Category: Medical Treatment (Page 22 of 36)

Workers’ Compensation Claim Errors and Misconceptions

Workers’ compensation is a vital program for the safety and health of our workforce in Washington State. It is relatively straight forward, and the Industrial Insurance Act governs the Workers’ Compensation system. However, in my experience, most people don’t really know how the system works.

Understanding workers’ compensation claims and L&I claims

Here are seven of the most common misconceptions about workers’ compensation claims.

Medical provider – Work injury claimants must see the doctor that the employer or L&I chooses

If you had an injury at work, you can see any provider that you choose. It doesn’t have to be the provider that the Department of Labor and Industries (L&I) or the employer say you should see. If the provider is a member of the Medical Provider Network or MPN. There are thousands of providers in the MPN. In fact, there is a good chance your primary care provider is a member of the MPN. Here is more information about the MPN and finding a doctor for your L&I claim.

L&I claim settlement – Injured workers get workers’ compensation claim settlement at the end of the claim

Technically, this is not true. People with work injury may or may not receive an L&I claim settlement at the end of their claim. Many work injury claimants receive what is called a Permanent Partial Disability or PPD award at the end of their claim. The award is based on the PPD rating. However, this isn’t a settlement and there is no guarantee that you will receive this award.

Employment – A PPD award will impact future employment

Some individuals with a work injury claim have concerns about PPD and PPD ratings. They think that rating means branding or labeling them as “disabled”. In turn, many believe it will impact their chances to find work in the future. This isn’t necessarily true. As an injured worker, the most important thing is for you to not exceed your permanent limitations in any future employment. Additionally, you don’t have to disclose your PPD award when seeking employment in the future.

Job of injury – The employer must hold your job or cannot terminate you

Employers cannot to retaliate when someone files a workers’ compensation claim. However, they are not obligated to keep a person’s job while they are off work due to a work injury or occupational disease.

Attorney fees – L&I covers the cost of a workers’ compensation attorney

Unfortunately, this is not accurate. Workers’ compensation attorneys work on a contingent fee basis. By law, fees are taken as a percentage of the monetary award that a work injury claimant receives under their L&I claim. There is one exception where a judge may award attorney fees.

Filing lawsuit against employer – You can sue L&I, the employer, or the claim manager for wrongdoing

This is false. As frustrating as workers’ compensation claims can be, there is no legal option for suing L&I, employers, or third-party administrators. In other words, it doesn’t matter how L&I, or your employer handle your claim. You cannot sue them for it.

Maximum medical improvement means L&I will close your claim

When some work injury claimants reach maximum medical improvement or MMI, their claims can close. However, this isn’t always true because some claims can remain open even after treatment is complete. Remember, if you reach maximum medical improvement and you are unable to return to work, you may still be eligible for vocational training services. Finally, vocational retraining can take up to two years.

L&I Claims and the Bias in Independent Medical Exam (IME) Reports

/ L&I attorney / 8 Comments

Independent Medical Examinations (IME) are part of every L&I claim and workers’ compensation claim in Washington State. Doctors that perform IME exams must have a certification from the Department of Labor and Industries (L&I). In turn, they provide L&I with an IME report. When performing IME tests, doctors have to abide by certain rules and regulations. These rules are available in L&I’s Medical Examiner Handbook. However, if that’s the case, then why is there bias in almost every IME report?

Bias in workers’ compensation IME exam and report

As a workers’ compensation attorney, in my experience, IME doctors often demonstrate clear bias. In many cases, they ignore relevant sections of the law and ignore accepted conditions under the claim. Furthermore, it’s common to see internally inconsistent exam notes and reports. Interestingly, L&I still accepts the results of bad IME tests. Even though they are undoubtedly contrary to the law and to the facts of cases and claims. Personally, I’m fed up with this trend, which neither helps L&I nor work injury claimants.

The reality of IME exams in L&I claims

Here are some examples of issues from actual cases.

Clearly biased

I recently cross-examined an IME provider who opined that the work injury claimant did not want to return to work. An opinion like that is nothing but biased, especially when it comes to the facts of the case. Looking at the facts, my client has been working and maintaining a job since the time of the examination.

Ignoring the law

In another workers’ compensation claim, the IME doctor states that the injured worker doesn’t need additional treatment. Furthermore, the doctor said that if the claimant needs a new MRI, then the MRI is not a treatment rather it’s diagnostic. The doctor’s response made my blood boil. In Washington State, people that suffer a work injury are eligible to receive necessary and proper health care services.

Ignoring accepted conditions

I recently received and reviewed an IME report. I was shocked when I saw the IME provider arguing that the complex medical condition does not exist. All while the work injury claimant is receiving ongoing treatment for the condition on a monthly basis. On top, L&I accepted the condition as final and binding years ago. At this point in the L&I claim, it’s very possible that L&I will accept the IME’s opinion. I won’t be surprised if L&I uses the wrongful report to make adverse determinations in this workers’ compensation claim.

IME report can be internally inconsistent

I came across yet another IME report the other day. Here, L&I asked the IME examiner to consider 3 possible jobs for my client following the work injury. All three jobs require prolonged standing on feet, which the work injury claimant can’t tolerate because of their industrial injury. In the report, the IME examiner disapproved 2 of the jobs. However, for reasons unclear to me, the IME doctor approved the 3rd job. Even though it also requires prolonged standing. L&I terminated time-loss compensation benefits and closed the workers’ compensation claim.

Some personal notes and conclusions about IME report quality

IME exams are now big business in Washington State. Unfair and biased exams don’t help L&I because as an L&I attorney, I’m ready for a legal fight. The fight is very costly to L&I. These IME reports also don’t help people that had a work injury. It stalls their L&I claims and their ability to return to work.

I believe that L&I needs to revisit the misuse of IME exams. They need to employ corrective measures. That means obtaining unbiased and consistent opinions. IME tests must rely on the facts and the reality of cases and claims. They must also comply with workers’ compensation law in Washington State.

L&I COVID-19 Respiratory Protection for Care Workers

/ L&I attorney / 2 Comments

On March 19, 2020, the Department of Labor and Industries (L&I) put out a fact sheet regarding respiratory protection for care workers. These care workers and care givers have ongoing exposure to the Corona Virus COVID-19. Specifically, care takers at high risk include nursing home care givers, rest home employees, as well as long-term care facilities.

L&I fact sheet for COVID-19 protection

In the fact sheet, L&I encourages facilities to group together patients suffering from COVID-19. That way, they can limit the number of employees that may have exposure to the virus. According to L&I, workers who come within 6 feet of COVID-19 patients can be at a high risk for contracting the virus. As a result, L&I recommends that employers assess situations for proper use of surgical masks or N95 respirators.

Surgical masks are cloth masks that protect the people who wear them. They provide protection from large droplets and splatters from coughs, sneezes and breathing. They do not protect against fine droplets. N95 respirators are the minimum respirator preferred to protect workers from air contamination. However, L&I lists a number of other options that offer even greater protection. These options include N99-100, R95-100, P95-100, and other types of purifying respirators.

Work injury, occupational disease and N95 respirators

Employers might ask employees to voluntarily use N95 respirators even if they have low risk of exposure. In areas and facilities that require workers to use N95 respirators, employers must first have a written respiratory protection program and designate a program administrator. On top, they must provide appropriate respirators such as N95 respirators, powered air purifying respirators, or elastomeric respirators.

If you have to wear N95 respirator at work, know that your employer has to ensure you are medically cleared to use it. Your employer must also fit-test the equipment, and train you on proper use and maintenance. Workers who use N95 respirators and other tight-fitting respirators are to remain clean shave in areas where it contacts the face. This is to ensure an air-tight seal. Lastly, follow the requirements outlined in WAC 296-842. L&I acknowledges that you may need to reuse N95 respirators considering the shortage of protection equipment.

L&I trying to help healthcare workers with work illness

In the end, I’m glad that L&I is helping healthcare workers by creating fact sheets like this one. However, the fact sheet suggests that the use of N95 (or better) respirators is voluntary. Yet, it should be mandatory. Reading between the lines, it appears that workers coming within 6 feet of COVID-19 patients should be wearing N95 (or other) devices.

L&I is attempting to take steps in the right direction, but there is more work to do to prevent work illnesses and occupational disease. There is certainly a lot we need to learn about COVID-19. We also need to figure out how to effectively care for patients, and how to protect our valuable healthcare workers the best way possible.