Category: LNI News (Page 4 of 22)

L&I Claim Interpretation Services in Washington State

The Department of Labor and Industries (L&I) oversees work injury claims in Washington State. Every L&I claim is unique. Moreover, L&I claims can be very challenging to work injury claimants. Some of the challenges are even more frustrating for workers who do not speak English well.

Interpreting services for L&I claims

L&I offers a variety of interpretation services for people with a workers compensation claim. Previously, interpretation services were available primarily for in-person appointments. For example, appointments or meetings such as a medical consult and vocational provider conversations. To set them up, providers go through the InterpretingWorks online system.

With COVID, L&I announced that interpreters who provide in-person services must be vaccinated. This is in line with the Washington State Governor’s mandate. In fact, the mandate requires most state employees, healthcare workers and long term care workers to be fully COVID-19 vaccinated by October 18, 2021. Moreover, under the mandate – employees, contractors, volunteers, and providers of goods and services in a healthcare setting must also get the vaccine. Hence, the mandate includes L&I interpreters.

L&I interpretation services for online meetings

With COVID-19, we’ve seen a surge in virtual, video, and telephonic appointments in L&I claims. Obviously, these kinds of appointments also have interpreting needs. Consequently, L&I provides telephonic and video interpretation services through CTS LanguageLink. The services are available whenever in-person interpretation services are impossible or unnecessary. Interestingly, CTS LanguageLink has been providing statewide interpretation services for Washington State agencies since 1999. They offer over-the-phone interpretation as well as video services.

Setting up interpretation services for your L&I claim

As before, it’s up to the service provider to set up interpretation services when they need them. Providers can use the phone numbers below to set up CTS LanguageLink services. More explicltly:

Medical providers should call 877-626-0678
Vocational counselors should call 844-303-7212
Activity coaches should call 844-303-5430
Client relations providers should call 855-579-2704

First, service providers need to set up an account with CTS LanguageLink in order to access the services. For signup, providers can establish an account by emailing their L&I provider number or ID, name, and email address to ClientRelations@Language.Link. Then, the company will verify your provider information before they activate your account. Once active, you can utilize the services whenever you need them.

The viewpoint of an injured worker

I’m a workers’ compensation attorney in Washington State representing work injury claimants. I’m always concerned that people understand what’s occurring in their L&I claim. Also, it’s imperative for injured workers to be able to communicate effectively with service providers. Therefore, it always encourages me to see service providers utilizing interpreter services. Furthermore, I am very grateful to L&I for making these services easily accessible.

L&I Claim Treatment Authorization for Low Back Conditions (and More)

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The Department of Labor and Industries (L&I) recently collaborated with the Industrial Insurance Medical Advisory Committee and the Lumbar Surgery Subcommittee. Together, they developed a new guideline for low back surgery. Consequently, medical providers that treat work injury claimants for low back conditions need to follow new rules starting October 3, 2021. The purpose of this article is to cover L&I treatment authorization topics for L&I claims involving back conditions.

L&I claim back injury treatment authorization

Under the guideline, the following procedures will not be authorized under any circumstances:

Artificial disc replacement
Sacroiliac joint fusion
Bone morphogenic protein-7 in lumbar spine fusions
Discography
Vertebroplasty, kyphoplasty, or sacroplasty
Percutaneous discectomy
Staggered lumbar fusion procedures
Interspinous process devices

However, if a work injury claimant meets certain criteria, the following procedures may be covered:

Lumbar decompressions including laminectomy, discectomy, microdiscectomy, and foraminotomy
Lumbar fusion
Bone morphogenic protein-2 in lumbar spine fusions.

Avoiding treatment denial in your L&I claim

Many work injury victims are treated for back injury under their workers’ compensation claim in Washington State. Under your L&I claim, you can check whether your claim administrator should authorize certain treatments. In fact, you can check the guideline and associated criteria on the L&I website. You must make sure that you meet the relevant criteria. If not, Comagine will automatically recommend to deny your treatment.

Sometimes, there are circumstances when providers feel that treatment is appropriate. This is true even if you don’t satisfy the authorization criteria. If that’s your case, then you have several options. First, the recommending provider can have a peer-to-peer review with Comagine. After that, the review might result in treatment authorization. Alternatively, you can appeal treatment denial to the Board of Industrial Insurance Appeals (BIIA).

Appealing L&I claim treatment denial

The BIIA follows legal standards when it reviews treatment authorization appeals. Under the law, treatment should be authorized if it’s proper and necessary. The term “proper and necessary” includes services to diagnose and treat any condition caused by an injury or occupational disease. Furthermore, treatments can also be curative or rehabilitative. Here, curative refers to treatment that produces permanent changes. For example, to eliminate or lessen the clinical effects of a condition. On the other hand, rehabilitative means treatment that helps regain functional activity on a long-term basis.

When appealing treatment authorization, BIIA follows legal definitions to determine if treatment is necessary and proper. Therefore, L&I treatment guidelines have little relevance to the BIIA analysis. Still, it’s unlikely that the BIIA will find new or experimental treatments necessary and proper in the workers’ compensation setting.

L&I Claim Appeal Cost in Washington State

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The Department of Labor and Industries (L&I) administers your workers’ compensation claim in Washington State. They decide what benefits work injury claimants can get. During your L&I claim (or self-insured employer claim), the department issues many decisions. Eventually, whenever you receive one, you can appeal the L&I claim decision. Furthermore, any party that disagrees with L&I’s decision can appeal to the Board of Industrial Insurance Appeals (BIIA).

Cost of BIIA appeal and the burden of proof

The BIIA is its own state agency and it’s completely separate from L&I. The BIIA reviews L&I decisions and acts like a court to decide the case. In fact, the BIIA decides the case according to the law. Here, the appealing party carries the burden of proving that L&I’s decision is wrong. In most cases, meeting the burden of proof requires testimony from expert witnesses. Usually, expert witnesses charge fees for testifying in BIIA proceedings. We refer to these fees as “costs of appeal”. Many times, these costs are significant.

People with a work injury claim are often upset when they learn about the cost of appeals. This is understandable. After all, most people don’t have thousands of dollars to cover costs. As a result, people might look for alternatives. In some cases, the issue at hand is primarily medical. When that’s the case, clients regularly ask me: “Can’t we just submit the medical records instead?”. The short answer is almost always: “No”.

L&I claim appeal and BIIA hearing procedure

In BIIA hearings, expert witnesses such as doctors must appear in person and testify. The BIIA will not allow notes, letters, reports or other documents into evidence if the other party objects to them. Practically, these kinds of documents are considered “hearsay”. Any reasonable attorney would object to them. Therefore, expert witnesses must testify when the issues under appeal involve benefits like:

My job as a workers’ compensation attorney

A big part of my job is helping work injury claimants decide for themselves whether the costs justify the benefits. However, in my experience, these decisions aren’t a simple cost-versus-benefit analysis. After suffering an injury at work, people have so much they have to consider. Deciding whether to proceed with an appeal is often one of the most difficult decisions they have to make.