Category: Medical Providers (Page 1 of 18)

What Happens If I Suffer a Work Injury While Working a Light-Duty Job?

If a worker has an L&I claim, then their employer might offer them light duty work. However, a light-duty job offer must be valid. Work injury claimants who refuse valid light duty work can no longer receive wage replacement benefits. These benefits include time loss compensation and loss of earning power benefits.

What is a valid light duty job offer?

There are many types of light-duty jobs. Yet, under the workers’ compensation claim system in Washington State, there are special considerations. More specifically, a light duty job offer is valid if it meets 5 criteria:

(1) The job must be with the employer of injury.

(2) The employer must send the job description (sometimes called job analysis) to the attending provider and the injured worker.

(3) The attending provider must approve the job.

(4) The employer has to provide a written job offer to the work injury claimant. The offer needs to include a reasonable start date.

(5) The employer must reinstate health care benefits at the same level as of the time of injury. One exception is when there’s a superseding agreement in place.

Workers’ concerns regarding light duty jobs

Some work injury claimants are nervous about doing light duty work. Personally, I regularly encounter 2 common concerns. First, there’s a fear of needing to perform work beyond the worker’s limitations. These limitations are set by the attending provider. Then, there’s a second concern – suffering another workplace injury while working light duty.

The first concern is easy to address. Employers cannot ask workers to do something that’s not in the job description. Remember, the attending provider approved the job description based on the worker’s limitations. Therefore, when this happens, the light duty job is no longer valid.

Suffering a work injury while working a light duty job

The second concern is not so simple. Unfortunately, in real life, work accidents do happen during light duty work. And then, when they do, they cause additional frustration and stress.

It’s important for workers to understand how to handle work injuries while working a light duty job. Here, there are different options and scenarios. One scenario pertains to temporary light duty jobs. The other applies to permanent light duty work. If you suffer a work injury while working a temporary or transitional light duty job, then you have coverage under your original L&I claim. However, for permanent jobs, you need to file a new workman’s comp claim.

Which conditions and benefits belong to what work injury?

Either way, the new work injury will likely complicate your claim. That’s because it’ll interrupt medical appointments and chart notes in the original claim. It also depends on the body area and the nature of the second injury. Many times, it can be hard to keep conditions and symptoms separate from the original injury.

In addition, it can be difficult to determine benefits. Do benefits apply under the original L&I claim? Or under the second work injury claim? Or both? Administratively, it can be very messy. Therefore, it’s important for workers and medical providers to be precise. In statements, in medical reports, and in all other documents.

Light-duty work injury can impact benefits

Another important point is the impact on financial benefits. Interestingly, your wage rate under the original claim and the new claim may not be the same. In the first case, the new work injury is under the original L&I claim. Here, the wage rate from the original claim applies. If the worker is receiving loss of earning power payments when the light duty injury occurs, then L&I will factor those benefits to wage rate calculations. Moreover, if the light duty injury means the worker can no longer work, then L&I will pay time loss compensation. Of course, as always, the worker must certify time loss with the attending provider.

The second case is when the light duty injury prompts a new claim. Here, L&I uses the wages of the light duty job to calculate benefits for the new claim. This holds true even when the light duty job pays less than the original job. When this happens, it’s incredibly frustrating for work injury claimants.

Some takeaways

To summarize, fear of re-injury at work isn’t a valid reason for declining a valid light duty job offer. Injuries that happen while working light are no fun! There are several ways to handle those injuries. They depend on whether the light duty work is temporary or permanent.

As always, the very best thing for workers and employers is to take all possible precautions. Do what you can to eliminate workplace injuries. However, if a light duty work injury occurs, then L&I is going to cover it. The coverage might be under the original claim or under a new workman’s comp claim.

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

/ L&I attorney / 0 Comments

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.

Self-Insured IME Exams: L&I Implements New Rules in Washington State

/ L&I attorney / 0 Comments

The Department of Labor and Industries (L&I) implemented new rules for self-insured independent medical examinations. These rules passed the legislative section during 2019-2020. I’m happy to share that the new rules officially kicked in on April 23, 2022.

Rules for self-insured medical exams

There are several changes under the new regulations. The most significant updates are summarized below. The first change relates to IME scheduling and notices. Previously, self-insured claim administrators provided injured workers a 14 days notice before an IME. However, under the new rule, the new time window is 28 days.

The second major change has to do with the notice form. Moving forward, self-insurers must include a standard form to notify workers’ compensation claimants of an upcoming IME. The form is available on the L&I website (although I wasn’t able to find it). More importantly, the form mandates insurers to provide critical information to workers. For one, it has to include the reason for the IME request.

Disputing independent medical exams in self-insured claims

The third rule change focuses on IME disputes. Here, workplace injury claimants can dispute upcoming IME exams. Moreover, the worker’s attending provider can also dispute an IME. Either way, it’s important to file the IME dispute at least 15 calendar days before the exam. The dispute must specify the reasons why the IME is inappropriate. In turn, L&I may postpone the IME. Moreover, there’s a very interesting case when an IME exam is under dispute yet the claimant attends it. If L&I determines the IME was in violation of RCW 51.36.070, then the IME report can’t be part of claim administration.

No more infinite IME exams

The fourth area of change is around the number of IME exams. From here on, there’s a limit on the number of independent medical exams that self-insurers can request. The actual number depends on the underlying issues and the reason for the IME. For example, IME doctors can perform only one exam when contending a new medical issue. The purpose of the one-time IME is to resolve the new medical issue before issuing a final order.

The fifth and final change I wanted to cover is for case-progress IME criteria. This happens when self-insured claim managers request an IME for accepted conditions. More explicitly, L&I considers IME exams for accepted conditions as case-progress exams. Self-insurers can only request these exams when:

1) The worker is not receiving necessary and proper treatment; or

2) Treatment stalled without any real improvement to physical or mental conditions.

So – what’s next?

The new rules are fresh out of the over. They are so new that it isn’t clear how they’ll impact the claim administration process. However, I applaud L&I for adopting the new rules. Clearly, they help protect work injury claimants. The changes eliminate excessive and inappropriate IME requests. These unnecessary IME exams tend to impede and inhibit productive claim progress.