Category: LNI Claim Appeal (Page 4 of 8)

L&I Rejected My Claim After a Work Injury – Now What?

Washington State has 2 types of workers’ compensation claims. One is a work injury claim. The other is an occupational disease claim. In this article, we’ll cover why L&I denied your L&I claim for a work injury claim. Next week, I will post another article about why L&I rejects occupational disease claims. And remember, if L&I rejected your claim, you should call an L&I attorney.

What are the requirements to file an L&I claim?

The Industrial Insurance Act governs all workers’ compensation claims in Washington State. Under the law, an industrial injury (see RCW 51.08.100) is something sudden and tangible. It’s an event that produces an immediate result. More simply, it’s when you suffer a work accident that results in an actual injury.

Washington State is biased towards workers. Yes, the law favors L&I claim approvals. You can file an L&I claim even for a minor workplace injury. Most likely, L&I will allow it. In fact, the Department of Labor and Industries (L&I) will allow a claim if you satisfy 2 requirements:

There must be a sudden tangible traumatic event. We call this event the “accident”; and
It must cause an immediate physical condition. The law calls this “bodily harm”.

Why did they deny my claim?

The requirements to file an L&I claim are very simple. Therefore, it can be very confusing when L&I rejects your claim. Some common reasons why L&I can deny your claim are below.

L&I denied my claim because the work accident didn’t happen

Sometimes, L&I gets information that the accident didn’t happen. Or that it didn’t happen at work. Information like this can come from employers, coworkers, or witnesses. If L&I thinks there’s credible evidence, then L&I will probably reject your claim. On occasion, L&I can question how the accident happened. For example, if they think it’s not as you describe it in the Report of Accident. In such cases, L&I may investigate and try to understand what really went on.

Therefore, you must always write down what happened. Use your own words. Do it as soon as you can. Describe to yourself everything in detail. Also, be sure to include the date, day, and time of accident. Write the location of the accident and who saw it. If there’s a video of the incident, then ask for a copy right away. Take phone numbers and email addresses for witnesses. Finally, if anyone says the accident didn’t happen (at all or at work) – ask witnesses to write what they saw.

L&I rejected my claim because I filed late

You have 1 year to file an L&I claim. That’s 1 year from the date of the accident. It seems like a lot. However, do not wait to file your claim. You should file as soon as possible. The longer you wait, the more likely it is that L&I rejects your claim. That’s because L&I will question the validity of your claim. Moreover, if you don’t file an L&I claim within 1 year, then L&I rejects your claim automatically. If L&I rejected your claim because of the 1-year limit – there’s (almost) nothing you can do about it.

L&I claim denied for lack of medical support

Not every workplace accident results in an industrial injury. To approve an L&I claim, there must be bodily harm. You have to show cause and effect. For example, falling off a ladder is a cause. A broken arm is an effect. Here, a medical professional must establish the connection between the accident and the body harm. In other words, a doctor must say your accident caused a medical condition that needs treatment. Alternatively, it can be a chiropractor, nurse practitioner, psychologist, or others medical professionals.

If there’s no supportive medical opinion – don’t be surprised if L&I rejects your claim. Therefore, make sure your provider fills the Physicians Initial Report completely. This form is part of the package they submit to L&I when filing your claim. Explain to your doctor exactly what happened. Make sure they understand how the accident caused the bodily harm.

L&I claim rejected because of incomplete report of accident

After a work injury, you must go to a medical provider. There, the medical office files your claim. To file, they fill the Report of Accident form. You must fill certain parts of the form. Other sections are the responsibility of the medical office. The form must be complete. Also, when sending the form to L&I, it must include the initial medical visit report.

L&I rejects claims if they don’t receive all the necessary paperwork. Hence, it’s important to fill your portion. Moreover, it’s absolutely fine to ask your provider if they filled their part. In general, issues with the Report of Accident are rare. On top, they are easy to fix.

Summary and conclusion

There are many reasons why L&I rejects or denies L&I claims. The purpose of this article is to provide some common reasons (and how to avoid them). There are other reasons too. However, please keep in mind the following takeaway. If you had an injury at work that needs medical attention – file a claim right away. If L&I rejects your claim, you have 60 days to appeal L&I’s decision. In those 60 days you need to figure out why L&I denied your claim. Put together evidence to show why L&I must approve your claim. Then, advocate for L&I to change the decision. If any of these things seems confusing or difficult – contact a workers’ compensation attorney for help right away.

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

/ L&I attorney / 2 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.

Workers’ Compensation Attorney Fee and Costs in Washington State

/ L&I attorney / 8 Comments

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.

L&I attorney fee – Maximum limits

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.