Category: Medical Treatment (Page 17 of 36)

L&I Claim and Workers’ Compensation Claim in Washington State: Common Mistakes and How to Avoid Them

As a workers’ compensation attorney, the most common question I get is: “What mistakes should I not make in my L&I claim?”. There is no easy answer for this question. Interestingly, while there’s a clear definition for potential L&I claim benefits, there is no list of potential pitfalls.

Every L&I claim is different

Generally speaking, the administration process for every workers’ compensation claim in Washington State follows certain administrative codes. However, every claim is individual and different. Every work injury or work-related disease has its own challenges. Similarly, every claim outcome is ultimately unique to the person that suffered the work injury. However, from my experience as an L&I attorney, here are a few tips I can offer for avoiding common mistakes and keeping your workman’s comp claim on track.

Use common sense to avoid L&I mistakes

Throughout your L&I claim process, you will need to make many decisions and response to communications. Therefore, it’s very important to use common sense. You should do what is logical. Frequently, I see that people get very anxious and worry about not messing up their work injury claim. Meanwhile, they forget to be logical. You must avoid this common mistake. If it helps, take a step back and think about the big picture. If you use common sense and remain logical, that’s probably the easiest way to keep your workers’ comp claim on track.

Recovery first

The first and most important thing in an L&I claim is to focus on your recovery. Let’s be honest: Whether you got hurt on the job or developed an illness at work, you want to recover. Nothing is more important than your health. Realistically, if you let other claim issues get in the way, it can distract or even derail your path to recovery. I sometimes see work injury claimants prioritize the handling of their claim over their personal health, which may lead to unfortunate outcomes.

L&I mistakes: Pay attention

It’s extremely important to pay attention to everything that is going on in your workers’ compensation claim. I am well-aware that keeping track of all the small details can feel like a full-time job. However, it’s not helpful to ignore certain steps or bury your head in the sand. In fact, it’s necessary to know what’s happening in your claim so that you can follow through and take appropriate actions. Monitoring your L&I claim progress will also help you spot red flags early. It’s critical to read notices and decisions from the Department of Labor and Industries (L&I) and address any issues while you still have time.

Ask for help

Most importantly – don’t wait too long to ask for help. Many work injury claimants may never need help from an L&I attorney. However, that isn’t true for everyone. If certain issues arise in your claim, then don’t delay asking for help. Specifically, if an issue in your case is heading to the Board of Industrial Insurance Appeals (i.e., BIIA or Board), it is advisable to speak with a workers’ comp attorney immediately. Appeals before the Board have timelines and certain litigation schedules. Waiting too long to contact an attorney can make it difficult for any lawyer to get involved. Remember, your attorney will need time to get up to speed or to provide meaningful advice. Moreover, if you are looking for a workers’ compensation attorney, it’ll take them time to prepare a winning case.

Final comments

In summary, when you have an L&I claim, there’s no concrete list of black and white rules to follow. However, I always recommend people to remember the key principles above. Use common sense and focus on recovery. Over time, follow closely and pay attention to what is happening in your claim. Finally (and arguably most importantly), do not delay asking for help.

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.

L&I Protest and Appeal: What if I Disagree With a Decision in My L&I Claim?

/ L&I attorney / 0 Comments

In Washington State, the Department of Labor and Industries (L&I) if the claim administrator for a state-funded claim. For a self-insured employer claim, the administrator is typically a third-party administrator (TPA). In every workers’ compensation claim, the claim administrator makes many decisions. These decisions include whether to allow a claim, the claim accepted-conditions, treatment authorization, payments of benefits, and more. Some decisions are favorable to the person that suffered the work injury. But, some are not. Whenever a claim administrator makes an unfavorable decision that impacts work injury claimants’ right to benefits, the administrator must inform them about their protest or appeal rights. However, in reality, you can protest or appeal any written decision you disagree with.

Protest a decision in an L&I claim

It is common to file a protest for an L&I claim the first time a claim administrator makes an unfavorable decision. Here, for the protest to be valid, you must submit it to L&I within 60 days. At minimum, an L&I claim protest must be in writing and state what you disagree with. If L&I gets a protest, then they must issue another decision. In most cases, L&I will base its decision on preponderance of the evidence. Simply put, it means that after considering all the evidence, the decision should be what is more probably true than not.

If strong evidence supports the decision is wrong, then L&I may change or reverse the decision. Otherwise, L&I will issue a new decision affirming that the previous decision is correct. If you have a work injury claim and you disagree with the new decision, you may appeal to the Board of Industrial Insurance Appeals (BIIA).

Appealing a decision in my L&I claim

Like protests, you must file an appeal within 60 days. The BIIA website has instructions and an online form making filing an appeal very easy. In fact, the BIIA is a separate agency in Washington State. It employs Industrial Appeals Judges (IAJ) to help mediate and hear evidence to resolve disputes. In time, the burden of proof is on the appealing party as it must present evidence to show the decision is wrong. Therefore, it means the appealing party must present their evidence first.

To meet the burden of proof, the evidence must show the decision is more probably incorrect than correct. On top, the appealing party presents the evidence through witness testimony. Very frequently, people with a work injury claim ask me if they can submit medical or other records instead of testimony. Unfortunately, the appeal process does not permit it in most cases (if not all). The law and procedure require us to present the evidence through testimony. Consequently, it allow each party to ask the witness questions.

I disagree with L&I decision – do I need an attorney?

After a work injury, people with a workers’ compensation claim are not required to have an attorney to protest or appeal a decision. The term for those who don’t have an attorney is pro se, meaning they represent themselves. Practically speaking, protests are less challenging. Protests happen at the L&I level and it’s not uncommon to not involve a workers’ compensation attorney. However, appeals are more difficult. With BIIA, L&I always employs an attorney from the office of the Assistant Attorney General. Self-insured and other employers also usually have an attorney.

Before BIIA, civil rule of procedure or the Washington State Administrative Code governs most procedures and rules. Attorneys know how to follow these rules. They can be confusing or difficult for a pro se individual. Moreover, attorneys with relevant experience also know how to evaluate the evidence and present testimony. Therefore, it’s usually a good idea to have an L&I attorney for an appeal.

Important conclusions

One of the biggest mistakes I see is waiting too long to hire a workman’s comp attorney. Appeals to the BIIA follow strict timelines. Hence, the longer you wait to hire a workers’ comp attorney, the less time the attorney has to prepare. Furthermore, attorney calendars may already be booked, and they may be too busy to take your case.

In summary, work injury claimants can protest or appeal any written decision L&I makes in their claim. Remember, there is a 60-day time limitation for filing a protest or appeal. To change the decision, you will need evidence to show that the decision is wrong. Finally, if you have an L&I claim or a workers’ compensation claim and you are considering filing an appeal, then you should speak with an experienced L&I attorney sooner than later.