Category: Medical Conditions (Page 13 of 19)

L&I Claim Medical Aid Rules and Fee Schedule

With an L&I claim or workers’ comp claim in Washington State, it can be very difficult to understand treatment payments, policies, and procedures. This is a big problem for L&I medical providers in the provider network (or MPN) and for people that have a work injury claim. For doctors, it’s challenging to know which billing codes to use. On top, it’s hard to tell the rates that the Department of Labor and Industries (L&I) pays for services. Finally, it’s unclear if and what services require pre-authorization.

L&I resources for medical questions

L&I created resources to address the challenges mentioned above. Unfortunately, many medical providers as well as work injury claimants don’t know that these resources exist or where to find them. Yet, questions about medical billing and fees arise in every workers’ compensation claim.

The L&I treatment policies are available in the Medical Aid Rules in chapter 296-20 of the Washington Administrative Code, or WAC in short. Reading or referencing the WAC can be frustrating and time consuming. After all, it’s code that people use mostly for legal purposes. Furthermore, not everyone is familiar with the administrative code writing style and language.

The L&I fee schedule reference

Fortunately, L&I has some useful and user-friendly tools on its website. For example, L&I publishes its annual Payment Policies and Fee Schedules, by year. One of the resources within these publications is a Quick Reference Card. Interestingly, this card contains the most common and frequently used codes. However, for services that are not available in the Quick Reference Card, there are several ways to find the fee schedule and payment policies.

Billing code lookup in an L&I claim

If you know a billing code, then L&I has a Fee Schedule Lookup tool that you can use. Here, simply enter the code and a box appears outlining coverage, fees, and authorization requirements. For example, for billing code 10004, we get the following information from the L&I website.

Even better, in cases where you must obtain pre-authorization, you can click the link that writes “Yes – Claim Manager”. After that, it redirects you to the pre-authorization form that you’ll have to use. Finally, it’s worth noting that many providers find it surprising that many treatments and services do not require pre-authorization.

Preventing Work Injury and L&I Claim Occurrences Among Young Workers

/ L&I attorney / 0 Comments

A catastrophic work injury is devastating and life-changing event. This is especially true when we talk about first-time or young workers that suffer an injury on the job. In fact, these are some of the most gut wrenching and challenging cases I handled during my career as a workers’ compensation attorney. Fatal work accident injury incidents are always emotionally difficult. However, they are significantly harder when they involve our younger workers.

Work injury among teen workers

According to studies, workers between the ages of 16 and 20 sustain more cases of injury at work than older workers. I previously wrote about some of these work injury examples. Consequently, Washington State employers that employ a higher percentage of young workers are likely to experience higher workplace injury rates. If you look around, young employees are part of the labor force in many common industries such as retail, hospitality, and the service industry. Moreover, we often see younger individuals taking jobs in health and fitness, childcare, and the automotive industry.

Some researchers suggest that young workers incur more work injury occurrences because they take more safety risks. Others attribute it to lack of experience and knowledge. Regardless of why it happens, we can all agree that improving safety and reducing the chances for workplace injury is an important goal.

How to reduce L&I claim incidents for young employees

Employers are always responsible for teaching their workers about work safety. However, additional resources such as the SAFEME app can help as well. For example, this application supplements employer safety education and targets younger workers. It aims to educate members of our younger labor force about how to work safely. The app is free. It’s available online and also for iPhone and Android.

The Department of Labor and Industries (L&I) helped to fund, develop and support the SAFEME application. Furthermore, in recent news, the Washington Retail Association secured a grant to translate the SAFEME app to Spanish and provide 24 training lessons. This work safety app is quickly becoming a useful resource for both employers and workers. I applaud this initiative and wholeheartedly hope that it will lead to safer work practices for employees in Washington State.

Fatigue is a Major Cause of Work Injury and Workers’ Compensation Claims

/ L&I attorney / 0 Comments

The Washington State Labor Council and the Department of Labor and Industries (L&I) recently held a seminar concerning Workers’ Compensation matters. I attended the seminar as it covers several topics that relate to my area of practice. The final segment included an important reminder about work safety: Fatigue is dangerous!

Fatigue can lead to work injury or workplace accident

According to the US Department of Labor, long, extended, and irregular work hours cause work fatigue. In fact, fatigue is a very serious workplace safety concern, especially during COVID-19. These days, workers are juggling so much and working under irregular circumstances. Furthermore, recent statistics show that fatigued working conditions and tired labor workers are currently at an all-time high.

Simply put, working longer irregular hours causes mental and physical stress. Consequently, these undesirable and stressful work conditions increase the risk for illness and workplace injury. More explicitly, loss of sleep and fatigue dramatically impact work safety in several ways:

1) Reaction time – If you sleep 6 hours or less, your reaction time can change from a quarter of a second to 4 seconds. Too often, this can mean the difference between making a lifesaving split-second decision and not.

2) Judgement and decision-making – workers that sleep 90 minutes less than usual are less alert. Specifically, this sleeping habit change can reduce alertness by 30%. Therefore, it becomes more difficult for workers to make good decisions. For example, in a high-risk work environment, it impacts the worker’s ability to recognize danger quickly and avoid work hazards.

3) Impairment – Fatigue from lack of sleep can cause more impairment than from drinking. Hence, fatigue-impaired workers cannot think clearly or critically.

Heavy equipment work injury as a result of fatigue

Workers operating dangerous or heavy equipment while experiencing fatigue is a recipe for disaster. It’s particularly concerning for people working as truck drivers under their commercial driver license (CDL). Realistically speaking, fatigue is a frequent factor in serious motor vehicle accidents. Just imagine an 18-wheel commercial truck and its driver, no matter how experienced, driving under exhaustion. Similarly, fatigue is a known contributor to errors in patient care and it increases workplace injury occurrences in the healthcare industry.

Interestingly, according to the US Department of Health, fatigue played a significant role in the following major accidents:

The 2005 BP oil refinery explosion
2009 Colgan air crash
Space shuttle Challenger explosion, and
Nuclear reactor accidents across the country

Worker health is top concern and priority

On top of increasing workplace accidents, occupational illnesses, and injuries, fatigue reduces the overall health of workers. Fatigue causes heart disease, stomach and digestive problems, and musculoskeletal disorders. Not to mention reproductive issues and depression. It can also contribute to some cancers (including breast and prostate cancer), sleep disorders, obesity, and worsening of chronic illnesses such as diabetes and epilepsy.

To summarize, fatigue is both dangerous and expensive. We all need to do our part to reduce fatigue in the workplace. Workers must get proper rest. When they do, they are more efficient, safer to themselves and their surroundings, and they are healthier. We are all very busy right now. On top, we are under a lot more stress than usual. However, we must do our best to not let these conditions impact the importance of rest and good sleep.