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

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L&I Control Over Medical Treatment: The MPN and Best Practices

Approximately 10 years ago, I remember attending a presentation with other workers’ compensation attorneys. The presenter was a representative of the Washington State Department of Labor and Industries (L&I). The main topic of discussion was rolling out the Medical Provider Network or MPN.

 

Concerns and challenges under the medical provider network

Every workers’ compensation attorney I know was understandably concerned. From our perspective, the MPN was merely an opportunity for L&I to control L&I claims. We feared that people with a work injury claim would have few providers to choose from. Moreover, we thought this would infringe on their ability to select their own medical provider. On top, we were suspicious of the requirement for providers to follow L&I’s “best practices”. Finally, we suspected that this MPN was more about cost savings than improving the quality of care.

 

I don’t think the Medical Provider Network turned out to be as terrible as we originally feared. However, not being as terrible as feared doesn’t mean it’s good. The MPN is problematic. I think the years have shown that our initial concerns over the MPN were valid. The MPN created challenges for people with a workers’ compensation claim to find a doctor or attending provider. This is especially true when work injury claimants need new doctors after the claim has been open for some time. Furthermore, finding treating psychiatrists has been incredibly difficult if not impossible.

 

L&I claim and best practices

Obviously, I’m very biased in my opinions. Naturally, I have the best interest of my clients and other work injury victims in mind. Therefore, I remain suspicious of L&I’s “best practices”. For example, according to L&I, the goal of their best practices is to improve quality of care and L&I claim outcomes.

 

From my perspective, best practices seem like a simple way for L&I to exert control over the medical aspects of a workers’ compensation claim and reduce costs. In fact, it’s not necessarily surprising for an administrative agency like L&I to have such goals. I think L&I has the obligation to eliminate excessive or unnecessary L&I claim costs. However, my concern is that best practices unfairly inhibit medical providers’ ability to use their own experience and judgment to appropriately treat people that suffer a work injury. Also, I think that following best practices creates more administrative work that burdens and frustrates providers.

 

My personal perspective

It’s clear that L&I is committed to maintaining the Medical Provider Network. It is here to stay. In fact, L&I has several pilot programs and initiatives to establish and test new best practices. Workers’ compensation claims are very complex. Hence, the ongoing initiatives try to tackle many aspects of medical claim management.

 

Medical providers already have many burdens without additional administrative work. Sadly, I find it very discouraging when medical providers avoid involvement in L&I claims because of the overhead. Simply put, they don’t want to be burdened with L&I claim administration demands. I genuinely applaud L&I’s efforts to improve the quality of care. At the same time, I’d like to see L&I taking steps to make things easier for providers. We must take steps to simplify processes and paperwork. Surely, it’ll make treating work injury claimants more appealing for medical (and other) providers.

L&I Claim Closed – Who is Paying for Future Medical Expenses?

What happens after my L&I claim closes? I get this question all the time. It’s one of the biggest points of stress for people after a work injury in Washington State. Moreover, this stress is particularly high for people that know they will incur additional medical costs after their L&I claim is closed.

 

Paying for medical expenses after L&I claim closure

Under WAC 296-20-124, the Department of Labor and Industries (L&I) will not pay for services after a workers’ compensation claim closes. However, L&I and self-insured employers are responsible to pay for services that relate to the claim reopening application. Furthermore, there are a couple of other important exceptions.

 

Workers’ compensation claim closure and payment exceptions

The first exception is for certain periodic medical exams. Here, L&I and self-insured employers must pay for certain periodic medical surveillance examinations. For example, these exams are very common in cases involving asbestos diseases. Generally, doctors recommend these exams under the medical protocol whenever they need to perform routine medical monitoring or maintenance.

 

Another exception is for medical equipment replacement. Under WAC 296-20-1102, L&I may cover repair or replacement of prosthetics, orthotics and other special equipment. However, after L&I claim closure, you need to get pre-authorization from the prescribing medical provider. Explicitly, your doctor needs to provide a document to L&I to explain the need to replace or repair the item. For example, your doctor will have to explain that the medical device incurred damages, broke, or is worn out. Finally, note that crutches, cervical collars, and lumbar and rib belts (as well as other low-cost orthotics) don’t require preapproval. Of course, there are also limitations on the kinds of items that L&I will cover. As an example, L&I will not cover inversion traction equipment, vibrators or heating pads. They will also not cover home furnishings, hot tubs and exercise equipment.

 

Personal recommendation

In my opinion, I always think it’s a good idea for people with a work injury claim to plan for their L&I claim closure. In part, they should discuss medical expense (and other) concerns before claim closure becomes final. On top, there are special considerations when medical surveillance exams or equipment repair applies in your L&I claim. In such cases, I recommend that claimants, medical providers and L&I get on the same page regarding process and procedure after claim closure.

L&I Claim Mental Health Treatment Options and Master Level Therapists

I’ve been serving as a workers’ compensation attorney in Washington State for over 15 years. One of my biggest challenges is to find mental health treatment for clients with an L&I claim. I will go a long way to help my clients. However, it’s sometimes impossible to find treating psychiatrists who are medical doctors. Yet, there are some good news from the Department of Labor and Industries (L&I) concerning this matter.

 

Mental health treatment in a workers’ compensation claim

In the past, it has been easier to find treating clinical psychologists. Recently, all that changed, and it’s become more challenging than before. But there’s some good news. A little over a year ago, L&I started a 4-year pilot project. The project authorizes and pays Master’s Level Therapists (MLT) to treat people with a work injury claim.

 

Interestingly, under current L&I medical treatment guidelines, the system doesn’t permit MLTs to provide mental health treatment in L&I claims. However, L&I is conducting the pilot program to provide structure. In the process, L&I is collecting data on behavioral and mental health services that MLTs provide to work injury claimants.

 

L&I program for mental health professionals

The enrollment for the 4-year pilot program began back in November 2019. L&I said it will allow up to 300 MLTs into the program. Initial signups include licensed independent clinical social workers (LICSW), licensed marriage and family therapists (LMFT), and licensed mental health counselors (LMHC).

 

Therapists and counselors that wish to apply for the L&I pilot program must meet some requirements. For one, every therapist must complete an L&I training module and submit a completion certificate with their application. In addition, each mental health therapist must submit a Non-network Provider Application. Finally, L&I requires mental health counselors to also submit the MLT Pilot Supplemental Application.

 

L&I claim and mental health treatment coverage

Once L&I approves an application, the MLT can treat work injury claimants under their workers’ compensation claim. Of course, you have to meet certain criteria for treatment coverage. For example, the attending provider on the L&I claim must refer the work injury claimant to the MLT. The referral should be for appropriate psychotherapy treatment, for a mental health condition that L&I previously accepted under the claim.

 

An MLT cannot diagnose mental health conditions or perform mental health evaluations following a workplace injury. However, in cases with accepted mental health conditions, the mental health therapist in the pilot program can provide eight treatment sessions. Importantly, these sessions do not require treatment pre-authorization or going through the utilization review process. After that, additional sessions beyond the first eight require a utilization review authorization.

 

The impact of mental health services after a work injury

Mental health conditions can seriously (and very negatively) impact your recovery after a workplace accident or work-related illness. As an L&I attorney representing work injury claimants, I hope this pilot program becomes permanent. It’s important to provide people that have a workers’ compensation claim with early and easy access to mental health treatment. I strongly believe this program will result in much better outcomes compared to the current status quo.

 

For more information, please refer to the Master’s Level Therapists pilot program on the L&I website.

 

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