Category: Medical Treatment (Page 31 of 36)

LNI approves acupuncture for workers compensation claims

L&I Approves Acupuncture to Treat Injured Workers in Washington State

There’s good news for injured workers in Washington State that seek alternative treatment options for industrial injuries or occupational diseases! I previously wrote an article about the L&I pilot program enabling acupuncture treatment for injured workers . It turns out that the pilot program is near completion. Consequently, L&I adopted rules for the authorization of acupuncture to treat symptoms associated with low back pain.

Workers’ compensation claims and acupuncture

Throughout the acupuncture pilot, L&I used information and data collected during the pilot project to draft WAC 296-23-238. Effective June 1st 2019, under WAC 296-23-238, L&I and self-insurers may pay for acupuncture to treat low back pain in workers’ compensation claims. Under this rule, the low back condition generating the pain must be an accepted condition in the claim. However, this week L&I reported that:

other conditions may be considered at a later date based on L&I’s review of available scientific and clinical evidence.

It is important to note that the pilot program will continue through May 31st 2019. Prior to June 1st 2019, only participants in the pilot program can use acupuncture to treat injured workers for work injuries. Beginning June 1st 2019, other non-pilot L&I providers that have a license to provide acupuncture treatment may begin using acupuncture to treat injured workers. Any providers who are new to treating injured workers will need to apply for an L&I provider number. Once an L&I provider number is obtained, L&I can release payments for acupuncture providers that treat injured workers.

Workers’ comp claim conditions for treatment

On top, there are several other important facts to remember regarding acupuncture treatment. For example, L&I allows up to a maximum of 10 acupuncture treatments over the course of the lifetime of a claim to treat low back pain associated with a casually related condition. In order for L&I to cover the treatment, the claim file must include documentation for the referral from the attending provider. On top, the treatment provided must be only for covered conditions, and the claim must be allowed and open. Furthermore, the treatment provider must submit validated functional instruments to track and document the treatment progress for the initial, middle and final treatment sessions. Validated functional instruments include the “2-item Graded Chronic Pain Scale” and the “Oswestry Disability Index”.

Acupuncture treatment isn’t for everyone. There are a variety of valid reasons injured workers may decline to consider acupuncture as a treatment option. When it comes to invasive procedures like the use of needles, injured workers always have the right to decide if they are willing to undergo the proposed treatment. However, for individuals who might like to explore alternative treatment options, especially for chronic pain, it is nice that L&I decided to extend coverage for this kind of treatment. More information can be found on the L&I website.

Workers Compensation Claim Structured Settlement

Workers’ Compensation Claims and Structured Settlement

/ L&I attorney / 9 Comments

Have you ever heard the term “structured settlement” as it relates to workers’ compensation claims or L&I claims? Ever wondered if it might make sense for your case?

The Stages of an L&I claim or Self-Insured Employer Workers’ Compensation Claim

I often describe claims as having three phases:

(1) The open and active phase. This is when a claim is open and the injured worker is actively receiving treatment. Here, the goal of the treatment is to cure their condition or improve the overall level of disability;

(2) The employability determination phase. In this stage there is an assessment of the injured worker’s ability to return to work given their permanent limitations;

(3) Claim closure. I usually tell people that all claims must close (with a few very rare exceptions). However, the main question is how they close.

Workers’ Compensation Claim Closure

Typically, claims close in one of three ways:

(a) Simple claim closure. In this case, the injured worker completely recovers and returns to work at the job of injury;

(b) Permanent partial disability (PPD) claim closure. This is when an injured worker fails to make a complete recovery but is capable of working; and

(c) Total permanent disability claim closure. This happens when an injured worker is permanently incapable of returning to work.

The description above covers most common cases phases of L&I claims and workers’ compensation cases. However, in general, there is another option for claim resolution through a structured settlement or CRSSA. The Department of Labor and Industries (L&I) describes structured settlement as an alternative to monthly time-loss benefits. Under this outcome, the injured worker and L&I agree to a sum of money that is received as a series of payments over a relatively short period of time. It’s important to note that medical benefits may continue for industrially related conditions.

Conditions and Requirements

Certain additional conditions apply for structured settlement. If you are an injured worker over 50 years old, and you have an accepted claim that is at least 180 days old, then you may qualify. Under the right circumstances, a structured settlement can be a very satisfying way of resolving a claim more expeditiously. From my experience, structured settlements make sense for injured workers who have become frustrated or tired of the claim process. They are also suitable for injured workers who have alternative sources of income, and have concrete plans for their financial future.

In my opinion, however, injured workers should never enter into a structured settlement because they are frustrated or desperate to resolve a claim. Injured workers should never feel like a structured settlement is their only option. It is only one of many options available under the Industrial Insurance Act and it may involve giving up other benefits. I strongly urge injured workers to consult with an experienced workers’ compensation attorney before agreeing to a structured settlement. In addition, you must remember that before it becomes final, the Board of Industrial Insurance Appeals (BIIA or Board) must review and approve the terms of the structured settlement.

Additional Resources

If you are looking for additional information, you can check out the following L&I flow chart. This chart can help injured workers better understand the various steps and process. Also, keep in mind that following Board approval, there is a 30-day revocation period in which any party may revoke consent to the settlement for any reason. L&I will continue to administer the claim and provide benefits during the time the Board reviews the structured settlement. Claim administration and benefits also continue with the 30-day revocation period.

Reopening L&I Claim or Self-Insured Employer Claim

/ L&I attorney / 14 Comments

You may have heard that L&I claims can be reopened after they close. This is true, but there are a few important things to remember regarding claim reopening.

Reopening an L&I claim

First, you can reopen a claim any time following claim closure for additional medical treatment. However, for an injured worker to receive additional monetary benefits such as time-loss compensation, loss of earning power benefits, increased permanent partial disability or permanent and total disability, the claim must be reopened within 7 years of the original claim closure. After 7 years, if you reopen a claim, then L&I will only provide medical treatment. The only exception is when the Director of L&I exercises discretion to grant additional benefits.

Second, the reopening of a claim is not guaranteed. If an injured worker or provider believes that a claim should be reopened for whatever reason, a reopening application must be filed documenting the basis for reopening. L&I will carefully evaluate the evidence to determine whether reopening is appropriate. If L&I feels that it is not appropriate, reopening of the claim will be denied. Like any decision, the decision to deny reopening can be protested or appealed for physical conditions.

Conditions to reopen a workers’ compensation claim

For the reopening of a claim to be granted there must be an objective worsening of a claim related condition between the time the claim last closed and the time the application to reopen is filed. In workers’ compensation, we refer to these dates as the terminal dates. The first terminal date is the date of the most recent claim closure. The second terminal date is the date the application to reopen is filed. Findings of disability that can be seen, felt, or measured by an examining physician are called objective findings.

Therefore, whether there has been an objective worsening of claim related conditions between the relevant terminal dates often involves a comparison of the objective medical findings at or around each of the two dates. However, if L&I denies an application to reopen, a medical opinion regarding the objective worsening will be required to prove that the decision to deny reopening was incorrect.

Conclusions and recommendations

If you want to reopen your L&I claim, you should have your current findings and compare them to the objective findings from the time of most recent claim closure. It is also important that your medical provider clearly explains in what ways there has been an objective worsening. Non-physical conditions such as mental health conditions do not require objective worsening for reopening to be granted. These kinds of conditions inherently cannot be seen, felt or measured. However, for reopening to be granted, a medical opinion concerning worsening of the non-physical condition between terminal dates will still be necessary.