If the Department of Labor and Industries (L&I) closes your L&I claim or workers’ compensation claim, then you might be able to reopen it. However, if your L&I claim closed, it’s important to note that L&I doesn’t automatically reopen claims. In fact, your case must meet certain criteria to reopen an L&I claim. Yet, many work injury claimants get discouraged and give up instead of trying to apply to reopen their workers’ compensation claim.
My L&I claim closed – Now what?
In fact, some medical providers believe that L&I does not reopen claims. Other treating professionals think that the reopening process is too difficult. This is simply not true. It’s important for both people with a work injury claim, and for medical providers, to fully understand the reopening process and requirements.
In claims for physical work injuries, to reopen a workers’ compensation claim, you must show that certain conditions objectively worsened between terminal dates. If you want to determine whether these criteria are met, you must first understand some workers’ compensation concepts. These three basic concepts are: (1) Terminal dates; (2) Causal relationship of conditions; and (3) Objective worsening.
Terminal dates in a workers’ compensation claim
When you file an application to reopen an L&I claim, the term “Terminal dates” refers to two important dates. The first terminal date is when L&I closed your claim most recently. The second date is when L&I denied the most recent reopening application. Take the most recent date of the two. We denote this terminal date as T1. Next, the second terminal date (which we call T2) is the date when you filed the most recent application to reopen your workers’ compensation claim.
Causal relationship in L&I claim
We say that conditions are “causally-related” if the industrial injury or occupational disease is the proximate cause of said conditions. Here, proximate cause means a cause that, in a direct sequence, produces the condition. The law acknowledges that there may be more than one proximate cause. Therefore, the industrial injury or occupational disease must be one of the causes of the condition. Said differently, it doesn’t need to be the only cause. Furthermore, a condition can also relate in a causal manner if the industrial injury or occupational disease aggravated it or worsened it.
Causal relationship requires medical reasoning. Here, you must obtain a written medical opinion to show that the work injury or work illness caused the condition. In other words, you must find a doctor or a competent medical expert to say there is a causal connection and explain why. Remember, reopening requires worsening of causally related conditions. Hence, we must first identify the condition and the causal relationship.
L&I sometimes reopens claims for worsening of a condition. For instance, if doctors did not diagnose or relate a condition to the claim before claim closure. If the medical evidence supports that the condition relates to your work injury, or that the condition worsened and requires treatment, then L&I will reopen the claim.
Objective worsening in work injury claim
If you have a workers’ compensation claim, then L&I considers anything that you say as subjective. For example, saying that you are experiencing pain increase is subjective. It’s insufficient for claim reopening purposes. Alternatively, objective findings are ones that a medical provider can see, feel, or measure. To reopen a claim, a medical provider must show that the causally related conditions got worse between the two terminal dates. Additionally, these conditions must require treatment, or increase your disability level.
Here is an example. Say that you were hurt at work and your work injury caused a herniated disc. The doctors can clearly see the disk herniation on MRI. Practically speaking, the doctors can measure the actual size of the herniation. Based on the initial size, they determine that the disc is not impacting the nerves. Therefore, you do not need surgery and your treatment concludes.
Next, the claim is closed. Over time, the herniation gets worse and causes additional symptoms. Doctors get a new MRI where they see that the herniation is bigger. Now, the disc is impacting the nerves and needs surgery. Right then, you should file an L&I reopening application, and L&I should grant it. Moreover, if reopening occurs within 7 years of the initial claim closure, you may receive additional monetary benefits such as time-loss compensation and increased PPD.
Final remarks
If you want to reopen an L&I claim or a workers’ compensation claim in Washington State, you have to understand some basic terms. However, it’s not difficult to learn and understand them. It’s also not difficult to reopen your claim. If the conditions that relate to your claim objectively worsened, then you should apply to reopen your claim. Furthermore, with objective worsening, there is no reason for L&I to deny your claim reopening application.
