Category: Time-Loss (Page 2 of 7)

Can I retire when I have an open L&I claim in Washington State?

Figuring out when to retire is always a big decision. Even if you don’t have an open workers’ compensation claim. However, retiring with an open L&I claim is even more complex. In fact, if you voluntarily retire while you have an open L&I claim, it can have serious impact on your L&I benefits.

Retirement during an L&I claim

The term Voluntary Retirement has a special meaning in workers’ compensation claims. Under WAC 296-14-100, you are “voluntarily retired” if:

You are not getting salary or wages from gainful employment; and
After your retirement, you don’t show any real attempts to go back to work.

Voluntary retirement can have negative effects on your L&I claim benefits. Specifically, under RCW 51.32.090(10), if L&I “determines that the worker is voluntarily retired and is no longer attached to the workforce”, then they won’t pay temporary total disability benefits. Moreover, under RCW 51.32.060(6), the same rule applies to permanent total disability benefits. That means, if a person voluntarily retires, they won’t receive L&I pension benefits.

Can I retire because of a work injury?

There are important nuances to the rules above. For one, a work injury claimant isn’t “voluntarily retired” when a proximate cause for their retirement is a workplace injury or occupational disease. What does it mean? If at least one reason for your retirement is directly because of your work injury, then your retirement isn’t “voluntary”.

Some people have severe disabilities because of their industrial injury or workplace illness. They can never return to work. These people may be eligible for an L&I pension. A pension is essentially a lifetime annuity. People that receive pension benefits under their L&I claim can also collect retirement money. Therefore, it’s usually better to make retirement decisions after L&I decides if you have permanent total disability.

Documenting your retirement reasons

However, delaying retirement isn’t always possible. Also, sometimes, it’s not practical. There are many reasons why people retire before L&I decides on permanent total disability. Unfortunately, in my experience, L&I usually assumes the retirement was “voluntary”. That is, if it happens while the claim is open and active. Yet, this assumption is often wrong. Many times, it’s not easy to decide if the retirement fits the legal definition of “voluntary retirement”. This is especially true when the retirement facts and circumstances are not well-documented.

Some people choose to retire while their claim is open. If the retirement has nothing to do with your work injury or disease, be ready to lose your time-loss benefits. Furthermore, you will not receive an L&I pension. But, if your decision to retire is based (at least in part) on the work injury or workplace illness, then you must document all claim-related reasons.

In summary…

If you retire with an open L&I claim, you’ll probably be giving up some benefits. You should seriously think about whether to retire while your workers’ comp claim is open. Make sure you understand the rules and consequences. I tried to explain some of the considerations in this article. However, retiring during an L&I claim is not a simple matter. Hence, I always recommend speaking with an experienced workers’ compensation attorney before making any retirement decisions.

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

/ L&I attorney / 10 Comments

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 attorney / 0 Comments

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.