Category: PPD (Page 6 of 8)

Workers’ Compensation and L&I Claim Benefits Versus Costs in Washington State

In Washington State, workers’ compensation is about providing benefits to workers and their dependents. Specifically, the benefits are for disabilities and deaths caused by a workplace injury and work-related disease. The Department of Labor and Industries (L&I) has a duty to administer your workers’ compensation claim. They decide what benefits to provide depending on the work injury and make decisions and issue orders for your L&I claim.

Benefits after a workplace injury under the Washington State workers’ compensation system

Some of the key financial benefits in a workers’ compensation claim are payments to a person injured at work (such as time loss compensation or temporary total disability), and coverage of medical expenses and treatment. For state claims, employers and workers make regular premium payments to L&I. Consequently, L&I makes the compensation payments to the injured work after a work accident. However, if the employer is a certified self-insured employer (i.e., the employer uses a private insurance for their workers’ compensation claims), then the employer or the insurance company makes these payments directly.

Personally, it seems to me that workers’ compensation rates and premiums often dictate how people feel about claims. L&I makes it loud and clear that the way to keep rates down is by reducing claim costs. From my viewpoint, employers and insurance companies keep their rates low by reducing medical expenses and keeping time off work to minimum (or eliminating the time off completely).

Workers’ compensation rates

Today, L&I sent out a press release boasting with a proposal to boast 0.8% reduction in workers’ compensation premiums for employers. The proposal applies to state funded claim. It does not apply to self-insured employer claims. This is the third year in a row where L&I is reducing employer insurance premium rates.

In 2018, L&I dropped the average employer premium rate by 2.5%. For 2019, L&I lowered the premium rates by another 5%. Interestingly, that was the largest rate decline in more than 10 years. Moreover, today’s press release states that employees will “see a very small increase in the amount they pay” due to increases in the average wage.

How to appeal the proposed workers’ compensation insurance rate changes

The 0.8% workers’ compensation claim rate reduction and the increase for employee premium rates is currently just a proposal. Clearly, public hearings will follow. That means we will all have an opportunity to comment on the rates proposed for 2020 at three public hearings:
(1) Tukwila, Oct. 29, 10 a.m., Dept. of Labor & Industries Tukwila Office
(2) Spokane Valley, Oct. 30, 9 a.m., Spokane CenterPlace
(2) Tumwater, Nov. 1, 10 a.m., Tumwater Labor & Industries Office

Another option for commenting is by writing to Jo Anne Attwood, administrative regulations analyst. Her address is P.O. Box 41448, Olympia, WA 98504-4148. You can also email Joanne at joanne.attwood@lni.wa.gov. Comments are due no later than 5:00 pm on November 5, 2019. Thereafter, final rates will be adopted by early December and go into effect January 1, 2020.

Summary and personal notes

Whether we are employers or employees, none of us really want to pay higher rates. However, I think it is important to know that we are benefiting from reduced rates because injured workers are being denied workers’ compensation benefits. I can’t help but ask: What is a greater value, lower insurance rates or healthy workers who receive a full and fair opportunity to benefit from the Industrial Insurance Act? Finally, you can read the full press release on the L&I website.

Workers compensation LNI claim PPD rating

Permanent Partial Disability (PPD) rating in Workers’ Compensation and L&I claims

/ L&I attorney / 0 Comments

What’s my L&I claim case worth? I get this question all the time. The answer is always the same: It depends. One way to determine the value of a work injury L&I claim case is based on the Permanent Partial Disability or PPD award. And, the same holds true for a workers’ compensation claim with private insurance companies and self-insured employers.

What is Permanent Partial Disability or PPD?

PPD is a monetary award that some injured workers receive when L&I closes their claim. In short, if the injured worker has: (a) Reached maximum medical improvement; (b) Continues to experience permanent residuals from the industrial injury or occupational disease; and (c) Is still capable of working, then a PPD award may be appropriate.

PPD award rating is based upon medical evidence. When the body part involved in the work injury is one that cannot be amputated, the PPD rating usually uses categories of impairment from the Washington Administrative Code or Washington Administrative Code (WAC). However, if the body part could potentially be amputated, the PPD is rated according to criteria from the American Medical Association (AMA) Guides to the Valuation of Impairment.

Who can provide PPD rating for my claim?

Within the medical provider network or MPN, some providers feel comfortable and are willing to provide PPD ratings. Yet, others do not. Consequently, from my perspective, it is always ideal when the attending provider (AP) that’s assigned to the claim is willing to rate the PPD. This is because that provider usually has the best sense of the injured worker’s permanent residuals from the work injury.

If an AP does not do PPD ratings, they will usually refer the injured worker to a provider that does. Alternatively, they can request an Independent Medical Examination (IME).

How much is my right arm worth?

On a personal note, before you continue reading, please know that I’m very uncomfortable placing a monetary value on parts of the body. The human body is sacred. Body parts are priceless. However, this is the world and the reality we live in.

Injured workers often want to know what the monetary value of the PPD will be. It is important to know that the value is a set number that varies based upon the date of injury. L&I publishes a “Permanent Partial Disability Award Schedule” that lists PPD values based on the date of injury. For example, the value of a 10% right arm PPD for a person injured on December 31, 2015 is $12,004.04. Here, it’s because 100% of the value of an arm for a 2015 date of injury is $120,040.41. However, without a medical opinion rating the PPD, it is virtually impossible to estimate the dollars-and-cents value for the award.

Workers compensation LNI claims help and problems

Solving Problems and Overcoming Roadblocks in Your Workers’ Compensation or L&I Claim

/ L&I attorney / 0 Comments

If you don’t succeed the first time, then you should try and try again. I think this should be the motto for injured workers dealing with their L&I claim as they navigate their workers compensation claim process and issues.

The Industrial Insurance Act (RCW 51) was created to provide “sure and certain” relief for people injured at work. However, this doesn’t mean that workers’ compensation claims go smoothly or without roadblocks. Far from it. In fact, much of what I do is figuring out the best way to navigate obstacles that arise in L&I claims and self-insured employer claims.

L&I and workers’ compensation claims are full of tough obstacles

Whether it is getting treatment authorized, a condition accepted, or finding resolution to a conflict that has arisen, problem solving is my job. I’ll be the first to admit that sometimes problem solving feels more like trial and error. This isn’t because I don’t know what I am doing. It is because over the years I’ve learned that there’s almost always more than one way to solve a workers’ compensation problem. The key is finding the most successful approach, which is usually based on the unique facts and circumstances of the case at hand.

One L&I case in particular

Explicitly, since October, I’ve been trying to solve a series of issues in one particular case. I’ve had difficult conversations with my own client. I’ve had even more difficult conversations with the Claim Manager at the Department of Labor and Industries (L&I). Moreover, I had some loud and rough calls with assistant attorney generals and their paralegals representing L&I.

While I was able to get my client on board with some aspects of my plan, other pieces remained an unresolved challenge. On no less than six separate occasions since October, my proposals were formally rejected. Each time, I went back to the drawing board to try and develop a plan that would succeed. I clearly am not allowed to disclose specific details about this case. However, I’m pleased to report that today I managed to successfully resolve all the remaining issues. Interestingly, the solution wasn’t much different than what I had proposed about ten months ago. Yet, this time around, I just needed to take the right approach, at the right time.

Personal notes

Today’s perseverance to try and try again really paid off. I secured time loss compensation benefits to an injured worker that desperately needed them. To satisfy their mounting debt, to make some urgent payments, and to get a brief temporary break. Equally important, we now have some much-needed breathing room. We are already preparing to tackle the next roadblock that we’re anticipating in this complicated L&I claim.