Category: Medical Treatment (Page 15 of 36)

L&I Claim Mental Health Treatment Options and Master Level Therapists

I’ve been serving as a workers’ compensation attorney in Washington State for over 15 years. One of my biggest challenges is to find mental health treatment for clients with an L&I claim. I will go a long way to help my clients. However, it’s sometimes impossible to find treating psychiatrists who are medical doctors. Yet, there are some good news from the Department of Labor and Industries (L&I) concerning this matter.

Mental health treatment in a workers’ compensation claim

In the past, it has been easier to find treating clinical psychologists. Recently, all that changed, and it’s become more challenging than before. But there’s some good news. A little over a year ago, L&I started a 4-year pilot project. The project authorizes and pays Master’s Level Therapists (MLT) to treat people with a work injury claim.

Interestingly, under current L&I medical treatment guidelines, the system doesn’t permit MLTs to provide mental health treatment in L&I claims. However, L&I is conducting the pilot program to provide structure. In the process, L&I is collecting data on behavioral and mental health services that MLTs provide to work injury claimants.

L&I program for mental health professionals

The enrollment for the 4-year pilot program began back in November 2019. L&I said it will allow up to 300 MLTs into the program. Initial signups include licensed independent clinical social workers (LICSW), licensed marriage and family therapists (LMFT), and licensed mental health counselors (LMHC).

Therapists and counselors that wish to apply for the L&I pilot program must meet some requirements. For one, every therapist must complete an L&I training module and submit a completion certificate with their application. In addition, each mental health therapist must submit a Non-network Provider Application. Finally, L&I requires mental health counselors to also submit the MLT Pilot Supplemental Application.

L&I claim and mental health treatment coverage

Once L&I approves an application, the MLT can treat work injury claimants under their workers’ compensation claim. Of course, you have to meet certain criteria for treatment coverage. For example, the attending provider on the L&I claim must refer the work injury claimant to the MLT. The referral should be for appropriate psychotherapy treatment, for a mental health condition that L&I previously accepted under the claim.

An MLT cannot diagnose mental health conditions or perform mental health evaluations following a workplace injury. However, in cases with accepted mental health conditions, the mental health therapist in the pilot program can provide eight treatment sessions. Importantly, these sessions do not require treatment pre-authorization or going through the utilization review process. After that, additional sessions beyond the first eight require a utilization review authorization.

The impact of mental health services after a work injury

Mental health conditions can seriously (and very negatively) impact your recovery after a workplace accident or work-related illness. As an L&I attorney representing work injury claimants, I hope this pilot program becomes permanent. It’s important to provide people that have a workers’ compensation claim with early and easy access to mental health treatment. I strongly believe this program will result in much better outcomes compared to the current status quo.

For more information, please refer to the Master’s Level Therapists pilot program on the L&I website.

L&I Claim for Crime Victims

/ L&I attorney / 3 Comments

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.

Filing a new L&I Claim or Workers’ Compensation Claim in Washington State

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People sometimes contact my office shortly after they suffer an injury at work. Other times, I get calls from people that started to develop a work illness or occupational disease. Often, these people are scared. They don’t know what to do. I can certainly understand why they want to call and talk to a work injury attorney. However, there’s very little I can do until they file an L&I claim. In fact, the most important thing for anyone injured on the job is to get medical attention right away.

How to file an L&I claim after a work injury

The Department of Labor and Industries (L&I) maintains the L&I website. The website contains lots of information (and forms) about filing a workers’ compensation claim. However, almost always, the first steps to file a work injury claim should be: (i) Report the work injury or work disease to your employer; and (ii) Get the medical attention and medical treatment you need.

The doctor will determine whether the injury or disease relates to your work. If they think it does, they will help you file a workers’ comp claim. The doctor’s office should already have the necessary paperwork, which is called Report of Accident. Furthermore, the doctor decides when the work injury claimant can return to work, and recommends follow up treatment. If for some reason the doctor doesn’t file the claim, L&I makes filing easy with their new Report of Accident online tool.

What happens after you file an L&I claim

When filing the L&I claim (either online or at the doctor’s office), L&I will need some information from the work injury victim. This information includes:
1. The place where the work injury happened (or where you developed the occupational disease);
2. Contact information for any witnesses;
3. Employer information;
4. Wage information;
5. Names and birth dates of your dependents; and
6. Medical provider information where you first received treatment.

Once L&I gets the claim paperwork, it decides whether to allow the claim. Then, if L&I allows the claim and provides appropriate benefits, the work injury victim may not need legal help. Early benefits may include treatment authorizations and wage replacement benefits. The benefits depend on your inability to work due to claim-related conditions. After that, if you receive any unfavorable decisions, you must protest or appeal them within 60 days. Otherwise, they become final and binding.

When to call a workers’ compensation attorney

Therefore, if L&I denies your workers’ compensation claim, it’s a good idea to speak with a workers’ compensation attorney right away. A good L&I attorney can help you determine your rights and options. From there, you can proceed to protest the L&I decision, and continue to follow the L&I claim process.