fee percentage gets lower.

 

Cost of L&I claim appeal

Appeal costs are different from attorney fees. Overall, costs refer to the money you need to win a board appeal. To win, you must meet the burden of proof. Here, costs come from things like ordering medical records and paying court reporters. On top, you must pay expert witnesses for their time. Good witnesses spend time preparing and then giving a thorough testimony. Win or lose, these costs are the responsibility of the work injury claimant.

 

Workers’ compensation and free consultation

A workers’ compensation claim can be very complex. Furthermore, hiring an attorney is not an easy decision. Therefore, it’s important to think and decide if hiring a workers’ compensation attorney makes sense for your case. That’s why most L&I attorneys offer free consultation. During the consultation, the attorney can explain your situation. A good L&I lawyer will help you figure out if hiring an attorney is the right thing to do.

 

It’s important to have a candid and genuine conversation with the attorney during a consultation. It’ll help you make a fair assessment about your claim. Personally, I’m always happy to help work injury claimants understand all their options. Many times, I tell people they don’t need an attorney and I explain why. However, if you think you need L&I claim help, feel free to give my office a call. Let’s chat and make sure you’re on the right track.

 

Closing L&I Claim: Do I Need an Attorney?

I get calls from work injury claimants often. The #1 reason they call is because their L&I claim is closing. Also, the same goes for self-insured employer claims in Washington State. L&I claim closure can be very stressful. To help, I put together this checklist below. You can use it to check for any red flags. If there are some, I strongly recommend you consult with a workers’ compensation attorney.

 

L&I claim cannot close before maximum medical improvement

Your L&I claim cannot close before you reach maximum medical improvement. Again, the same applies to self-insured employers. Maximum medical improvement is sometimes calls medical fixity. You achieve it when there’s nothing more that doctors can do for you. Unfortunately, it doesn’t mean you’re healed. In short, it means that doctors don’t think you’ll get better with more medical treatment. Yet, many times, it’s unclear if you’re at maximum medical improvement. After all, it’s a doctor’s opinion. Therefore, it’s possible your claim is closing while your medical provider thinks you need more treatment. If that’s so, then it’s a red flag. You definitely want to contact an attorney.

 

Future employment issues

L&I must address future employment concerns before a claim can close. For example, if you have total disability. That’s one example where L&I can’t just close the claim. At very least, they have to pay for your disability. Total disability means you have physical or mental impairment. It impacts your ability to find or maintain a job. Any type of job within your skills. Not only the job at the time of your work injury. However, total disability doesn’t mean you’re helpless.

 

L&I has to evaluate and decide if you’re employable. For that, they consider your age, education, skills, and training. They also consider your experience and any previous limitations. Furthermore, they take into account limitations from your work injury. One way for L&I to resolve total disability is with L&I pension. Therefore, you should think if you have total disability. If you do, and if your claim is closing without pension, then call an attorney.

 

Permanent partial disability

We refer to permanent partial disability as PPD. Some work injuries or occupational diseases cause permanent conditions. For example, a loss of body function can be permanent. L&I has methods to assess your level of PPD. On top, there are several evaluation techniques. For assessments, a PPD rating medical expert must examine you. Many times, an IME performs the PPD rating. Other times, the attending provider can perform the PPD rating. After the rating, L&I decides the amount of your PPD award. One red flag is when you have permanent limitations without PPD rating. Or, when your rating seems low considering your symptoms. Another red flag is when you don’t receive a PPD award. Finally, it’s possible that some doctors disagree with your PPD rating. All these cases are red flags. It’s important you talk to an attorney.

 

 

Unresolved problems in your L&I claim

Some L&I claims start to close when there are ongoing issues. That’s a red flag. For example, closing a claim while there are time-loss compensation payment problems. On top, closing a claim with outstanding medical bills. And so on. You know your claim. You can tell if there are any lingering issues. If there are, then it’s critical to resolve them before the claim closes.

 

L&I claim closing when it should

There are plenty of cases with no red flags. Very often, L&I claim closure is appropriate. However, improper claim closure is also common. When you L&I claim closes, then L&I sends you a letter. If your claim closed and you didn’t receive a letter, then you must speak with an attorney. Usually, the closing letter contains a payment order or notice of decision. After that, the decision becomes final in 60 days. This means you have 60 days to protest or appeal. Personally, I always think it’s a good idea to talk to an L&I attorney if your claim is closing. You can always receive free information and tips that can help.

 

L&I claim reopening

Say your L&I claim closes inappropriately. Now, you can appeal and fight claim closure. If successful, L&I will keep the claim open and work to resolve the remaining issues. However, say your claim closes after they fix all remaining problems. In this case, you can still reopen your L&I claim in the future under certain circumstances.

 

Reopen L&I claim after it closes

These are certain requirements for reopening a claim. They are:

1) There must be an aggravation. This means that a condition in your claim got worse. More explicitly, for physical conditions, there must be objective medical findings. A doctor has to determine that your work injury condition deteriorated. In addition, you must show some medical tests to support the doctor’s opinion.

2) The aggravation requires more medical treatment or justifies higher disability rating.

3) The aggravation occurs between two specific dates. The first date is when the claim closed. It can also be the last date when L&I denied an application for reopening. Then, the second one is the most recent reopening application date.

 

Reopening due to new medical conditions

Sometimes, L&I can reopen a claim when a doctor finds new conditions. The conditions must relate to the workplace injury or work illness. This is true even if the condition wasn’t known prior to claim closure.

 

The 7 year L&I claim reopening rule

Many work injury claimants reopen a claim within 7 years of claim closure. If that’s the case, all L&I claim benefits may be available after reopening. This includes medical treatment, time loss compensation, and loss of earning power. On top, it includes increase in PPD, and even L&I pension benefits. But, if you reopen a claim after 7 years, you can only get more treatment. Unless the director of L&I grants you other benefit under their discretion.

 

Workers’ Compensation Appeals: How Long Will My L&I Claim Appeal Take?

The Department of Labor and Industries (L&I) decides when work injury claimants receive benefits under their L&I claim. When L&I makes a decision about entitlement, the decision is usually in writing. Frequently, the decision is labeled “Notice of Decision”. However, decisions can also be under “Payment Order”, “Wage Order”, or any other written document.

 

L&I claim protest versus claim appeal

Any party that disagrees with a written decision can protest or appeal it. For jurisdiction, a protest stays with L&I. However, an appeal takes the disagreement to the Board of Industrial Insurance Appeals (BIIA). In fact, there are many reasons a claim protest may be strategically better than an appeal, and vice versa.

 

I get questions about protests and appeals regularly. The most common question is: How long will it take to get a decision? Often times, L&I makes decisions following a protest very quickly. Surprisingly, sometimes I receive decisions just days after filing my client’s claim protest. When this happens, it makes me wonder whether L&I really took the time to fully reconsider if the decision is correct. In contrast, I’ve seen cases where L&I protests have gone months and even years without checking or addressing them. Yet, there’s some good news. With some prompting and nudging, the Department of Labor and Industries usually acts on protests relatively quickly.

 

Workers’ compensation claim appeal in Washington State

L&I appeals are different. First, the Board of Industrial Insurance conducts a mediation process. There, one or more mediation conferences take place, where the parties discuss and try to reach resolution without litigation. Afterwards, if mediation does not produce an acceptable outcome, then the case advances to litigation.

 

If the parties cannot agree or settle the claim, then it usually takes much longer to get a decision in an appeal. That’s because appeal hearings are essentially a legal proceeding. The appealing party has the burden of proving that L&I’s decision is wrong. This requires that party to present testimonies. Therefore, there can be significant costs associated with an L&I claim appeal under this path. For most benefits, at least some of the testimony must come from experts like doctors, therapists, and vocational counselors. This presentation of testimony takes time.

 

 

Board appeal and petition under a work injury claim

Once the parties finish presenting their evidence, the hearing judge reviews and compiles all the materials. Then, the judge issues a written Proposed Decision and Order. The decision contains findings of fact and conclusions of law for each issue in the appeal. Furthermore, any party that disagrees with the Proposed Decision and Order may file a Petition for Review. The goal of the petition is to ask the Board of Appeals to review the decision. Afterwards, if the Board grants the review, it must issue a follow-on Decision and Order. Once again, the Decision and Order comprises findings of fact and conclusions of law.

 

Work injury client representation and challenges

Personally, it’s important for me that people that suffer an injury at work have realistic expectations. Clients must understand how much time claim appeals can take. It’s particularly important because many injured workers are without money or access to claim medical treatment during the appeal.

 

I used to tell work injury clients that claim appeals could take as much as a full year. That’s from the time we file an appeal until we receive a decision. Recently, that estimation has changed dramatically. Currently, it seems that the Board of Appeals is backlogged. It appears they have challenges issuing written decisions. Some of my client cases are waiting 150 days or more for a written decision. Therefore, right now it’s very difficult for me to give accurate estimates.

 

I’m deeply concerned about the length of time for L&I claim appeals. Remember, many work injury claimants do not have access to financial or medical benefits during the process. Many are barely making it through.

 

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