Category: Medical Treatment (Page 24 of 36)

L&I Claim Travel Reimbursement

If you have a work injury claim, such as a workers’ compensation claim or L&I claim, then you can see any medical provider you choose. The only requirement is that the medical provider must be a member of the Medical Provider Network or MPN. For work injury claimants living in rural places or remote areas, finding a provider in the MPN can mean extensive travel. The good news is that L&I provides travel reimbursement in some cases.

How to get travel reimbursement for my workers’ compensation claim?

Under certain circumstances, the Department of Labor and Industries (L&I) will reimburse injured workers for travel to medical appointments. However, you must meet three criteria in order to get reimbursement for your travels. If you think that you meet all the requirements, then you should fill a travel reimbursement form. Once you complete the form, be sure to submit it to your claim manager.

First, the medical provider must be more than 15 miles away from the residence of the work injury claimant. Second, there can’t be any other available providers that have closer offices. Third, you must get pre-authorization for the reimbursement from your L&I claim manager. Furthermore, it is important to note that you can get reimbursements for mileage, toll road payments, and parking fees in excess of $10.

What do I need to do to get travel reimbursement from L&I?

On its face, travel reimbursement seems like a relatively simple and a valuable benefit for people with L&I claim. Clearly, it’s an excellent benefit for people with a work injury that incur extraordinary travel expenses for treatment. However, practically speaking, it is rather challenging to successfully receive travel reimbursement.

One of the most frustrating problems is when a workers’ compensation claim manager questions the need for travel. In my experience, this happens all the time when work injury claimants need to change their medical provider in the middle of an L&I claim. Nearly all medical providers are reluctant to become the attending physician for an older L&I claim. Therefore, people with existing claims often need to travel afar to find a doctor that is willing to see them.

L&I claim travel reimbursement form and pre-authorization

In many cases, before authorizing travel reimbursement, some L&I claim managers require us to produce a journal showing that we tried to find a provider within 15 miles of the worker’s residence. Despite the frustration, once we submit the journal to the claim manager, the claim manager usually authorizes the reimbursement.

Another common frustration I encounter all the time is when work injury claimants are unaware of the travel reimbursement requirements. It’s common for me to speak with people with a workers’ compensation claim who completely gave up on the reimbursement process. Usually, they give up because they either don’t understand or don’t seem to meet the requirements. The most frequent mistake I see is failing to get pre-authorization. Interestingly, in most cases it’s because they do not fill out the travel reimbursement form correctly. However, having done this so many times, it is fairly easy to correct these errors.

Takeaways and final notes

In summary, if you got hurt at work and you have a workers’ compensation claim or L&I claim, if you travel to medical appointments, then you can (and should) get travel reimbursement. Remember, to get travel reimbursement and eliminate unnecessary frustration, make sure you know the requirements, fill the form above, and ask for pre-authorization from your claim manager.

IME Exam in L&I Claims in Washington State

/ L&I attorney / 2 Comments

The Department of Labor and Industries (L&I) sometimes requires injured workers to attend Independent Medical Examinations or IME. In many cases, L&I asks work injury claimants to attend an L&I IME exam to help L&I make claim-related decisions. From L&I’s perspective, an IME provides objective medical-legal examination for the purpose of establishing medical findings, opinions and conclusions about an injured worker’s physical condition.

IME tests in L&I claim appeals

It’s important to note that IME exams can only be performed medical examiners that are pre-approved by L&I. Fundamentally, I don’t share L&I’s perspective on IME examinations. When I represent work injury plaintiffs in appeals before the Board of Industrial Insurance Appeals (BIIA), often L&I medical arguments rely on IME opinion. In fact, it is very common for me to cross examine the same seven or eight IME doctors repeatedly.

IME panels in Washington State

There are several panel corporations that provide IME services to L&I. These include Sunrise Medical, Objective Medical Assessments Corporation (OMAC), Central Seattle Panel of Consultants, Medical Consultants Network (MCN), and others. Interestingly, most of the examiners who perform IME tests are contracted with more than one of these panels. In other words, having a variety of panels offering IME tests does not result in a greater variety of examiners.

IME exams are inherently biased and unfair

On occasion I’m surprised by the outcome of an IME. However, more often I predict the outcome before the examination even occurs. There are several reasons for this. L&I argues that IME tests are an objective process. I’ve had IME doctors testify that they are in the best position to provide opinions to L&I because they have no stake in the outcome. Whether these providers want to admit it or not, they have a bias in favor of L&I.

The Department of Labor and Industries controls the process and procedure of every IME from start to finish. For one, L&I sets the ground rules for these examinations. Moreover, as mentioned earlier, the examiners must be approved by L&I. In addition, examiners are mandated to follow the Medical Examiner’s Handbook written by L&I.

IME examiners are asked to answer specific questions given to them by the claim manager. Typically, along with the questions presented to IME doctors, the claim manager usually provides claim related information. This information can include the status of the claim, the L&I claim accepted conditions and the contested conditions. The IME examiner reviews the medical records provided by L&I and is paid according to fee schedules dictated by L&I. Finally, the examiner must produce a report in accordance with L&I timelines.

IME exams from the viewpoint of injured workers

In my experience, injured workers who are required to attend an IME rarely feel that the process is unbiased and objective. For example, a work injury claimant has no choice when it comes to the IME doctor. In addition, the date and time of the IME exam is set by L&I. Then, if there are any scheduling conflicts for the injured worker, he or she must ask for permission from the claim manger to reschedule.

Frequently, injured workers feel attacked and judged by the IME examiners. It’s very common for work injury plaintiffs to report that the examiners seem to ignore what they are saying. Consequently, the IME process leaves work injury claimants feeling frustrated, insecure, and unheard. People that suffer a work injury contact me all the time to inquire about representation. Many times, they call me because they have been scheduled for an IME, or recently attended an IME. As a result, they are concerned about the future of their claim.

IME notes from an L&I attorney

In my opinion, there are many legitimate reasons for which L&I needs outside, impartial medical opinions to help resolve L&I claim issues. However, I don’t believe that the current IME process is fair. I also don’t feel that the current format of IME examinations accomplishes the goals of the Industrial Insurance Act.

L&I Claim Notices: Notice of Decision, Payment Order

/ L&I attorney / 10 Comments

Workers’ compensation claims can be overwhelming. Recently, I’ve consulted with several injured workers who have been completely overwhelmed with their claims. As a result, they started avoiding claim related documents. Among those, are L&I notice of decision letters. You must not ignore those.

Dealing with L&I claim orders and communications

Some work injury claimants I talk to no longer open their mail because it was causing them too much anxiety. I call this the “ostrich approach”. Just like an ostrich, burying its head in the sand, injured workers with a work injury claim who avoid claim-related communication don’t see the danger that is coming. They may miss critical deadlines, which in turn, can cause permanent harm to their workers compensation claim.

The Department of Labor and Industries (L&I) has the obligation to administer work injury claims. Similarly, claimants have the right to challenge L&I decisions that they believe are a mistake. However, work injury claimants only have 60 days to challenge and protest an L&I decision. If you do not file a request for reconsideration within 60 days, then you essentially waive your right to challenge L&I.

Remember, L&I makes mistakes. There’s no question about it. But, like it or not, it’s your job to be on top of things. In other words, if you don’t appeal an L&I decision, their mistake becomes final and binding under the law, no matter how wrong it may be.

L&I notice of decision

When L&I makes a decision concerning an issue in an L&I claim, they must notify the injured worker. In fact, they have to send something called a written order. Usually, these decisions are titled “NOTICE OF DECISION”. Here is what one that comes from L&I looks like:

L&I payment order

Sometimes L&I makes unfavorable decisions in what they title “PAYMENT ORDERS”. You would think something called a payment order would be a favorable decision issuing a payment. It isn’t uncommon for L&I to make a decision denying time-loss compensation or closing a claim in a decision called “PAYMENT ORDER”. Here is an example:

Can I protest a notice of decision or payment order?

Whether a decision is a NOTICE OF DECISION, PAYMENT ORDER, or has some other label, it’s’ easy to tell if you have the right to protest. For that, you can refer to the bottom of the decision letter and read it carefully. For example, it will look something like this:

In some cases, work injury claimants protest a decision. Then, after some time goes by, L&I affirms its previous determination. When this is the case, the notice of appeal rights looks as follows:

Monitor your L&I claim

If you have a work injury claim or L&I claim, the most important thing you can do is to pay attention to notices. You can protect yourself and protect your workers compensation claim by protesting or challenging L&I’s mistakes on time. There is nothing more heartbreaking for me than being contacted by an injured worker who disagrees with an L&I decision after they waited too long to dispute a decision.

Don’t be overwhelmed by your claim. If your claim and the associated correspondence is causing you too much anxiety, contact an experienced attorney who can help alleviate your anxiety. Your attorney will receive all the communications directly. They will oversee your claim and ensure that the Department’s mistakes are challenged on time.