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

Category: Retraining Vocational (Page 2 of 5)

Closing L&I Claim: Do I Need an Attorney?

I get calls from work injury claimants often. The #1 reason they call is because their L&I claim is closing. Also, the same goes for self-insured employer claims in Washington State. L&I claim closure can be very stressful. To help, I put together this checklist below. You can use it to check for any red flags. If there are some, I strongly recommend you consult with a workers’ compensation attorney.


L&I claim closure and maximum medical improvement (MMI)

Your L&I claim cannot close before you reach maximum medical improvement. Again, the same applies to self-insured employers. Maximum medical improvement is sometimes calls medical fixity. You achieve it when there’s nothing more that doctors can do for you. Unfortunately, it doesn’t mean you’re healed. In short, it means that doctors don’t think you’ll get better with more medical treatment. Yet, many times, it’s unclear if you’re at maximum medical improvement. After all, it’s a doctor’s opinion. Therefore, it’s possible your claim is closing while your medical provider thinks you need more treatment. If that’s so, then it’s a red flag. You definitely want to contact an attorney.


Future employment issues

L&I must address future employment concerns before a claim can close. For example, if you have total disability. That’s one example where L&I can’t just close the claim. At very least, they have to pay for your disability. Total disability means you have physical or mental impairment. It impacts your ability to find or maintain a job. Any type of job within your skills. Not only the job at the time of your work injury. However, total disability doesn’t mean you’re helpless.


L&I has to evaluate and decide if you’re employable. For that, they consider your age, education, skills, and training. They also consider your experience and any previous limitations. Furthermore, they take into account limitations from your work injury. One way for L&I to resolve total disability is with L&I pension. Therefore, you should think if you have total disability. If you do, and if your claim is closing without pension, then call an attorney.


Permanent partial disability

We refer to permanent partial disability as PPD. Some work injuries or occupational diseases cause permanent conditions. For example, a loss of body function can be permanent. L&I has methods to assess your level of PPD. On top, there are several evaluation techniques. For assessments, a PPD rating medical expert must examine you. Many times, an IME performs the PPD rating. Other times, the attending provider can perform the PPD rating. After the rating, L&I decides the amount of your PPD award. One red flag is when you have permanent limitations without PPD rating. Or, when your rating seems low considering your symptoms. Another red flag is when you don’t receive a PPD award. Finally, it’s possible that some doctors disagree with your PPD rating. All these cases are red flags. It’s important you talk to an attorney.



Unresolved problems in your L&I claim

Some L&I claims start to close when there are ongoing issues. That’s a red flag. For example, closing a claim while there are time-loss compensation payment problems. On top, closing a claim with outstanding medical bills. And so on. You know your claim. You can tell if there are any lingering issues. If there are, then it’s critical to resolve them before the claim closes.


L&I claim closing when it should

There are plenty of cases with no red flags. Very often, L&I claim closure is appropriate. However, improper claim closure is also common. When you L&I claim closes, then L&I sends you a letter. If your claim closed and you didn’t receive a letter, then you must speak with an attorney. Usually, the closing letter contains a payment order or notice of decision. After that, the decision becomes final in 60 days. This means you have 60 days to protest or appeal. Personally, I always think it’s a good idea to talk to an L&I attorney if your claim is closing. You can always receive free information and tips that can help.


Reopening L&I claim

Say your L&I claim closes inappropriately. Now, you can appeal and fight claim closure. If successful, L&I will keep the claim open and work to resolve the remaining issues. However, say your claim closes after they fix all remaining problems. In this case, you can still reopen your L&I claim in the future under certain circumstances.


Reopen L&I claim after it closes

These are certain requirements for reopening a claim. They are:

1) There must be an aggravation. This means that a condition in your claim got worse. More explicitly, for physical conditions, there must be objective medical findings. A doctor has to determine that your work injury condition deteriorated. In addition, you must show some medical tests to support the doctor’s opinion.

2) The aggravation requires more medical treatment or justifies higher disability rating.

3) The aggravation occurs between two specific dates. The first date is when the claim closed. It can also be the last date when L&I denied an application for reopening. Then, the second one is the most recent reopening application date.


Reopening due to new medical conditions

Sometimes, L&I can reopen a claim when a doctor finds new conditions. The conditions must relate to the workplace injury or work illness. This is true even if the condition wasn’t known prior to claim closure.


The 7 year L&I claim reopening rule

Many work injury claimants reopen a claim within 7 years of claim closure. If that’s the case, all L&I claim benefits may be available after reopening. This includes medical treatment, time loss compensation, and loss of earning power. On top, it includes increase in PPD, and even L&I pension benefits. But, if you reopen a claim after 7 years, you can only get more treatment. Unless the director of L&I grants you other benefit under their discretion.


L&I Retraining: What Are My Options?

L&I claim retraining is one of the most valuable benefits during your workers’ compensation claim in Washington State. Retraining benefits aren’t available for everyone. In fact, retraining is a discretionary benefit. However, when the retraining option is available, I always recommend work injury clients to seriously consider retraining.


L&I claim retraining in Washington State

Strictly speaking, the director of the Department of Labor and Industries (L&I) authorizes retraining benefits. Usually, vocational counselors provide recommendations to L&I. Then, the director exercises discretion and grants retraining on the basis of vocational inputs. Over time, I represented many work injury claimants who very much wanted to pursue a retraining program. However, L&I did not offer the retraining option to them. Yet, although retraining is a highly valuable benefit, it’s not always the best path for you.


L&I retraining is not for everyone

There are two common scenarios for when retraining isn’t right. First, when the retraining plan doesn’t make sense. And second, when the work injury claimant has no interest in retraining. When retraining doesn’t make sense, it’s typically a good idea to dispute the vocational determination. Remember, workplace injury claimants can file a dispute up to 15 days from the day L&I approves the retraining plan.


Personally, from my prospective, there are several common scenarios when retraining doesn’t make sense. They include cases where:

1) The injured worker cannot maintain a stable work schedule. This can be a result of the work injury or any pre-existing conditions.

2) The work injury claimant lacks the physical or mental ability to complete the retraining or the job goal.

3) The retraining plan won’t make the work injury victim employable in a competitive manner.


Vocational option 1 and option 2

Sometimes, a retraining plan does make sense, but the worker doesn’t want to retrain. Here, the work injury claimant has options. The 1st, which is my least favorite option, is refusing to participate in retraining. If L&I approves your plan and you fail to participate, they will find you non-cooperative and suspend your L&I claim. You don’t want to end up in L&I claim suspension. It’s very difficult, if not impossible, to overturn this claim outcome.



The 2nd  option, which is my second least favorite one, is Vocational Option 2. I often call this the “opt-out” option. In short, workers can choose retraining option 2 to opt out of retraining. After that, the work injury claimant is eligible to a vocational award equivalent to 9 months of time-loss compensation payments. Once the worker selects option 2, the workers’ compensation claim moves towards closure. Moreover, work injury claimants may only select option 2 one time across all their claims and reopening. I’m not a fan of this option because it lacks long-term thinking. The funds will run our sooner than later. What then? It’s best to plan for the long run.


Additional options for L&I vocational retraining

If you are over 50 years old, then you have another option. This 3rd option is to pursue an L&I structured settlement.  For me, this is potentially a valid option. But, it all depends on whether retirement is appropriate for the worker. Furthermore, it boils down to the timing when funds from the L&I settlement become available. Finally, it also depends on whether the worker can use the funds for a proper retirement plan outside of the L&I claim.


The 4th and final option is to try the retraining plan. Many times, work injury claimants find that retaining is very enjoyable. In addition, an L&I retraining plan can last as long as 2 years. While retraining, workers receive L&I time-loss compensation. This option can genuinely serve as a great opportunity to acquire new skills and receive additional recovery time before re-entering the workforce.


Final words

In summation, retraining is a valuable benefit in your workers’ compensation claim, but it isn’t for everyone. If the L&I retraining plan doesn’t make sense, it’s important to submit an appropriate vocational dispute. However, if the plan makes sense but it isn’t what you want, you have options. Some of these options are better than others. Therefore, it’s a good idea to carefully consider your decisions. Choose the option that makes the most sense for you and for your life.


L&I Claim Retraining: The Importance of Good Retraining Plans

The Department of Labor and Industries (L&I) provides a variety of vocational services. The goal of L&I claim vocational services is to help work injury claimants resume continuous, successful, and gainful employment.


L&I claim retraining – Who is eligible?

Job retaining isn’t available to everyone. If you have a workers’ compensation claim in Washington State, you may be eligible for retraining if you meet certain conditions. First, you can no longer work at your job of injury. Second, you don’t possess skills to do work under your physical limitations. Finally, if you’re eligible for retraining, then time loss payments continue while you actively and successfully participate in retraining.


Retraining plans must be reasonable and appropriate

Retraining programs are a significant benefit following a work injury. However, in my opinion, for a retraining plan to be effective, it must be reasonable and appropriate. For starters, let me explain what I mean by reasonable and appropriate.


Reasonable: From my perspective, reasonable plans are within the aptitudes of work injury claimants. They are written for success and not repeated failure. Also, when submitting plans, there’s sufficient time for approval. Moreover, plans allow the work injury claimant to obtain the necessary books, hardware, and other supplies BEFORE the term begins. Good plans include provisions for any necessary educational accommodations. Furthermore, accommodations are pre-arranged and pre-approved with the educational facility. Finally, they are drafted based on recent information about program requirements and course offerings. The latter minimizes the likelihood of class unavailability or program changes.


Appropriate: In my opinion, appropriate plans provide a real chance to obtain work once the plan completes. Therefore, there must be actual demand and labor market. Additionally, the job must be something the work injury claimant can sustain in real life. Whenever possible, the plan should also involve a retraining goal that interests the work injury claimant.



The importance of good work retraining programs

It’s important for retraining plans to be reasonable so that injured workers succeed. Unreasonable plans have a very high likelihood of failure. For example, when plans exceed the aptitudes of a work injury claimant, they tend to fall behind, fail classes, and often must repeat classes. In fact, I’ve seen plans that include repeat classes in the coursework because of vocational counselor’s assumption the injured worker will fail the class the first time. This doesn’t inspire success. On the contrary. It makes work injury claimants feel defeated before they begin.


Another unreasonable issue is when work injury claimants don’t get the hardware, books, supplies or help they need until weeks into the term. By then, they are already behind and may not recover in time to achieve passing grades. In short, plans that are not reasonable make work injury claimants feel like they’ve been set up to fail. Reasonable plans, on the other hand, inspire success.


As a primary matter, any retraining goal must be physically appropriate for the work injury claimant. They need to be able to do the work with success and continuity. Beyond that, work injury claimants are far more likely to become successfully employees after retraining if they can obtain a job that satisfies them. The first step towards that goal is ensuring the retraining plan will enable workers to obtain a satisfying job. In my experience, there’s rarely anything more defeating than telling an injured worker they’ve lost a job they love to disability and have no choice but to do a job they hate. While the law does not require people to return to their pre-injury earning capacity, it also doesn’t require them to be miserable.


Personal experiences

In summary, plans that are reasonable and appropriate are likely to succeed. Plan success means achieving the goal of vocational services to help work injury claimants resume continuous, successful, and gainful employment. Retraining is an incredibly valuable benefit. For many, retraining is the only hope for returning to work. However, to achieve employability, for it to truly succeed, the plan must be reasonable and appropriate. Sadly, I don’t feel like we place enough emphasis on the importance of reasonable and appropriate retraining plans. While not universally true, I feel that stakeholders put more effort on pushing plans through approval than ensuring they’re reasonable and appropriate. I commend and thank the vocational rehabilitation counselors who actively work for reasonable and appropriate plans. Your work truly changes lives for the better!


Interestingly, Terry, my paralegal, was injured at his previous workplace and went through retraining under his workers’ compensation claim. That’s how he achieved his paralegal diploma. Recently, I asked him what retraining meant to him. He replied:

When I went through the plan development process, it was important to me that I found a plan that fit my aptitudes and physical restrictions. I needed my training program to provide me with the skills needed to safely support myself and my family in a new job. I was fearful that I would not be able to find this because early on in the process, I was being presented with options such as weeks-long office assistant that appeared to be within my physical restrictions, but very minimal in the job skills that would be acquired. If I had not been able to get in a program that was appropriate for my educational and physical situation, I would have likely ended up back in a labor-based job, risking further injury.

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