Category: LNI Pension (Page 5 of 6)

L&I Cost of Living Adjustment (COLA) and the Washington State Accident Fund

The Department of Labor and Industries (L&I) recently announced the 2020-2021 benefits schedule. Every year, around July, L&I determines if a Cost of Living Adjustment (COLA) applies to workers’ compensation benefits. Sometimes COLAs are not applied. However, this year, there are adjustments to monetary benefits.

Cost of living adjustment under an L&I claim

In short, L&I benefits are going to increase by a little over 6% this year. This is a historically high increase. Last year, the cost of living change of 5.5% was also historically high. COLAs are based on the average annual wage of all workers in Washington State. In order for the increase to be over 6%, average annual wages of employees must also increase in a similar amount. For work injury claimants, this news could not come at a better time. If you would like to review more information about the COLA this year, please refer to the 2020-2021 Benefits Schedule.

However, we must also think ahead considering our current reality. Businesses, workers and employees have been severely impacted by the COVID-19 pandemic. Consequently, unemployment rates are very high. And, many businesses have been forced to close. Some of those closures are temporary. However, many are permanent. This is especially true in certain industries such as hospitality and retail. Both are industries that previously employed many workers. The Corona virus is going to negatively impact our economy for quite some time.

What is the L&I accident fund?

The Department of Labor and Industries administers the Accident Fund. Say that you had a workplace injury. Moreover, say that you are receiving payments and financial benefits under your workers’ compensation claim. Then, it’s important to know that the money is coming from the Accident Fund.

Previously, economic downturns had negative impact on the financial health of the Accident Fund. Specifically, during economic waves in the early and mid-2000s, Washington State businesses experienced L&I rate increases. In other words, employers had to pay higher worker’s injury insurance rates towards the fund. In 2003, the rate increase was an astonishing 28.8%.

Starting in 2007, we saw four straight years of L&I rate increases. Unfortunately, these rate increases were necessary. Businesses received significant rate rebates that left the Accident Fund nearly empty. In fact, there were $200MM in workers compensation rebates for employers in 1999 and 2000, and $315MM in rebates in 2007. It isn’t a coincidence that L&I rates had to increase after those employer rebates.

L&I workplace injury insurance rates in Washington State

The employer rebates depleted the Accident Fund. Therefore, L&I implemented an increase to the work injury insurance rate to repair it. Business and labor stakeholders on the Worker’s Compensation Advisory Committee (WCAC) decided to do something about it. Explicitly, the WCAC established targets to ensure that the reserves in the Washington State Accident Fund will be sufficient to withstand the next recession. Thanks to COVID-19, that next recession is already knocking on our door.

Currently, the Accident Fund is healthy enough to sustain the upcoming recession. Interestingly, recent forecasts estimate that the Washington State government faces $8.8B revenue shortfall through 2023. That kind of shortfall is going to require cuts. Because the Accident fund is healthy, the workers’ compensation system is going to be an easy target for tax cuts. Therefore, now more than ever, it’s important to focus and monitor the financial health of the Accident Fund.

Cost of living adjustment: Viewpoint of a workers’ compensation attorney

Our (currently) healthy workers’ compensation ecosystem provides a critical safety net for working families. That safety net prevents financial ruin when catastrophe strikes. For that reason, we must actively resist the kinds of Accident Fund depletion that we saw in 1999, 2000, and 2007.

As a society, we cannot afford to empty this workers’ compensation insurance fund and hope to save it with rate-increases later. For more information about this issue, please read this recent article. It was written by The Stand, which is a publication for workers in Washington State.

What Does My L&I Claim Worth? An Overview of Workers Compensation Claim Benefits

/ L&I attorney / 12 Comments

What’s the value of my L&I claim? What’s my workers’ compensation case worth? I get these questions all the time. And, my answer is always the same: “It depends”. For a better answer, it’s important to review the value of your L&I claim benefits.

What is the value of my workers’ compensation claim?

Knowing the value of your workers’ compensation claim or L&I claim in Washington State is tough. Calculating it isn’t easy. Remember- first you have to file your claim. Then, if the Department of Labor and Industries (L&I) allows it, you may receive various L&I claim benefits. Some of these benefits have a monetary value. Furthermore, the value is unique to each L&I claim because every claim is different.

The purpose of this article is to help you figure out the potential value of all available benefits. Remember, there’s no one-size-fits-all answer. There is no formula to calculate the exact value of your workers’ compensation claim. But, if you want to get a rough estimate, you can sum up the total value of all L&I claim benefits.

L&I claim benefits: Medical treatment

It’s very difficult to put a dollar amount on the value of medical treatment. For many, and in my opinion as well, it is invaluable. Generally, if your claim has been allowed, then L&I (or the self-insured employer) will cover your medical bills and expenses. That is, so long that the treatment is for conditions that relate to your work injury claim.

It is important to keep in mind that certain treatment recommendations must go through an authorization process. However, once you receive authorization, then L&I will cover your treatment 100%. This means that there are no out-of-pocket expenses. For example, co-pays or deductibles. It’s also reassuring knowing that you have a path to medical recovery. It’s always good to know that L&I will cover your medical bills for your L&I claim treatment.

Time-Loss Compensating – a key benefit

Say that you have an L&I claim. Also, say that L&I already allowed your claim. In addition, let’s assume that you’re unable to work. Then, you are eligible for monetary wage replacement benefits. Time loss compensation (TLC) is one such benefit. It’s what you get when you are temporarily incapable of working.

Your time loss wage rate is based on what you were making at the time you got injured at work. A single male of female individual with no dependents receives 60% of their wage. For time-loss calculations, take the 60% at the time you got hurt on the job. If you are married or have children, then you’ll receive a higher percentage.

Loss of Earning Power under an L&I claim

In some cases, after a work injury, some people are still able to work with limitations. For example, some work injury claimants can work less hours than before. Others might perform a light duty job that pays less than their job of injury. If you can after your injury, and your new salary is lower than before – you’ll receive compensation for lost wages.

Loss of Earning Power (LEP) covers this situation. It’s an L&I benefit. L&I pays it when you’re doing limited work that results in 5% (or more) decrease in your wage-earning capacity. This is a significant monetary value in any workers compensation claim. The specific value varies from individual to individual. As explained earlier, it all depends on your earnings at the time of injury at work or occupational disease manifestation.

Vocational services in L&I workers compensation claims

Some people are permanently incapable of returning to your work. If you are one, you can be eligible for retraining. If L&I approves your retraining, they will pay for your retraining program for up to two years. The total cost is approximately $18,000. But that’s not all. In addition to the $18,000 cost of retraining, L&I will pay time-loss compensation benefits. L&I will pay it throughout your entire retraining program.

The topic of vocational services in workers compensation claims is very broad. It is also very complex. There are many steps and services. You can read about important topics relating to vocations services by following the resources below:
1) Option 1 vs Option 2
2) Vocational services plan development
3) Job analysis
as well as many others. You can also refer to the high-level summary of vocational services in L&I workers compensation claims.

Permanent Partial Disability in L&I claim

Permanent partial disability (PPD) refers to loss of bodily function because of a work injury or work illness. The degree to which you lose bodily function is what we call PPD rating. In this context, you have to go through a PPD rating exam by a qualified medical professional.

There are many rules in PPD rating exams. Say that your permanent condition if for parts of the body that can be amputated. For example, an arm or a leg. Here, the PPD rating is based on percentage of loss of function. Then, there are parts of the body that cannot be amputated. For instance, the spine or mental health disability. In such cases, the PPD rating is based on levels called “categories of impairment”. These categories, and other rules and guidelines, are available in the Washington Administrative Code (WAC).

Either way, a doctor will try to assess the loss of your body function. For that, the examining doctor compares your condition with the condition described in the categories. Then, the doctor selects the category that best describes your level of impairment. The monetary value of the PPD is based on a PPD award schedule. The PPD award schedule is available on the L&I website.

Permanent Total Disability is an important L&I benefit

Total disability is a physical or mental impairment that prevents you from working. Usually, medical professionals or vocational counselors decide if you can work. If your disability prevents you from returning to work in the foreseeable future – we refer to it as Total Disability. L&I considers it to be a permanent condition.

With total disability, you must obtain an opinion from a medical provider. The provider will establish the likelihood that your disability will continue to impact your ability to work in the future. If you are indeed permanently totally disabled (PTD), then you’ll probably receive a pension under your L&I claim.

Pension in L&I claims

An L&I pension means that you receive monthly payments for the remainder of your life. L&I will send you payments so long as you cannot, and do not, return to work. As before, your pension payments depend on the amount you were earning before the injury. The pension benefit provides a source of income for people with severe injuries that can never return to work.

L&I Claim Fraud Hurts People with Work Injury Claims

/ L&I attorney / 0 Comments

Over the last week, the Department of Labor and Industries (L&I) issued two separate news bulletins about L&I claim fraud. Without question, people who defraud the workers’ compensation system in Washington State hurt other work injury claimants. It is a very serious matter. Again, anyone that commits any type of fraud relating to a workers’ compensation claim hurts injured workers.

Workers compensation fraud in L&I news

In one case, L&I received an anonymous tip that a Renton delivery truck driver was collecting workers compensation pension benefits while working. L&I says that this has resulted in one of the largest fraud cases in recent history. The accused man has been charged with theft of $325,000 in disability benefits that he wasn’t entitled to. Over the course of a 2-year investigation, L&I uncovered evidence including traffic infractions, payroll records, and trucking logs. The evidence shows that the man worked transporting apples between 2012 and 2017 while collecting disability pension benefit.

In addition to driving, the man was also reportedly lifting loads of 100-500 pounds. Clearly, it’s a very physical demanding work. Individuals are only entitled to pension benefits under their L&I claim or workers’ compensation claim if they are incapable of working as a result of their industrial injury or occupational disease. The man filled out declarations under oath stating that he wasn’t working, even though he was. Consequently, as is permitted under the Industrial Insurance Act, the Attorney General’s office is now prosecuting the man for felony fraud. At the same time L&I found that he willfully misrepresented himself and has demanded repayment of the benefits he wrongfully collected (with a 50% penalty on top).

Another case of workers compensation claim fraud

In another case this week, a 65 year old commercial real estate broker from Bothell pleaded guilty to attempted second-degree theft. As a result, he has been sentenced to 60 days jail time (with home monitoring) and 2 years probation. In addition, he must repay $86,484 to L&I in benefits that he shouldn’t be receiving. Upon investigation, L&I obtained damning surveillance footage, business records, and even exchanged undercover emails with the man regarding his services.

Workers compensation attorney and L&I attorney point of view

First and foremost, as an L&I attorney and workers’ compensation attorney representing workplace injury claimants in Washington State, our office condemns any and all claim fraud activity. At the same time, when I read stories like these, I am very conflicted.

On the one hand, fraud must not be tolerated. It is fraudulent activity that places all people that suffer a work injury under suspicion. On top, it drains the accident fund in Washington State: I believe L&I spends tremendous resources chasing cases of alleged fraud. Often, the injured workers that are investigated are innocent. They go through hell before that’s determined. Additionally, many work injury claimants spend their days fearful of doing something that will be perceived as fraud. That’s because work injury victims have been accused of fraud for engaging in simple activities like grocery shopping.

L&I claim videos showing work injury claimants

I regularly receive video footage from L&I or from opposing counsels showing “fraud” activity concerning my clients. The resources spent by L&I to obtain such videos are significant, and in my opinion, are also misused. I’ve received many videos showing the wrong person. Moreover, I regularly get videos of clients that show nothing more than usual daily activities.

Injured workers should know that it is not fraud to engage in the activities of daily living. However, it is important to modify activities and avoid doing things that exceed limitations imposed by medical providers. This is not only to prevent fraud accusations. It is for recovery and to avoid a reoccurrence of an injury. If you are an injured worker who is contacted by an L&I investigator, it is probably a good idea to speak with an L&I attorney first.