Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

Category: Medical Conditions (Page 1 of 18)

I Have 2 Or 3 L&I Claims – Can I Combine Them Into One Claim?

Some work injury claimants have 2, 3 or more L&I claims. In fact, you’d be surprised how many people have more than 1 workman’s compensation claim. Sometimes, you can combine multiple L&I claims into one. In legal terms, when you combine multiple claims into one, we call it “claim consolidation”. When can you consolidate several L&I claims? It depends. You can only combine claims if you meet certain requirements. For one, you can combine claims if they are duplicate L&I claims. Alternatively, you can consolidate L&I claims if they involve a subsequent aggravation.

 

Duplicate L&I claims

What is a duplicate L&I claim? Say you already have a workman’s comp claim for a work injury or occupational disease. A duplicate claim is when you file a 2nd claim for the same injury or illness. The new claim has the same injury date. And, it contains the same diagnosis or body part.

 

Sometimes, duplicate claims happen when you file an L&I claim that should be a self-insured employer claim. For example, say your doctor’s office filed a state-funded L&I claim on your behalf. Then, when they discover that your claim needs to be a self-insured claim, they file a second application. The 2nd submission is for the exact same work injury. Another example is when different medical providers file duplicate paperwork. For instance, a worker goes to the ER for an acute injury. After that, the worker follows up with a regular provider the next day. The regular provider may submit an L&I claim. However, they might not realize the ER provider also filed a claim the day before.

 

Subsequent aggravation resulting in multiple L&I claims

Say that L&I accepts your worker’s compensation claim. Here, under this first claim, L&I accepts coverage responsibility for certain medical conditions. A subsequent aggravation is when you file a new claim for an aggravation of these conditions, when:

1) There is already an open and symptomatic claim;

2) The conditions accepted in the first open claim are susceptible to re-injury; and

3) There weren’t new incidents or additional exposure.

 

For example, a workplace injury claimant develops a muscle strain lifting heavy objects. The worker files a claim. Moreover, L&I allows the claim and the claim is open. Fast forward, the person is getting treatment. Later, the medical condition gets worse. Eventually, the doctor files a new L&I claim for the worsening condition. Hence, if this happens, the new claim is a duplicate of the original claim.

 

When should I not combine all my L&I claims?

If the new claim isn’t duplicative and isn’t a subsequent aggravation, then you shouldn’t consolidate claims. In fact, I get calls from work injury claimants telling me their doctor, employer, or self insured third party administrator combined their claims. Every time I hear this – it’s a red flag. Only L&I has the power to consolidate claims.

 

If anyone thinks that consolidating claims is appropriate, they must ask L&I to do it. The request will be handled by the claim manager. Or, by the adjudicator responsible for the original claim. It’s important for L&I to make a formal decision about consolidation. This way, it gives the parties protest or appeal rights when the consolidation isn’t correct.

 

Additional examples for consolidating multiple L&I claims

On occasion, work injury claimants simply want to consolidate claims to manage their claims more easily. I certainly understand why they feel this way. Having multiple open claims at the same time can be confusing and difficult. However, unless the claims are duplicative or subsequent aggravations, consolidation isn’t appropriate. It doesn’t matter how much easier it may seem to manage the claims. You simply shouldn’t do it.

 

To summarize, there are only two circumstances to combine multiple L&I claims. The 1st is when you have duplicate claims. Then, the 2nd is if you have a claim for subsequent aggravation. Most importantly, only L&I can consolidate claims. If anyone else does it, you better contact a worker’s compensation attorney. Finally, by law, convenience alone isn’t a sufficient reason to combine claims.

 

L&I Denied My Claim for Occupational Disease – Why? What can I do?

Last week, we talked about cases where L&I rejected a work injury claim. Here, we’ll discuss examples and reasons when L&I denies claims for occupational disease. Remember, an occupational disease is when you develop a medical condition due to your work settings. In contrast, a work injury is when a sudden accident happens at work.

 

Occupational disease L&I claim

Occupational disease is sometimes called industrial illness. In Washington State, the law that governs this topic is RCW 51.08.140. By law, “occupational disease” means a disease or infection arising naturally (or approximately) out of employment conditions. That’s a complex definition. In simple words, it refers to cases where unique work conditions cause an illness or infection. Usually, these diseases develop over time due to your workplace environment.

 

The law in Washington State favors work injury claimants. Simply put, it’s more likely that L&I will approve or allow your workers’ compensation claim than not. To allow an occupational disease claim, there must be objective medical evidence. On top, the medical facts must show that your distinctive employment conditions are the reason for the disease.

 

Why did L&I deny my claim?

You must file your L&I claim on time. Don’t delay or file late. For timing, the rules for an occupational disease claim are different than for a workplace injury. Here, the time limit is 2 years. More explicitly, it’s 2 years from when a medical provider informs you (in writing) that you have an occupational disease.

 

Generally, filing and timing is almost never an issue. However, the top 1 most common reason for L&I to deny a claim is lack of causation. In other words, it’s when you don’t show how your work conditions caused the disease. Furthermore, if we dig deeper, then there are 2 main issues with showing causation. The first is lack of distinctive conditions at your job. Then, the second is when there are other conditions in your life that are more likely to cause the disease.

 

L&I claim denied – a deeper dive

Let’s talk about the first issue. Remember, your work environment must have unique conditions that can cause the illness. To meet this requirement, you have to show how your employment, more probably than not, gave rise to your sickness. Your work conditions have to be truly unique. They can’t overlap with conditions you encounter in everyday life. Or in other general jobs. To approve your claim, L&I must be able to connect the dots between your work and the illness. And, unless the connection is obvious, you have to help them.

 

For example, say you catch the flu at work. There’s no chance that L&I will approve your claim. Why? Because you’re equally likely to catch the flu outside of work. Even if you work in a hospital treating flu patients daily (with one exception for Covid – please refer to other articles on my blog to learn about Covid workers’ comp claims).

 

Identifying the reason and source of your industrial disease

The second issue with claim denial is causation. Even if you show unique work conditions. Still, you must also show how the conditions are responsible for the illness. One challenge I see often is that there are many different causes for diseases. For instance, Carpal Tunnel Syndrome (CTS) is an occupational disease with many legal contentions. Many times, your employer will contest your claim for Carpal Tunnel Syndrome.

 

Medical literature supports that certain work activities are risk factors for Carpal Tunnel Syndrome. For example, repetitive forceful pinching and grasping. However, there are other known potential contributing factors. They include age, gender, body weight and pregnancy. Frankly, blaming causation on other risk factors (especially aging) is the most common reason to deny a workers’ compensation claim.

 

Workers’ comp claim denial due to causation

L&I can deny your claim for more complex reasons. Sometimes, in certain work environments, the medical community is still trying to understand the sources of certain sicknesses. For example, we now know that working in nuclear power plants caused workers to develop cancer. However, workers weren’t aware of these risks when they worked there. Furthermore, the cancer diagnosis came years later. The Hanford nuclear site in Washington State is a good example. Occupational disease claims stemming from working at Hanford remain highly contested.

 

Another more complex reason is showing exposure. Particularly, this problem arises when workers get exposure to certain toxins at work. In such cases, workers don’t need to show that a specific toxic agent caused the disease. It’s probably already known in the medical literature. Yet, they still must prove their exposure at work. As before, workers must show how the exposure to the toxins (in contrast to other factors) caused the disease. This can be extremely difficult to prove without identifying specific toxins. Moreover, identifying toxins in the workplace requires significant expertise. It can be a very expensive process.

 

Final notes

Occupational disease claims are complex. They have many moving parts. Plus, there are many reasons why L&I denies industrial illness claims. However, no matter what, if you believe you have an occupational disease, go see a medical provider. Then, file a claim at the provider’s office. After that, if L&I rejects your claim, you only have 60 days to protest or appeal the decision. Use these 60 days to figure out why L&I denied the claim. Assemble evidence to show why they should allow the L&I claim. Advocate for L&I to change their decision. As always, if things get too confusing, contact a workers’ compensation attorney for help.

Why Did L&I Reject My Claim After a Work Injury?

Washington State has 2 types of workers’ compensation claims. One is a work injury claim. The other is an occupational disease claim. In this article, we’ll cover why L&I denied your L&I claim for a work injury claim. Next week, I will post another article about why L&I rejects occupational disease claims.

 

What are the requirements to file an L&I claim?

The Industrial Insurance Act governs all workers’ compensation claims in Washington State. Under the law, an industrial injury (see RCW 51.08.100) is something sudden and tangible. It’s an event that produces an immediate result. More simply, it’s when you suffer a work accident that results in an actual injury.

 

Washington State is biased towards workers. Yes, the law favors L&I claim approvals. You can file an L&I claim even for a minor workplace injury. Most likely, L&I will allow it. In fact, the Department of Labor and Industries (L&I) will allow a claim if you satisfy 2 requirements:

  1. There must be a sudden tangible traumatic event. We call this event the “accident”; and
  2. It must cause an immediate physical condition. The law calls this “bodily harm”.

 

Why did L&I deny my L&I claim?

The requirements to file an L&I claim are very simple. Therefore, it can be very confusing when L&I rejects your claim. Some common reasons why L&I can deny your claim are below.

 

L&I claim denial because the work accident didn’t happen

Sometimes, L&I gets information that the accident didn’t happen. Or that it didn’t happen at work. Information like this can come from employers, coworkers, or witnesses. If L&I thinks there’s credible evidence, then L&I will probably reject your claim. On occasion, L&I can question how the accident happened. For example, if they think it’s not as you describe it in the Report of Accident. In such cases, L&I may investigate and try to understand what really went on.

 

Therefore, you must always write down what happened. Use your own words. Do it as soon as you can. Describe to yourself everything in detail. Also, be sure to include the date, day, and time of accident. Write the location of the accident and who saw it. If there’s a video of the incident, then ask for a copy right away. Take phone numbers and email addresses for witnesses. Finally, if anyone says the accident didn’t happen (at all or at work) – ask witnesses to write what they saw.

 

L&I rejected my claim because I filed late

You have 1 year to file an L&I claim. That’s 1 year from the date of the accident. It seems like a lot. However, do not wait to file your claim. You should file as soon as possible. The longer you wait, the more likely it is that L&I rejects your claim. That’s because L&I will question the validity of your claim. Moreover, if you don’t file an L&I claim within 1 year, then L&I rejects your claim automatically. If L&I rejected your claim because of the 1-year limit – there’s (almost) nothing you can do about it.

 

L&I claim denied for lack of medical support

Not every workplace accident results in an industrial injury. To approve an L&I claim, there must be bodily harm. You have to show cause and effect. For example, falling off a ladder is a cause. A broken arm is an effect. Here, a medical professional must establish the connection between the accident and the body harm. In other words, a doctor must say your accident caused a medical condition that needs treatment. Alternatively, it can be a chiropractor, nurse practitioner, psychologist, or others medical professionals.

 

If there’s no supportive medical opinion – don’t be surprised if L&I rejects your claim. Therefore, make sure your provider fills the Physicians Initial Report completely. This form is part of the package they submit to L&I when filing your claim. Explain to your doctor exactly what happened. Make sure they understand how the accident caused the bodily harm.

 

L&I claim rejected because of incomplete report of accident

After a work injury, you must go to a medical provider. There, the medical office files your claim. To file, they fill the Report of Accident form. You must fill certain parts of the form. Other sections are the responsibility of the medical office. The form must be complete. Also, when sending the form to L&I, it must include the initial medical visit report.

 

L&I rejects claims if they don’t receive all the necessary paperwork. Hence, it’s important to fill your portion. Moreover, it’s absolutely fine to ask your provider if they filled their part. In general, issues with the Report of Accident are rare. On top, they are easy to fix.

 

Summary and conclusion

There are many reasons why L&I rejects or denies L&I claims. The purpose of this article is to provide some common reasons (and how to avoid them). There are other reasons too. However, please keep in mind the following takeaway. If you had an injury at work that needs medical attention – file a claim right away. If L&I rejects your claim, you have 60 days to appeal L&I’s decision. In those 60 days you need to figure out why L&I denied your claim. Put together evidence to show why L&I must approve your claim. Then, advocate for L&I to change the decision. If any of these things seems confusing or difficult – contact a workers’ compensation attorney for help right away.

 

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