Category: PPD (Page 4 of 8)

L&I Claim and Workers’ Compensation Claim in Washington State: Common Mistakes and How to Avoid Them

As a workers’ compensation attorney, the most common question I get is: “What mistakes should I not make in my L&I claim?”. There is no easy answer for this question. Interestingly, while there’s a clear definition for potential L&I claim benefits, there is no list of potential pitfalls.

Every L&I claim is different

Generally speaking, the administration process for every workers’ compensation claim in Washington State follows certain administrative codes. However, every claim is individual and different. Every work injury or work-related disease has its own challenges. Similarly, every claim outcome is ultimately unique to the person that suffered the work injury. However, from my experience as an L&I attorney, here are a few tips I can offer for avoiding common mistakes and keeping your workman’s comp claim on track.

Use common sense to avoid L&I mistakes

Throughout your L&I claim process, you will need to make many decisions and response to communications. Therefore, it’s very important to use common sense. You should do what is logical. Frequently, I see that people get very anxious and worry about not messing up their work injury claim. Meanwhile, they forget to be logical. You must avoid this common mistake. If it helps, take a step back and think about the big picture. If you use common sense and remain logical, that’s probably the easiest way to keep your workers’ comp claim on track.

Recovery first

The first and most important thing in an L&I claim is to focus on your recovery. Let’s be honest: Whether you got hurt on the job or developed an illness at work, you want to recover. Nothing is more important than your health. Realistically, if you let other claim issues get in the way, it can distract or even derail your path to recovery. I sometimes see work injury claimants prioritize the handling of their claim over their personal health, which may lead to unfortunate outcomes.

L&I mistakes: Pay attention

It’s extremely important to pay attention to everything that is going on in your workers’ compensation claim. I am well-aware that keeping track of all the small details can feel like a full-time job. However, it’s not helpful to ignore certain steps or bury your head in the sand. In fact, it’s necessary to know what’s happening in your claim so that you can follow through and take appropriate actions. Monitoring your L&I claim progress will also help you spot red flags early. It’s critical to read notices and decisions from the Department of Labor and Industries (L&I) and address any issues while you still have time.

Ask for help

Most importantly – don’t wait too long to ask for help. Many work injury claimants may never need help from an L&I attorney. However, that isn’t true for everyone. If certain issues arise in your claim, then don’t delay asking for help. Specifically, if an issue in your case is heading to the Board of Industrial Insurance Appeals (i.e., BIIA or Board), it is advisable to speak with a workers’ comp attorney immediately. Appeals before the Board have timelines and certain litigation schedules. Waiting too long to contact an attorney can make it difficult for any lawyer to get involved. Remember, your attorney will need time to get up to speed or to provide meaningful advice. Moreover, if you are looking for a workers’ compensation attorney, it’ll take them time to prepare a winning case.

Final comments

In summary, when you have an L&I claim, there’s no concrete list of black and white rules to follow. However, I always recommend people to remember the key principles above. Use common sense and focus on recovery. Over time, follow closely and pay attention to what is happening in your claim. Finally (and arguably most importantly), do not delay asking for help.

L&I Pension – Permanent Total Disability

/ L&I attorney / 14 Comments

An L&I pension is an important benefit after a serious work injury. For example, a catastrophic work injury or occupational disease can make work injury victims unemployable. Here, unemployable means that the person is unable to “perform or obtain a gainful occupation with a reasonable degree of success and continuity”. If medical treatment or vocational services cannot make the person employable, then the work injury claimant is permanently and totally disabled. If you have an L&I claim or workers’ compensation claim, and you are permanently totally disabled, then you are entitled to “L&I pension” benefits under your claim.

L&I pension payments

When the Department of Labor and Industries (L&I) places a work injury claimant on L&I pension, then their L&I claim is closed. However, the injured worker receives L&I pension benefits for the rest of their life, so long as they remain unemployable. L&I pays out pension benefits monthly, around the 15th of each month. The amount depends on the worker’s salary and wages at the time of injury. Furthermore, if the worker is married, then he or she can choose for their spouse to get survivor benefits. Simply put, “survivor benefits” means that if the work injury claimant passes then their spouse will receive the pension benefits. Under certain circumstances, this choice may also impact the monthly L&I pension amount.

Permanent total disability and L&I pension

There are many factors to consider when determining whether a work injury claimant is permanently and totally disabled. These factors include the following considerations, among others:

1) The worker’s work pattern at the time of injury – part-time employment, full time, seasonal worker, and so on.

2) Whether the work-accident, injury, or work-related illness cause the permanent physical or mental limitations.

3) Were there any preexisting permanent (physical or mental) limitations?

4) The person’s wage-earning capacity.

5) The local labor market.

6) The worker’s strengths and weaknesses.

7) The work injury claimant’s age, education, training, and experience.

Based on these factors, L&I may consider the workplace injury claimant as permanently and totally disabled. Even if a person is not physically or mentally helpless, they can still fall under the qualifications. However, we have to remember that an injured worker doesn’t have permanent total disability just because they cannot return to their former job. In fact, if the worker can perform or obtain any gainful work with success and continuity, then they are employable.

Employability: Are you employable?

The Department of Labor and Industries places great value on employability, for a variety of reasons. From my perspective, there are some issues with how L&I views and evaluates employability. In my opinion, saying that someone is employable on paper is not the same as how things manifest themselves in the real world. Furthermore, it’s not uncommon for employability determinations to be based on erroneous or insufficient medical or vocational evidence.

Getting L&I pension help from an L&I attorney

As I see it, most people with a workers’ compensation claim recover from their injuries or illness and return to work. However, there are many individuals with L&I claims that need assistance to return to work. Comparatively, only a small number of workplace injury claimants have permanent and total disability. If you have an L&I claim or a workers’ compensation claim, and the claim administrator is saying you are employable when you are not, then you should immediately speak with a workers’ compensation attorney.

L&I Claim Settlement and Workers’ Compensation Claim Settlement

/ L&I attorney / 6 Comments

How do I settle my claim? Can I get paid for my claim? What can I do to get an L&I claim settlement? These are common questions I get from people with an L&I claim or a workers’ compensation claim. To answer, I usually have to explain how L&I claims work in Washington State. That way, I may have a better understanding of what the person really means by “settlement”. In most cases, the work injury claimant is just looking for a fast track end their L&I claim. In other words, they are just hoping for a monetary payout in exchange to the claim. Unfortunately, it doesn’t always work this way.

Workers’ compensation claim settlement – How do I settle my L&I claim?

There are two types of work injury claims in Washington State. First, there are L&I claims – the Department of Labor and Industries (L&I) administers these claims. Second, we have self-insured employer claims, where a Third-Party Administrator or TPA handles the claim. Monetary payouts are not available for your L&I claim but it might be an option for a self-insured claim. If you want to receive a monetary payment for your self-insured employer claim, you must understand the consequences.

In practice, if you agree to a monetary payout, it means that you are giving up your work injury claim in exchange for some money. By giving up, I mean that you are agreeing to allow the insurance company to reject your workers’ compensation claim or close your claim. This is a quick way to resolve claims. It is sometimes referred to as “sidebar agreement”. It’s important to note that only a very small portion of workers’ compensation claims reach resolution this way. And with that in mind, work injury claimants should first speak to a workers’ compensation attorney before making this decision.

L&I claim structured settlement

Another type of settlement is called structured settlement or CRSSA. Generally, it resolves all future benefits under your workers’ compensation claim. If you have a work injury claim and you are 50 years old (or older), then you can consider this L&I claim settlement option. In addition, to qualify, your claim must be approximately 6 months old. Under CRSSA, you typically agree to close your L&I claim or workers’ compensation claim. In exchange, the claim administrator will pay you a certain sum of money and you will receive partial payments over time. Most importantly, under this option, you may still be eligible to receive additional treatment if the medical condition that relates to your L&I claim gets worse.

In my experience, self-Insured employers are often open to CRSSA claim settlement because it’s a way for them to resolve a claim. On the other hand, L&I claims will consider CRSSA once the work injury claimant reached maximum medical improvement. However, in my recent experiences with L&I, their CRSSA offers rarely make sense. Especially when you take into consideration the benefits that people with a workplace injury claim are giving up. For this reason, I strongly advise work injury claimants to speak to an L&I attorney before they agree to a CRSSA.

Permanent Partial Disability or PPD

Generally speaking, when clients ask about claim settlement, they are really asking about Permanent Partial Disability or PPD awards. L&I usually gives a PPD award at claim closure. Only an attending provider or an IME provider can perform a rating exam to determine the PPD impairment. These definition of PPD ratings include a certain percentage and a category. Furthermore, the value of the PPD rating is based on the date of injury.

In some cases, PPD awards can be very straightforward and do not require the involvement of a workers’ compensation attorney. For example, when you reach maximum medical improvement and return to work. However, L&I can also choose to close your claim without paying you a PPD award, even if you are unable to go back to work. In that case, it’s extremely important to speak with an experienced attorney to learn your rights and options.

Final Thoughts and Conclusions

To summarize, there is a lot more to workers’ compensation claim settlement than what most people think. I know that work injury claims can be tough, long, and cause people a lot of stress. However, taking the easy way out isn’t always worth it in the end. It could mean that you’re giving up benefits that you’ll require at a later time under the Industrial Insurance Act. Therefore, I always recommend that folks consult with a workers’ compensation attorney before “settling” their claim.