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

Category: Medical Treatment (Page 16 of 36)

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

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

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.

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.

 

L&I claim billing code

 

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.

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