Category: Time-Loss (Page 4 of 7)

Vocational Retraining in L&I Claim: The Difference Between Option 1 & Option 2

People with work injury in Washington State may be eligible for retraining under their L&I claim or workers’ compensation claim. The Department of Labor and Industries (L&I) provides more benefits than just medical coverage. In fact, the Industrial Insurance Act lists a variety of benefits including medical, wage replacement, vocational services, retraining, disability awards, and even disability pensions. At some point in the claim, you might have to choose L&I claim option 2 vs option 1. The purpose of this article is to explain your options and what they mean.

Vocation retraining eligibility under L&I claim

Not all work injury claimants are eligible to receive all the benefits under the Industrial Insurance Act. Realistically, benefit entitlement depends on the specific facts. They also depend on the circumstances of each L&I claim. Vocational retraining is possible when a person can never go back to work at their job of injury, or any other job for which they have relevant skills. Usually, deciding whether a person can work is based on objective medical evidence. Generally, the medical evidence includes things that medical providers can see, feel, or measure. However, in cases involving non-objective medical conditions such as mental health, those cases don’t require objective evidence.

Vocational retraining plan in L&I claims

When a person cannot return to their job, or doesn’t have the skill to perform other work, they may be eligible for vocational retraining. L&I assigns vocational counselors to determine if retraining is appropriate. If it is, the vocational counselor prepares and submits a retraining plan for approval. There must be a concrete job goal for the plan. Moreover, the job must be available in the work injury claimant’s labor market. Finally, the retraining can take as long as two years. As of July 1, 2021, the maximum allowed cost for retraining under a workers’ compensation claim increased to $19,414.34.

Option 1 vs option 2 in vocational retraining

Once L&I approves your retraining, you can choose between Option 1 and Option 2. Choosing an option is a very serious decision. With Option 1, it means you agree to fully participate in the retraining that L&I approved. This includes registering for and attending classes as well as maintaining satisfactory grades. Here, you will have to complete all class requirements and maintain contact with the vocational counselor.

In contrast, Option 2 is essentially opting out of retraining. When you choose option 2 you get a “vocational award” equivalent to 9 months of time loss compensation. After that, L&I pays the benefit payments in installments, the claim is closed, and you receive permanent partial disability (PPD) award as appropriate. You may also access retraining funds to use at any accredited facility you choose. However, you can only use the money for classes, education, or retraining.

L&I claim option 2: Conclusion and final notes

The decision to go with Option 2 and opt out of retraining has serious implications. In my opinion, people with a workers’ compensation claim should not select Option 2 after a work injury because they feel they have no choices. There’s always some other choice. If you feel that Option 2 is your only choice, then you should consult with a workers’ compensation attorney before you make a decision.

L&I Claim Closed – How to Reopen a Workers’ Compensation Claim in Washington State?

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If the Department of Labor and Industries (L&I) closes your L&I claim or workers’ compensation claim, then you might be able to reopen it. However, if your L&I claim closed, it’s important to note that L&I doesn’t automatically reopen claims. In fact, your case must meet certain criteria to reopen an L&I claim. Yet, many work injury claimants get discouraged and give up instead of trying to apply to reopen their workers’ compensation claim.

My L&I claim closed – Now what?

In fact, some medical providers believe that L&I does not reopen claims. Other treating professionals think that the reopening process is too difficult. This is simply not true. It’s important for both people with a work injury claim, and for medical providers, to fully understand the reopening process and requirements.

In claims for physical work injuries, to reopen a workers’ compensation claim, you must show that certain conditions objectively worsened between terminal dates. If you want to determine whether these criteria are met, you must first understand some workers’ compensation concepts. These three basic concepts are: (1) Terminal dates; (2) Causal relationship of conditions; and (3) Objective worsening.

Terminal dates in a workers’ compensation claim

When you file an application to reopen an L&I claim, the term “Terminal dates” refers to two important dates. The first terminal date is when L&I closed your claim most recently. The second date is when L&I denied the most recent reopening application. Take the most recent date of the two. We denote this terminal date as T1. Next, the second terminal date (which we call T2) is the date when you filed the most recent application to reopen your workers’ compensation claim.

Causal relationship in L&I claim

We say that conditions are “causally-related” if the industrial injury or occupational disease is the proximate cause of said conditions. Here, proximate cause means a cause that, in a direct sequence, produces the condition. The law acknowledges that there may be more than one proximate cause. Therefore, the industrial injury or occupational disease must be one of the causes of the condition. Said differently, it doesn’t need to be the only cause. Furthermore, a condition can also relate in a causal manner if the industrial injury or occupational disease aggravated it or worsened it.

Causal relationship requires medical reasoning. Here, you must obtain a written medical opinion to show that the work injury or work illness caused the condition. In other words, you must find a doctor or a competent medical expert to say there is a causal connection and explain why. Remember, reopening requires worsening of causally related conditions. Hence, we must first identify the condition and the causal relationship.

L&I sometimes reopens claims for worsening of a condition. For instance, if doctors did not diagnose or relate a condition to the claim before claim closure. If the medical evidence supports that the condition relates to your work injury, or that the condition worsened and requires treatment, then L&I will reopen the claim.

Objective worsening in work injury claim

If you have a workers’ compensation claim, then L&I considers anything that you say as subjective. For example, saying that you are experiencing pain increase is subjective. It’s insufficient for claim reopening purposes. Alternatively, objective findings are ones that a medical provider can see, feel, or measure. To reopen a claim, a medical provider must show that the causally related conditions got worse between the two terminal dates. Additionally, these conditions must require treatment, or increase your disability level.

Here is an example. Say that you were hurt at work and your work injury caused a herniated disc. The doctors can clearly see the disk herniation on MRI. Practically speaking, the doctors can measure the actual size of the herniation. Based on the initial size, they determine that the disc is not impacting the nerves. Therefore, you do not need surgery and your treatment concludes.

Next, the claim is closed. Over time, the herniation gets worse and causes additional symptoms. Doctors get a new MRI where they see that the herniation is bigger. Now, the disc is impacting the nerves and needs surgery. Right then, you should file an L&I reopening application, and L&I should grant it. Moreover, if reopening occurs within 7 years of the initial claim closure, you may receive additional monetary benefits such as time-loss compensation and increased PPD.

Final remarks

If you want to reopen an L&I claim or a workers’ compensation claim in Washington State, you have to understand some basic terms. However, it’s not difficult to learn and understand them. It’s also not difficult to reopen your claim. If the conditions that relate to your claim objectively worsened, then you should apply to reopen your claim. Furthermore, with objective worsening, there is no reason for L&I to deny your claim reopening application.

L&I Claim Settlement and Workers’ Compensation Claim Settlement

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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.