Category: Medical Conditions (Page 12 of 19)

L&I Claim for Crime Victims

Did you know the Washington State Department of Labor and Industries (L&I) provides coverage and benefits following for crime victims, after a violent crime? L&I provides this coverage under the Crime Victims Act. Yes, you can have an crime victim L&I claim. It can be extremely helpful to victims with significant injury or limited health insurance. It can also be very useful for families of homicide victims. While there are important differences, the L&I claim process to administer these claims is similar to a workers’ compensation claim.

L&I claim benefits and requirements for victim of crime

Crime victim L&I claim benefits are available to individuals that sustained a physical injury or mental health trauma from a gross misdemeanor or felony crime. Eligibility requires the injury victim or the family of the deceased to: (1) Report the crime to law enforcement; and (2) File a timely application for benefits.

Filing a report and applying for benefits

A necessary first step is filing a police report. Surprisingly, failure to make a police report is one of the most common reasons for L&I to deny a claim. Then, in addition to reporting the crime, the victim must cooperate with the investigation. Timing wise, you must file the report within one year from the date of the crime.

Furthermore, the injury victim (or family of the deceased) must sign and submit an application to L&I. Here, there are different forms available for injury victims versus the family of homicide victim. On top, you have to file the application within two years of the date of the police report. However, in some circumstances L&I may allow you to file the application up to five years. Additionally, for minors, applications are timely if submitted within two years of their 18th birthday. Given all these variances, it’s best to file the police report and application for benefits without delay.

Crime victim L&I claim: payments and limitations

Every L&I claim for crime victims is different. Consequently, L&I pays different benefits based on the facts and circumstances under each claim. Potential benefits include medical, dental and/or mental health treatment (including grief counseling). Moreover, they can include medication, partial wage replacement, and funeral expenses. In some cases, they can also cover expenses such as copays and deductibles. However, L&I does not cover payments for crime scene cleanup, identity theft, or loss of personal property.

The maximum payment amount under an L&I claim for crime victims is $190,000. Yet, other limitations also apply. For example, just like time-loss compensation benefits, wage replacement benefits in a crime victim L&I claim is 60% of the victim’s wages. The maximum dollar amount paid in wage replacement benefits for temporary disability is $15,000. In actuality, this money can be a vital lifeline for recovering victims. If a victim is permanently and totally disabled and cannot return to work, wage replacement benefits are limited to $40,000. Similarly, medical expenses also have limits. More explicitly, $150,000 is the maximum coverage amount for medical and mental health treatment.

Finally, L&I claims for crimes include benefits to families of homicide victims. Family benefits are limited to $40,000. This figure includes a maximum of $6,620 for burial expenses.

Work injury as a result of a crime

In conclusion, if you suffer a crime-related injury while you were working, then you are covered by the Industrial Insurance Act. This is the same law that covers any other work injury claim or workers’ compensation claim in Washington State. Furthermore, this act is not subject to the limitations above, for L&I claims for crime victims. Also, individuals that suffer an injury while committing a felony crime are not eligible for benefits under either act.

Denying Medical Condition in L&I Claim: Work Injury Causation vs Degenerative Changes With Age

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As we all get older with age, our body tends to wear down. Like all things human, the rate and severity of a wear and tear from aging varies from person to person. In this article, we cover cases where L&I condition is denied. For example, because of age.

Age-related degenerative medical conditions

Medically speaking, many refer to the term musculoskeletal aging as “degenerative” or “arthritic” changes. Most human adults are going to experience these changes. However, they do not always cause symptoms such as pain, limitation of movement, and others. In general, doctors can determine the severity of the changes through an X-ray or MRI test.

Because of aging, our body may also be more prone to injuries or illness, including work injury and occupation disease. If you suffer an injury on the job, our age and degenerative changes can sometimes complicate matters. In fact, they can make it more difficult to find the cause for a certain medical condition. For example, after an injury at work, did the work injury cause the medical condition? Or is it the person’s age and the natural aging process?

If L&I denied a medical condition then…

Personally, it’s very common to see the Department of Labor and Industries (L&I) denying these bodily changes under a workers’ compensation claim. That’s because L&I considers the changes as degenerative. In other words, they often argue that the cause isn’t the workplace injury or work illness (or work-related exposure). However, in my opinion, this assessment is wrong in many cases. Moreover, the Industrial Insurance Act contains clear legal principles concerning causation in the context of aging.

Workers compensation claim in Washington State: The law

In Washington State, workers’ compensation covers all workers regardless of their age or prior health. When considering the impact that a work injury or workplace exposure has on a person, the basis for the consideration must be the individual worker. Therefore, it doesn’t matter what the impact of similar workplace injury or illness might have on some other persons. However, having said that, we must take into account preexisting conditions. And when we do, we must examine their status, i.e., what each condition was like previously.

Say that a person with an L&I claim or workers’ compensation claim had a condition that wasn’t causing any problems. According to the law, if the work injury or occupational disease made it symptomatic, then the condition is causally-related. Similarly, take another example where a person with a work injury claim had a condition that was causing problems. Here, if the work accident or illness made the condition worse, then it’s also causally related.

The age factor when a condition is denied by L&I

Hence, in every workers’ compensation claim, we have to pay special attention to conditions that can worsen with age. As we get older, more medical conditions may surface with our natural aging process. Yet, it doesn’t preclude L&I from accepting the medical condition under an L&I claim. Most importantly, with every workers’ comp claim, it’s critical to examine the facts that pertain to the individual claimant, including his/her conditions, now and in the past.

Work Safety and L&I Claim for Fire Fighters Dealing with Fire and Smoke

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The Department of Labor and Industries (L&I) has good news for fire fighters and others that expose themselves to fire smoke. Explicitly, Washington State will be among the first states to develop health and safety rules to protect wild fire workers in their jobs. This article covers fire fighter L&I claim issues and special considerations.

Fire fighting and air quality

Wild fire occurrences increase every year. Sadly, over time, the entire West Coast is losing more land and woods to fires. Therefore, every fire fighter in the fire department has greater exposure to more unhealthy air quality during wild fire season. In fact, fire smoke during September 2020 caused some of the worst air quality in the world in Western Washington. The poor air quality lasted a long period of time. As a result, the authorities encouraged residents to stay indoors and avoid breathing the toxic air.

Unfortunately, outdoor workers cannot stay inside to avoid the bad air. If you are a construction worker, mail carrier, farm worker, or firefighter, you must be outside to perform your job. Moreover, we have to consider that wild fire season aligns with harvest time for many crops in Washington State.

Fire fighter L&I claim: Exposure to fire, smoke and chemicals

According to studies, long exposure to this kind of toxic air causes acute health conditions and occupational diseases. The hazards include more than the smoke alone. Fire fighters, for example, expose themselves to not only to fire smoke but also to chemicals and gases. Many other workers also deal with fine particles in the air that can lead to significant health issues. These health effects are expensive, both in terms of treatment costs and lost work time.

Last September, outdoor worker and advocates accused employers (and the government) of not doing enough to protect them from fire and smoke. In response, L&I took steps recently to begin drafting rules to remedy the situation. Here, the goal for L&I is to develop clear health and safety regulations for identifying and controlling harmful exposures. Thus far, we know that the regulation will also include the use of personal protective equipment (PPE).

Conclusion

Personally, I’m proud to share that Washington State will be the second state to develop these safety rules and regulations. Consequently, L&I will work closely with fire fighters and other stakeholders to ensure the new rules are on point. Like always, there will be opportunities for the public to provide comments and weigh in as well.