Category: LNI News (Page 5 of 22)

How Does L&I Occupational Therapy Work in My Claim?

The Department of Labor and Industries (L&I) has been working on a new Work Rehabilitation Guideline. The overarching purpose of the guideline is to address physical therapy and occupational therapy in L&I claims.

L&I claim work rehabilitation and utilization review

L&I collaborated with professionals from multiple relevant disciplines to develop the guideline. In fact, they worked with physical therapists, occupational therapists, and vocational counselors. In addition, they collaborated with representatives of the Office of the Medical Director at L&I. The 58-pages guideline draft is currently available on the L&I website.

The goal for the new guideline is to instruct providers and shape the policy for work rehabilitation. Importantly, it’s also intended to improve the L&I claim utilization review process. Personally, I think this new guideline extends L&I’s approach towards more uniform practices across all L&I claim medical providers. Furthermore, it seems to focus on early intervention and return to work (RTW).

Work rehabilitation in L&I occupational therapy

If you have an L&I claim or workers’ compensation claim in Washington State, you might be eligible for work rehabilitation. In general, for eligibility, a work injury claimant must meet the following criteria:

1) The L&I claim attending provider must opine that the work injury claimant is ready to participate in the program.

2) The injured worker must have had at least 2 months of recovery since the injury.

3) The person with the work injury must demonstrate good likelihood of succeeding in the program. Claim managers consider multiple factors when assessing the worker’s likelihood of success. Overall, these factors include vocational issues, behavioral health needs, and support network.

4) The claim administrator must clearly identify a return-to-work goal. Also, the goal has to include an applicable job analysis. Alternatively, it can include a description of job demands.

5) The program intensity has to match the work injury claimant’s individual needs. It must also consider the job demands and the availability of modifications-to-the-job within the labor market.

The new L&I occupational therapy guidelines

From my perspective, this new guideline seems to offer some good improvements. For example, I’m happy to see that L&I is focusing on the specific needs of each injured worker and their return-to-work goal. Previously, similar programs seem to follow a “one-size-fits-all” approach. Now, I genuinely believe that work injury claimants will perform much better because the program addresses their individual needs.

However, I’m concerned that this guideline falls short of meeting the intent and purpose of the Industrial Insurance Act. Specifically when it comes to this part:

“to protect injured workers, to provide them with sure and certain relief for their injuries, and to reduce to a minimum their suffering and economic harm.”

With this in mind, I feel strong disheartening when I read the definition of “work disability” in the draft guideline:

“Work Disability is a concept describing the overall societal context of why workers may have continued disability. This model includes the personal aspects (like physical injury and coping strategies of the worker) and places them within a framework of the larger healthcare, legislative and workplace systems; all of which have impact on the benefits, incentives and decision-making for RTW options. Ultimately, these factors influence the worker to make a decision on when, or if, they RTW. Addressing these factors is part of a worker’s recovery and when particular barriers to recovery are identified, efforts can be made to address and work toward satisfactory solutions. This requires proper messaging from all providers about the nature of work disability and methods to foster patient engagement.”

Concerns and opinion

First, this definition isn’t consistent with the legal definition of total disability. Beyond that, it demonstrates one of the biggest challenges work injury claimants face during L&I claims. Explicitly, having their pain complaints taken seriously. Sure, pain is a subjective complaint. Workers’ compensation laws require at least one objective finding to support the extent of a work injury claimant’s physical disability. However, treatment providers are not required to rely solely on objective findings.

Guidelines like this should do a better job in helping treatment providers understand how to appropriately acknowledge and validate work injury claimant pain complaints. Being in pain doesn’t mean that a person doesn’t want to get back to work. It also doesn’t mean they think of themselves as disabled. Moreover, in my experience, if you treat people after an injury at work as if their pain is driven by disability conviction, return to work avoidance, or secondary gain – that’s the best way to destroy the provider-patient relationship. Consequently, there’s a very good chance that their treatment will fail.

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

/ L&I attorney / 11 Comments

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

/ L&I attorney / 0 Comments

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.