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

Category: Medical Treatment (Page 19 of 36)

Light Duty Work in L&I Claims and Workers’ Compensation Claims

After a work injury or occupational disease, people with an L&I claim or workers’ compensation claim might have medical conditions that impact their ability to return to work. We refer to workers incapable of working during their recovery as temporarily and totally disabled. These workers receive time-loss compensation benefits, which is a type of wage replacement. When the Department of Labor Industries (L&I) pays time-loss compensation benefits, it negatively impacts L&I insurance rate for the employer. Consequently, L&I created alternative programs and incentives to help employers improve their rate. In this article, we cover the topic of light duty work. It’s one such incentive program for employers.

 

Light duty work and job offers

For one, L&I offers cost reimbursement to employers. Here, employers are eligible to recoup costs when they accommodate employees after a work injury and offer them a light duty job.  L&I refers to this program as Stay at Work (WA-SAW).  Explicitly, if a work injury claimant has limitations because of claim-related conditions, the employer can offer a job that fits within those limitations. Interestingly, L&I considers a light duty job as valid if it meets the following criteria:

1) The work injury claimant must have limitations because of conditions that relate to their workers’ compensation claim. These limitations must impact their ability to work.

2) The employer must submit a written (and detailed) job description for the light duty job to the attending physician.

3) The attending provider must approve the light duty job in writing.

 

After the criteria are met, the employer can make a light duty job offer to the worker. Light duty job offers vary significantly between employers and industries. For example, grocery stores frequently offer stockers or checkers light duty jobs as door greeters. Also, another good example is sedentary office work. Furthermore, if the wages for the new job are 5% less (or lower) than the worker was making before, then the worker can apply for loss of earning power benefits.

 

The economic incentives of this program are advantageous to employers. In fact, the program has many other benefits too. For one, after a work accident, it helps keep employers and employees connected during the recovery process. Furthermore, it creates less ambiguity concerning the work status of the employee. These advantages are only realized when the program is used for the right reasons. Unfortunately, too frequently, that is not the case.

 

The reality of light duty jobs in some L&I claims

I have seen employers offer light duty “jobs” such as watching safety videos for the entire work shift. I’ve also seen light duty “job” offers that involve sitting at a desk doing nothing. Clearly, these are not legitimate light duty jobs and the sole intention behind them is to save costs. Sometimes, employers ask workplace injury claimants to perform duties outside the details in their job description. Other times, employers require the worker to perform tasks contraindicated by explicit medical limitations. Realistically, many complain about harassment and intimidation while trying to perform light duty jobs.

 

Some employers tell light duty job employees to schedule medical appointments and treatments outside work hours. This can be difficult if not impossible. Finally, many workers are placed under a performance microscope while doing light duty work. For example, when the employer writes them up for clocking in a minute late. Another example is when the employer writes them up for playing a game on their cell phone out of sheer boredom because the light duty work was a do-nothing desk job. Yet another, is writing up the employee because he or she places their swollen foot on a desk shelf to reduce pain and swelling, while performing a do-nothing job. These are all real-life examples. Surprisingly, when you inspect personnel records, one must wonder why this excessive performance oversight didn’t happen prior to the work injury or occupational disease.

 

Advocating for people with a workers’ compensation claim

In the past, employers and administrative workers called me out for my criticism of L&I programs like WA-SAW. Proponents of the program cite studies, charts and data showing that early return to work (even in light duty capacity) dramatically reduces long term disability. I don’t dispute these findings.  I too, want workers I represent to regain their quality of life, including their full wage-earning potential, as quickly as possible.  However, I believe that the WA-SAW program is often misused and fails to accomplish its intended goals.

 

Too often, when employers use the program solely for cost savings without any regard to the feelings or needs of the work injury claimant, I see workers sour towards their employer. I see work environments become hostile, mental health conditions develop, and L&I claims become unnecessarily contentious. It’s for that reason that I will continue to advocate for a more worker centric overhaul of these incentive programs.

 

L&I Claim Closed – How to Reopen a Workers’ Compensation Claim in Washington State?

If the Department of Labor and Industries (L&I) closes your L&I claim or workers’ compensation claim, then you might be able to reopen it. However, if your L&I claim closed, it’s important to note that L&I doesn’t automatically reopen claims. In fact, your case must meet certain criteria to reopen an L&I claim. Yet, many work injury claimants get discouraged and give up instead of trying to apply to reopen their workers’ compensation claim.

 

My L&I claim closed – Now what?

In fact, some medical providers believe that L&I does not reopen claims. Other treating professionals think that the reopening process is too difficult. This is simply not true. It’s important for both people with a work injury claim, and for medical providers, to fully understand the reopening process and requirements.

 

In claims for physical work injuries, to reopen a workers’ compensation claim, you must show that certain conditions objectively worsened between terminal dates. If you want to determine whether these criteria are met, you must first understand some workers’ compensation concepts. These three basic concepts are: (1) Terminal dates; (2) Causal relationship of conditions; and (3) Objective worsening.

 

Terminal dates in a workers’ compensation claim

When you file an application to reopen an L&I claim, the term “Terminal dates” refers to two important dates. The first terminal date is when L&I closed your claim most recently. The second date is when L&I denied the most recent reopening application. Take the most recent date of the two. We denote this terminal date as T1. Next, the second terminal date (which we call T2) is the date when you filed the most recent application to reopen your workers’ compensation claim.

 

Causal relationship in L&I claim

We say that conditions are “causally-related” if the industrial injury or occupational disease is the proximate cause of said conditions. Here, proximate cause means a cause that, in a direct sequence, produces the condition. The law acknowledges that there may be more than one proximate cause. Therefore, the industrial injury or occupational disease must be one of the causes of the condition.  Said differently, it doesn’t need to be the only cause. Furthermore, a condition can also relate in a causal manner if the industrial injury or occupational disease aggravated it or worsened it.

 

Causal relationship requires medical reasoning. Here, you must obtain a written medical opinion to show that the work injury or work illness caused the condition. In other words, you must find a doctor or a competent medical expert to say there is a causal connection and explain why. Remember, reopening requires worsening of causally related conditions. Hence, we must first identify the condition and the causal relationship.

 

L&I sometimes reopens claims for worsening of a condition. For instance, if doctors did not diagnose or relate a condition to the claim before claim closure. If the medical evidence supports that the condition relates to your work injury, or that the condition worsened and requires treatment, then L&I will reopen the claim.

 

Objective worsening in work injury claim

If you have a workers’ compensation claim, then L&I considers anything that you say as subjective. For example, saying that you are experiencing pain increase is subjective. It’s insufficient for claim reopening purposes. Alternatively, objective findings are ones that a medical provider can see, feel, or measure. To reopen a claim, a medical provider must show that the causally related conditions got worse between the two terminal dates. Additionally, these conditions must require treatment, or increase your disability level.

 

Here is an example. Say that you were hurt at work and your work injury caused a herniated disc. The doctors can clearly see the disk herniation on MRI.  Practically speaking, the doctors can measure the actual size of the herniation.  Based on the initial size, they determine that the disc is not impacting the nerves. Therefore, you do not need surgery and your treatment concludes.

 

Next, the claim is closed.  Over time, the herniation gets worse and causes additional symptoms.  Doctors get a new MRI where they see that the herniation is bigger.  Now, the disc is impacting the nerves and needs surgery. Right then, you should file an L&I reopening application, and L&I should grant it. Moreover, if reopening occurs within 7 years of the initial claim closure, you may receive additional monetary benefits such as time-loss compensation and increased PPD.

 

Final remarks

If you want to reopen an L&I claim or a workers’ compensation claim in Washington State, you have to understand some basic terms. However, it’s not difficult to learn and understand them. It’s also not difficult to reopen your claim. If the conditions that relate to your claim objectively worsened, then you should apply to reopen your claim. Furthermore, with objective worsening, there is no reason for L&I to deny your claim reopening application.

 

L&I Covid-19 Premium Deferral Program and the L&I Accident Fund

The Department of Labor and Industries (L&I) administers workers’ compensation benefits in Washington State. These include financial benefits such as time-loss compensation, loss of earning power, work injury pension, and more. Payments come from the L&I accident fund. Furthermore, benefits include medical treatment, evaluation, vocational services and retraining, and others. Also, self-insured employers administer their claims according to the requirements of the Industrial Insurance Act.

 

L&I premium payments for employers and employees

A few weeks ago I posted an article  about the health of the L&I Accident Fund.  There, I discussed how historic rebates depleted the fund and led to significant premium hikes. However, these last few months, COVID-19 impacted our economy greatly. Therefore, we must be especially careful to maintain the health of the L&I Accident Fund.

 

Typically, employers pay their L&I insurance premium on a quarterly basis. L&I premium payments for the second quarter of 2020 are due July 31st, 2020.  However, according to a recent L&I news bulletin, employers that experience financial hardship and cannot pay their workers’ compensation premiums can request a 90-day payment deferment. Under this relief package, L&I will give employers until November 2nd, 2020 to pay those premiums for the second quarter of 2020. These premiums cover the months of April, May, and June of 2020. Interestingly, this is the second premium extension this year. Recall, L&I already extended the premium deadline for the first quarter of 2020 to July 31st, 2020.

 

Why is L&I extending the premium payment period?

In extending these premium payment deadlines, L&I acknowledges that the Corona-Virus pandemic continues to impact employers financially. As a result, employers may either request a 90-day extension for payment or a 90-day payment plan. Regardless of the request, L&I will not penalize employers. Furthermore, late payments will not incur interest charges as long as employers pay the premiums within the 90-day extension period.

 

However, it’s important to note that employers are not automatically eligible for the premium-payment extension program. If granted, employers must still file quarterly reports on time by July 31st, 2020.  Here, to take advantage of the program, employers must contact the L&I Collections, Education and Outreach Unit and apply. You can reach this unit via email at dialercollections@lni.wa.gov or by calling 1-800-301-1826.

 

The impact of the extension on the L&I Accident Fund

The 90-day deferment option seems like a reasonable way for L&I to help employers. After all, many employers are experiencing significant financial impact due to COVID-19. Moreover, L&I’s actions will help maintain sufficient level of funding for the L&I Accident Fund. And yet, it’s critical that we monitor the financial health of the fund. The L&I Accident Fund is the safety net for work injury victims. Despite the economic impacts of the pandemic, we must ensure that the Accident Fund remains stable and intact.

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