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

Category: Medical Treatment (Page 33 of 36)

L&I Workers Compensation Claims and Acupuncture

Did you know that the Department of Labor and Industries (L&I) has an acupuncture pilot project? Until very recently, acupuncture as a treatment was not covered on L&I claims. Recently L&I decided to launch a pilot program designed to collect information about the use of acupuncture to treat low back pain, including treatment provided by East Asian Medicine Practitioners (EAMPs). During the project L&I will pay qualified providers participating in the project to provide acupuncture treatment to injured workers with low back pain that is related to an accepted condition under their claim.

 

For treatment to be covered, it must focus on helping inured workers heal and return to work. Furthermore, the treatment must be ordered by the attending provider (AP) and documentation must show clinically meaningful improvement in pain and function with the acupuncture treatment. If these conditions are met, up to 10 acupuncture treatments over the lifetime of the claim may be authorized. As treatment progresses, participating providers are required to use the Oswestry Disability Index and 2-item Graded Chronic Pain Scale score to assess the improvement in pain and function and send reports to the Department continuing this data.

 

As an attorney representing Washington State injured workers, I am very excited that the Department is finally exploring acupuncture as a treatment option under L&I claims. For years, acupuncture has often been recommended to assist injured workers in overcoming painful conditions and dependence on pain medications like opioids. However, injured workers were often disappointed to learn the recommended treatment would not be covered by the Department. It was not uncommon for me to represent individuals so desperate for pain control they were willing to cover the cost of acupuncture treatment out of pocket. However, for struggling injured workers, paying out of pocket is often not possible. In my experience, many injured workers have had very positive results from acupuncture.

 

Are you an injured worker that has been able to take advantage of the L&I acupuncture pilot project? If so, I’d love to hear from you about your experience.

Finding an Attending Physician for Your L&I Workers’ Compensation Claim

Injured workers are required to designate an attending provider or attending physician (AP) on their L&I claim or workers’ compensation claim. In very simple terms the AP is the medical provider that manages treatment, reports progress to L&I, and assesses the injured workers’ medical ability to return to work in regular intervals as the claim progresses. It is the injured worker who gets to choose their AP, but the AP must be within L&I’s medical provider network (MPN) and the chosen provider must be willing to see the injured worker.

 

I’m often asked by injured workers what kind of AP they should select. People are often concerned with finding a provider that will be “good” for their case and often believe that in order for the provider to be “good” they must be a MD. While the opinions of medical doctors can sometimes carry greater weight than other types of providers, I don’t always agree that an MD is the best AP. I usually tell injured workers to select an AP they are comfortable with. It is important for injured workers to have good communication with their providers, to feel comfortable with the medical advice they are given and with asking questions. It is also important for injured workers to have attentive AP’s that pay attention to the facts and details of the claim, provide appropriate and well-reasoned treatment recommendations and referrals, and who are willing to respond to inquiries from the Department.

 

There are many kinds of medical providers that can be APs including, but not limited to, medical doctors (MD), osteopathic doctors (DO), chiropractors (DC/DCM), naturopaths (ND), physicians’ assistants (PA-C), and advanced registered nurse practitioners (ARNP). Many injured workers are surprised to learn that their “family doctor” or “primary care physician” may be within the medical provider network and able to take on the role of AP. Therefore, it is best to take your time and do your research when selecting an attending physician. Injured workers can change the AP designation by filling out a Transfer of Care card, and can search for MPN providers through the Department’s Find a Doc website.

L&I and Workers Compensation Claims for Loss of Hearing Injuries

I’ve been working on a hearing loss claim and thought it would be a good idea to share some basic information about occupational hearing loss L&I claims in Washington State. Hearing loss claims are governed by RCW 51.28.055. Unless hearing loss occurs as a direct result of a sudden, traumatic event (which would be more appropriately classified as an industrial injury), occupational hearing loss claims are typically allowed as occupational disease claims. This kind of hearing loss is usually called sensorineural hearing loss.

 

However, these claims have some particular rules related to the timing of filing a claim that can significantly impact the long term value of the claim. In short, claims for occupational disease hearing loss must be filed within two years of being informed in writing by a physician or ARNP that an occupational disease claim exists and that a claim may be filed. As a practical matter, it is very rare for a physician or ANRP to put this kind of information in writing without taking the additional step of filing a claim. Therefore, it is very rare to see claims be denied solely because an application was not filed within an appropriate timeframe.

 

It is very important to know that just because an occupational hearing loss claim is allowable does not necessarily mean it is compensable. For an individual for a hearing loss claim to receive compensation under the claim (most frequently a Permanent Partial Disability or PPD award) the claim must be filed within two years of when the worker was last exposed to occupational noise in employment. In order words, if an individual stops working in an environment with occupational noise exposure in 2010 and does not file a claim until 2020, the claim may be allowed for medical aid benefits (typically hearing aids and lifetime repairs or replacements) but not other monetary benefits such as a PPD.

 

In summary, if you are a worker and you believe that your work has contributed to your hearing loss it is best not to delay in seeking out a medical examination to assess your hearing loss and to file a claim for occupational disease hearing loss to ensure that you will be afforded both medical and compensation benefits under the Industrial Insurance Act.

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