Category: LNI Pension (Page 3 of 6)

Claim closure – What does claim closure mean?

People with an L&I claim in Washington State tend to have lots of questions about claim closure. Some of the most common questions I get are: Why is my claim closed? What does closure mean? What if my condition gets worse after my workers’ compensation claim closes? Did I get everything I was supposed to? What if I disagree with L&I closing my claim?

Every L&I claim is unique

Every work injury and workman’s comp claim are unique. As a result, people have different questions about their specific situation. Therefore, it’s very difficult to give general answers that apply to everyone. Sure, there are some high-level pieces of information that apply to all. However, a general answer might not fit your L&I claim circumstances. Either way, it’s always a good idea to consult with an L&I attorney or a workers’ compensation attorney before your claim closure becomes final.

My claim closed – What does closure mean?

The Department of Labor and Industries (L&I) closes claims after treatment completes and after they determine your return to work or employability status. Once a workers’ comp claim closes, work injury claimants cannot receive any more benefits under the claim. Specifically, your L&I claim no longer pays for medical treatment and medication. Furthermore, L&I stops paying benefits like time loss compensation and loss of eating power (LEP). Finally, L&I stops providing services such as vocational counseling or guidance. However, if L&I decides you are permanently and totally disabled, you will receive monthly L&I claim pension benefits after the claim closes.

What if my condition gets worse after my claim closed?

The most common concern I hear from clients is about worsening medical condition. Here, there are some good news – You can reopen an L&I claim! To do it, you must show objective worsening that relate to the medical conditions under your L&I claim. Practically speaking, you must show that you need further medical treatment. Alternatively, you can show that your disability is worse than before. Then, there are slightly different rules for mental health conditions. For example, with mental health claims, objective worsening isn’t a prerequisite. Yet, it’s still mandatory to have an expert medical opinion on worsening before L&I reopens your claim.

If you reopen your workers’ compensation claim after 7 years, then you might be able to receive all types of benefits. After 7 years, you can still reopen your L&I claim, but only for medical treatment. Even then, you can ask the L&I Director to exercise discretion and grant additional benefits.

Did I get everything I deserve?

This is the most challenging claim closure question to answer. Every work injury has different circumstances. Consequently, there are different benefits under every claim. Benefits can include medical treatment, time loss compensation, and loss of earning power. There can also be vocational services and retraining benefits. Sometimes, permanent partial disability awards and permanent total disability might apply. If you’re not sure you received the benefits you deserve, you should speak with a workers’ compensation attorney.

What if I disagree with closing my claim?

Many work injury victims disagree with their workers’ comp claim closure. If you are one of them, you must protest L&I’s decision within 60 days. However, if L&I affirms its decision, you can submit an appeal to the Board of Industrial Insurance Appeals (BIIA). If you do, make sure you have strong medical (and sometimes vocational) evidence to show that claim closure is wrong.

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.

l-and-i claim closure and medical expenses

L&I Claim Closed – Who is Paying for Future Medical Expenses?

/ L&I attorney / 0 Comments

What happens after my L&I claim closes? I get this question all the time. It’s one of the biggest points of stress for people after a work injury in Washington State. Moreover, this stress is particularly high for people that know they will incur additional medical costs after their L&I claim is closed. In this write-up, I’m hoping to enlighten workers about claim closure and who pays for future medical expenses.

Paying for medical expenses after L&I claim closure

Under WAC 296-20-124, the Department of Labor and Industries (L&I) will not pay for services after a workers’ compensation claim closes. However, L&I and self-insured employers are responsible to pay for services that relate to the claim reopening application. Furthermore, there are a couple of other important exceptions.

Workers’ compensation claim closure and payment exceptions

The first exception is for certain periodic medical exams. Here, L&I and self-insured employers must pay for certain periodic medical surveillance examinations. For example, these exams are very common in cases involving asbestos diseases. Generally, doctors recommend these exams under the medical protocol whenever they need to perform routine medical monitoring or maintenance.

Another exception is for medical equipment replacement. Under WAC 296-20-1102, L&I may cover repair or replacement of prosthetics, orthotics and other special equipment. However, after L&I claim closure, you need to get pre-authorization from the prescribing medical provider. Explicitly, your doctor needs to provide a document to L&I to explain the need to replace or repair the item. For example, your doctor will have to explain that the medical device incurred damages, broke, or is worn out. Finally, note that crutches, cervical collars, and lumbar and rib belts (as well as other low-cost orthotics) don’t require preapproval. Of course, there are also limitations on the kinds of items that L&I will cover. As an example, L&I will not cover inversion traction equipment, vibrators or heating pads. They will also not cover home furnishings, hot tubs and exercise equipment.

Personal recommendation

In my opinion, I always think it’s a good idea for people with a work injury claim to plan for their L&I claim closure. In part, they should discuss medical expense (and other) concerns before claim closure becomes final. On top, there are special considerations when medical surveillance exams or equipment repair applies in your L&I claim. In such cases, I recommend that claimants, medical providers and L&I get on the same page regarding process and procedure after claim closure.