Workers Compensation - Washington

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

Category: Uncategorized (page 1 of 8)

L&I claim notices: Notice of Decision, Payment Order

Workers’ compensation claims can be overwhelming. Recently, I’ve consulted with several injured workers who have been completely overwhelmed with their claims. As a result, they started avoiding claim related documents.

 

Dealing with L&I claim orders and communications

Some work injury claimants I talk to no longer open their mail because it was causing them too much anxiety. I call this the “ostrich approach”. Just like an ostrich, burying its head in the sand, injured workers with a work injury claim who avoid claim-related communication don’t see the danger that is coming. They may miss critical deadlines, which in turn, can cause permanent harm to their workers compensation claim.

The Department of Labor and Industries (L&I) has the obligation to administer work injury claims. Similarly, claimants have the right to challenge L&I decisions that they believe are a mistake. However, work injury claimants only have 60 days to challenge and protest an L&I decision. If you do not file a request for reconsideration within 60 days, then you essentially waive your right to challenge L&I.

Remember, L&I makes mistakes. There’s no question about it. But, like it or not, it’s your job to be on top of things. In other words, if you don’t appeal an L&I decision, their mistake becomes final and binding under the law, no matter how wrong it may be.

 

L&I decision

When L&I makes a decision concerning an issue in an L&I claim, they must notify the injured worker. In fact, they have to send something called a written order. Usually, these decisions are titled “NOTICE OF DECISION”. Here is what one that comes from L&I looks like:

 

L-and-I Notice Of Decision

 

L&I payment order

Sometimes L&I makes unfavorable decisions in what they title “PAYMENT ORDERS”. You would think something called a payment order would be a favorable decision issuing a payment. It isn’t uncommon for L&I to make a decision denying time-loss compensation or closing a claim in a decision called “PAYMENT ORDER”. Here is an example:

 

L&I Payment Order

 

Can I protest a notice of decision or payment order?

Whether a decision is a NOTICE OF DECISION, PAYMENT ORDER, or has some other label, it’s’ easy to tell if you have the right to protest. For that, you can refer to the bottom of the decision letter and read it carefully. For example, it will look something like this:

 

L&I protest order

 

In some cases, work injury claimants protest a decision. Then, after some time goes by,  L&I affirms its previous determination. When this is the case, the notice of appeal rights looks as follows:

 

L&I Notice Of Appeal

 

Monitor your L&I claim

If you have a work injury claim or L&I claim, the most important thing you can do is to pay attention to notices. You can protect yourself and protect your workers compensation claim by protesting or challenging L&I’s mistakes on time. There is nothing more heartbreaking for me than being contacted by an injured worker who disagrees with an L&I decision after they waited too long to dispute a decision.

Don’t be overwhelmed by your claim. If your claim and the associated correspondence is causing you too much anxiety, contact an experienced attorney who can help alleviate your anxiety. Your attorney will receive all the communications directly. They will oversee your claim and ensure that the Department’s mistakes are challenged on time.

What does my L&I claim worth? An overview of workers compensation claim benefits

What’s the value of my L&I claim? What’s my workers’ compensation case worth? I get these questions all the time. And, my answer is always the same: “It depends”.

 

What is the value of my workers’ compensation claim?

Knowing or calculating the value of your workers’ compensation claim or L&I claim in Washington State is tough. If you file a work injury claim and the Department of Labor and Industries (L&I) allows your claim, then you may be entitled to a variety of benefits. Some of these benefits have a monetary value. Furthermore, the value is unique to each L&I claim because every claim is different.

 

The purpose of this article is to help you figure out the potential value of all available benefits. Remember, there’s no one-size-fits-all answer or formula to calculate the exact value of your workers’ compensation claim. But, if you want to get a rough estimate, you can sum up the total value of benefits.

 

Medical treatment under L&I claim

It’s very difficult to put a dollar amount on the value of medical treatment. For many, and in my opinion as well, it is invaluable. Generally, if your claim has been allowed, then L&I (or the self-insured employer) will cover your medical bills and expenses, as long as the treatment is for conditions that relate to your work injury claim.

 

It is important to keep in mind that certain treatment recommendations must go through an authorization process. However, once authorized, the treatment is covered 100%. This means that there are no out-of-pocket expenses such as co-pays or deductibles. Moreover, when you are incapable of working because of your work injury conditions, having a path to medical recovery and the peace of mind that your medical bills will be covered, is priceless.

 

Time-Loss Compensating benefits in L&I claim

If you have an allowed workers compensation claim or L&I claim and you are unable to work, then you are entitled to monetary wage replacement benefits. Time loss compensation (TLC) is one such benefit. It’s what you get when you are temporarily incapable of working.

 

Your time loss wage rate is based on what you were making at the time you got injured at work. A single male of female individual with no dependents receives 60% of their wage at the time they got hurt on the job. If you are married or have children, then you’ll receive a higher percentage.

 

Loss of Earning Power under an L&I claim

In some cases, after a work injury, some people are still able to work with limitations. For example, some injured workers can work reduced hours. Others might perform a light duty job that pays less than their job of injury. If you’re able to work after you were injured at work, and your new salary is lower than what you were making before, then you might be entitled to receive compensation for lost wages.

 

Loss of Earning Power (LEP) benefits are paid when you are doing limited work that results in a 5% or more decrease in your wage-earning capacity. This is a significant monetary value in any workers compensation claim. The specific value varies from individual to individual. And as explained earlier, it all depends on your earnings at the time of industrial injury or occupational disease manifestation.

 

Vocational services in L&I workers compensation claims

If you have an allowed L&I claim and you are permanently incapable of returning to your work, then you should be eligible for retraining. If L&I approves your retraining, they will pay for your retraining program for up to two years at total cost of approximately $18,000. In addition to the $18,000 cost of retraining, L&I will pay time-loss compensation benefits throughout your retraining program.

 

The topic of vocational services in workers compensation claims is very broad. They include many steps and services. You can read about important topics relating to vocations services by following the resources below:
1) Option 1 vs Option 2
2) Vocational services plan development
3) Job analysis
as well as many others. You can also refer to the high-level summary of vocational services in L&I workers compensation claims.

 

Permanent Partial Disability in L&I claim

Permanent partial disability (PPD) refers to a loss of bodily function because of an industrial work injury or a work disease. The degree to which you lose bodily function is called PPD rating. In this context, a PPD rating exam must be performed by a qualified medical professional.

 

In general, for parts of the body that can be amputated such as an arm or a leg, the PPD rating is based upon percentage of loss of function. For parts of the body that can’t be amputated, like the spine or mental health disability, the PPD rating is based on levels called “categories of impairment”. These categories, alongside other rules and guidelines, are outlined in the Washington Administrative Code (WAC).

 

In order to assess the loss of body function, the examining doctor compares your condition with the condition described in the categories. Then, the doctor selects the category that best describes your level of impairment. The monetary value of the PPD is based on a PPD award schedule, which is available on the L&I website.

 

Permanent Total Disability in L&I claim

Total disability is a physical or mental impairment that prevents you from working. Usually, medical professionals or vocational counselors determine if you are capable to work. If your disability is preventing you from returning to work in the foreseeable future, then we refer to it as Total Disability and consider it to be a permanent condition.

 

You must obtain an opinion from a medical provider to establish the likelihood that your disability will continue to impact your ability to work in the future. If you are indeed permanently totally disabled (PTD), then you are likely entitled to receive a pension under your L&I claim.

 

Pension in L&I claims

A pension in workers’ compensation claims mean that you receive monthly payments for the remainder of your life. Payments are made so long as you cannot, and do not, return to work. Like to time-loss compensation, your pension payments depend on what you were earning at the time of your work injury or disease manifestation. The pension benefit is intended to provide a source of income under an L&I claim for people with severe work injury that can never go back to work.

L&I claim fraud hurts people with work injury claims

Over the last week, the Department of Labor and Industries (L&I) issued two separate news bulletins about L&I claim fraud. Without question, people who defraud the workers’ compensation system in Washington State hurt other work injury claimants. It is a very serious matter. Again, anyone that commits any type of fraud relating to a workers’ compensation claim hurts injured workers.

 

Workers compensation fraud in L&I news

In one case, L&I received an anonymous tip that a Renton delivery truck driver was collecting workers compensation pension benefits while working. L&I says that this has resulted in one of the largest fraud cases in recent history. The accused man has been charged with theft of $325,000 in disability benefits that he wasn’t entitled to. Over the course of a 2-year investigation, L&I uncovered evidence including traffic infractions, payroll records, and trucking logs. The evidence shows that the man worked transporting apples between 2012 and 2017 while collecting disability pension benefit.

 

In addition to driving, the man was also reportedly lifting loads of 100-500 pounds. Clearly, it’s a very physical demanding work. Individuals are only entitled to pension benefits under their L&I claim or workers’ compensation claim if they are incapable of working as a result of their industrial injury or occupational disease. The man filled out declarations under oath stating that he wasn’t working, even though he was. Consequently, as is permitted under the Industrial Insurance Act, the Attorney General’s office is now prosecuting the man for felony fraud. At the same time L&I found that he willfully misrepresented himself and has demanded repayment of the benefits he wrongfully collected (with a 50% penalty on top).

 

Another case of workers compensation claim fraud

In another case this week, a 65 year old commercial real estate broker from Bothell pleaded guilty to attempted second-degree theft. As a result, he has been sentenced to 60 days jail time (with home monitoring) and 2 years probation. In addition, he must repay $86,484 to L&I in benefits that he shouldn’t be receiving. Upon investigation, L&I obtained damning surveillance footage, business records, and even exchanged undercover emails with the man regarding his services.

 

Workers compensation attorney and L&I attorney point of view

First and foremost, as an L&I attorney and workers’ compensation attorney representing workplace injury claimants in Washington State, our office condemns any and all claim fraud activity. At the same time, when I read stories like these, I am very conflicted.

 

On the one hand, fraud must not be tolerated. It is fraudulent activity that places all people that suffer a work injury under suspicion. On top, it drains the accident fund in Washington State: I believe L&I spends tremendous resources chasing cases of alleged fraud. Often, the injured workers that are investigated are innocent. They go through hell before that’s determined. Additionally, many work injury claimants spend their days fearful of doing something that will be perceived as fraud. That’s because work injury victims have been accused of fraud for engaging in simple activities like grocery shopping.

 

L&I claim videos showing work injury claimants

I regularly receive video footage from L&I or from opposing counsels showing “fraud” activity concerning my clients. The resources spent by L&I to obtain such videos are significant, and in my opinion, are also misused. I’ve received many videos showing the wrong person. Moreover, I regularly get videos of clients that show nothing more than usual daily activities.

 

Injured workers should know that it is not fraud to engage in the activities of daily living. However, it is important to modify activities and avoid doing things that exceed limitations imposed by medical providers. This is not only to prevent fraud accusations. It is for recovery and to avoid a reoccurrence of an injury. If you are an injured worker who is contacted by an L&I investigator, it is probably a good idea to speak with an L&I attorney first.

Causation in L&I claims and Workers’ Compensation Claims

After you get hurt on the job or suffer a work injury, you then file an L&I claim or a workers’ compensation claim. From that point on, the Department of Labor and Industry (L&I) decides what is going to happen with your claim. If you work for a self-insured employer, then a third-party administrator (TPA) is also involved in some decisions. With each decision, L&I issues a formal letter and sends you the decision notice.

 

L&I decisions in workers’ compensation claims

Surprisingly, there is lack of consistency in workers’ compensation and L&I decisions. For example, I regularly see inconsistencies in workers’ compensation claims involving the upper extremities. In many cases, these L&I claims are carpal tunnel syndrome, cubital tunnel syndrome, lateral epicondylitis, or radial tunnel syndrome. It is also common to see conditions such as wrist sprains and strains, trigger finger, cervical degenerative disc disease, thoracic outlet syndrome, and cervicobrachial syndrome fall under this category. In my opinion, this is because these conditions can be caused by a variety of occupational and non-occupational factors.

 

Work injury claimants with the same medical condition

As an L&I attorney and workers compensation attorney, I sometime represent multiple people with a similar work injury claim. Moreover, they all have identical occupations and they develop the same medical condition. However, they receive very different decisions from L&I regarding their L&I claim. I’ve seen this in people that work as park aides, sheet metal workers, retail cashiers or checkers, and office clerks. Furthermore, this also happens with laborers such as drywall workers, painters, stone masons, nurses or certified nursing assistants, as well as medical records clerks.

 

I find particularly irritating when an L&I claim is rejected on the basis that there is no connection between the job of injury and the medical condition or diagnosis. It rubs me the wrong way because I can usually think of multiple examples from within my caseload where one can easily reach an opposite conclusion. But, in workers’ compensation claims, the problem is that an argument such as “other workers in the same profession have allowed claims for the same condition” is generally irrelevant. That’s because the law requires L&I to evaluate each workers’ compensation claim based on the facts and circumstances particular to the individual injured worker.

 

L&I claim for Carpal Tunnel Syndrome

I accept the importance of considering each work injury claim based on the individuality of the injured worker. However, I go from being irritated to indignant when the reasons given for an L&I claim rejection are outright false. For example, an L&I claim for carpal tunnel syndrome may be rejected on the basis that the work activity does not cause or contribute to the development of the condition. Many times, this argument is stated as if it’s a black-and-white fact. It’s not!

 

The AMA medical guide in workers’ compensation claims

One publication frequently cited in workers’ compensation is called “The AMA Guides to the Evaluation of Disease and Injury Causation”. This publication compiles medical research and literature to provide insight into the risk factors for developing various conditions. Many Independent Medical Examination (IME) reports reference this guide, especially in the context of causation.

 

Take an L&I claim for carpal tunnel syndrome as an example. According to the AMA guide, there is very strong evidence that a combination of force and repetition, or force and posture, contribute to the development of carpal tunnel syndrome. In fact, several studies referenced in the guide show that blue collar work is a significant risk factor for carpal tunnel syndrome. Moreover, they report that there is an increased risk of developing carpal tunnel syndrome with frequent wrist flexion and extension in combination with the use of vibratory tools. On top, they mention that carpal tunnel syndrome is associated with jobs involving using a forceful power grip for long periods.

 

Other risk factors include highly repetitive work combined with other factors or with forceful work. Obviously, there are also non-occupational factors as well that impact the condition such as age, gender, genetics, diabetes, and body mass index.

 

The legal definition of proximate cause

When we speak about cause in workers’ compensation, you have to remember that we’re talking about proximate cause. Proximate cause has a very specific legal definition:

The term proximate cause means a cause which in a direct sequence produces the condition complained of and without which such condition would not have happened.

 

In my experience, IME doctors often follow this definition when they need to express their opinion regarding causation. Often, IME doctors reference other factors (especially age, gender and genetics) to support their conclusion that the condition would have happened independent of work activity. The problem is, there is more to the definition of proximate cause. Specifically:

There may be one or more proximate causes of a condition. For a worker to be entitled to benefits under the industrial Insurance Act, the work conditions must be a proximate cause of the alleged condition for which entitlement to benefits is sought. The law does not require that the work conditions be the sole proximate cause of such condition.

 

Simply put, if a person is an overweight female with a family history of carpal tunnel syndrome, she has several risk factors for developing carpal tunnel syndrome. When she is diagnosed with the condition, those risk factors cannot be ignored. However, if she also works in a job where she spends much of her workday forcefully grasping and operating a tool like a sander, then I would argue that you cannot exclude work activity as a proximate cause of her carpal tunnel syndrome.

 

Summary and some personal notes

I find it unacceptable that work activities that significantly increase the risk of developing conditions like carpal tunnel syndrome are ignored in the presence of other risk factors. Even worse, this kind of exclusion happens inconsistently across the board. The Industrial Insurance Act was enacted to provide protections for ALL workers. That means all workers deserve the exact same level of consideration regarding the facts, supporting medical literature and studies, and application of the law.

 

If an L&I claim manager rejects a workers’ comp claim because he or she only applied part of the definition of proximate cause, and they completely exclude work activity from the definition or consideration, then the rejection is unfair. When the worker is then saddled with the financial burden of proving that the rejections is incorrect based on the law and facts, the very intent and purpose of the Industrial Insurance Act has failed. And, when the purpose and intent of the Industrial Insurance Act fails, it hurts injured workers, their families, their employers, and society in general. The health of our workforce is critical to the health of our society.

 

Work injury and L&I claim occurrences during the holiday season

Did you know that workplace injuries tend to increase around the holidays? According to organizations like the Department of Labor and Industries (L&I), many employers see an increase in workplace injuries just before or after the holidays.

 

Why do work injury rates increase during the holidays?

The US Department of Labor and the Occupational Safety and Health Administration (OSHA) performed studies to try and understand this phenomenon better. And, several studies suggest there are a variety of reasons for this. One reason is the number of new employees that are hired for holiday seasonal work. The studies have shown that work injury or injuries are much more common amongst new employees. Interestingly, another reason is that some employers ask workers to increase their workday and work more hours to meet holiday demand. Finally, the holiday season creates a busy and stressful work environment.

 

Back in 2016, the CDC published an article outlining the various dangers for workplace injuries and diseases for seasonal employees, especially in retail. In that article, the CDC identifies risks for work injury including crowd management, workplace violence, as well as long hours and shiftwork. The article also mentions risks such as prolonged standing, musculoskeletal injuries, and young workers.

 

Work injury and L&I claims for retail workers

By far, retail sales commands the greatest numbers of employees during the holidays. Explicitly, retailers hired an estimated 650,000 seasonal retail employees in 2018 to supplement the 4.6 million people that already work in retail year-round. Working to meet the demand of holiday shoppers takes a significant toll on workers’ physical and psychological health. Exposure to stressful working conditions decreases retail wellness.

 

Retail workers exposed to repeated stress at work demonstrate a number of symptoms. The symptoms include headaches, stomach problems, increased blood pressure, difficulty sleeping, and mental fatigue. Those symptoms, in turn, cause difficulty focusing, concentrating and paying attention to detail. As a result, it produces a work environment that is a “perfect storm” for workplace injuries. Furthermore, injuries in environments involving industrial equipment can be severe and even deadly.

 

Final notes and summary

The CDC and OSHA wrote several guides and publications to help retailers improve the working environment for seasonal employees. Simple processes designed to provide support for employees and reduce workplace stresses have been effective in lowering the number of workplace injuries that happen around the holidays.

 

If you are an employee in a stressful holiday work environment, please be safe this holiday season. Make sure that you take breaks when needed, that you are getting proper nutrition and hydration, and that you are getting plenty of sleep. When working, do your best to ensure that you are clear minded and focused. Please stay safe out there!

L&I claim for Thoracic Outlet Syndrome and Cervicobrachial Syndrome

I am a workers’ compensation attorney and L&I attorney representing work injury claimants in Washington State. Over the years, I’ve seen a wide variety of work injuries and occupational diseases. As a result, I’ve learned a lot about a wide range of medical diagnoses. I’ve also come to recognize diagnoses that are likely to complicate an L&I claim, potentially resulting in a highly complex workers compensation claim. In my experience, an L&I claim for Thoracic Outlet Syndrome and Cervicobrachial Syndrome are likely to become very convoluted. Thankfully, our office has vast experience handling these conditions and claims.

 

What is Thoracic Outlet Syndrome?

In order to understand thoracic outlet syndrome, you need to understand some basic facts about human anatomy. The human body has a network of cervical nerve roots that join to connect signals between the brain and the shoulders, and upper extremities or arms. This network is often called the brachial plexus. Injuries to the brachial plexus cause pain, numbness, tingling and even paralysis of the shoulders and arms.

 

The medical community is still working to fully understand brachial plexus injuries. There seems to be a general consensus that there are at least two primary varieties of thoracic outlet syndrome (TOS) that can result from brachial plexus injuries. These are: (1) Vascular thoracic outlet syndrome; and (2) Neurogenic thoracic outlet syndrome. Vascular TOS occurs as a result of trauma to the arteries or veins around the brachial plexus. Neurogenic TOS occurs when the brachial plexus nerve fibers are compressed.

 

As far as the Department of Labor and Industries (L&I) is concerned, certain criteria must be met to allow a diagnosis of neurogenic TOS under an L&I claim in Washington State. Those criteria are outlined in the L&I treatment guideline.

 

L&I treatment guidelines for Thoracic Outlet Syndrome

The L&I medical and treatment guidelines for TOS are complicated. In short, the diagnosing medical provider must produce certain clinical exam findings that are corroborated by an electrodiagnostic study showing that the brachial plexus nerves are being compressed.

 

Historically, a third kind of TOS called “disputed” TOS was recognized by some. According to the L&I treatment guidelines for TOS, “disputed” TOS occurs when there are positive clinical exam findings of neurogenic TOS, but the electrodiagnostic study is normal and does not confirm impingement of the brachial plexus nerves. In the past, work injury victims with disputed TOS diagnosis were facing challenges in their L&I claims. That’s because the treatment guidelines only include true neurogenic TOS and vascular TOS.

 

Until recently, if an injured worker was diagnosed with disputed TOS, L&I would issue an order or decision stating that thoracic outlet syndrome is not an accepted condition on the workers compensation claim. Luckily, that’s no longer the case.

 

What is Cervicobrachial Syndrome?

In February 2019, L&I updated its thoracic outlet syndrome treatment guideline to include cervicobrachial syndrome. According to L&I, the symptoms of cervicobrachial syndrome mimic those of neurogenic TOS but lack the required electrodiagnostic results to diagnose true neurogenic TOS. The symptoms of Cervicobrachial Syndrome include pain and muscle spasm in the cervical or brachial region.

 

Symptoms may also include neck and headache, and sometimes numbness and tingling in one or both upper extremities. However, cervicobrachial syndrome does not include other common characteristic of TOS such as decreased reflexes, dermatomal sensory loss, specific muscle weakness or atrophy of the upper extremity, and abnormal electrodiagnostic tests that corroborate the presence of objective brachial plexus involvement.

 

Thoracic Outlet Syndrome and Cervicobrachial Syndrome in a work injury

Thoracic outlet syndrome may develop when workers experience extended periods of time or postures limited to carrying heavy shoulder loads. Workers that their work involves pulling shoulders back and down, or reaching above shoulder level, can also develop thoracic outlet syndrome. This is because those kinds of work activities tend to cause swollen or inflamed mid-back, shoulder and neck muscles and tendons. When swelling occurs around the brachial plexus, it compresses the nerves and blood vessels between the neck and shoulders. And, the result is thoracic outlet syndrome.

 

L&I claim for jackhammer operators, welders and aircraft assemblers

In the worker’s compensation setting, neurogenic and disputed TOS are more commonly diagnosed than vascular. L&I acknowledges that certain work activities may exacerbate neurogenic TOS. These activities include (but are not limited to) lifting overhead, holding tools or objects above shoulder level, reaching overhead, and carrying heavy weights. Occupations often associated with neurogenic thoracic outlet syndrome include dry wall hangers, plasterers, welders, beauticians, assembly line workers, shelf stockers and dental hygienists.

 

With respect to cervicobrachial syndrome, the medical community still doesn’t fully understand the types of activities that cause the condition. However, some activities thought to cause cervicobrachial syndrome include sprains and strains involving the cervical or brachial region, shoulder joint dislocation or fracture, rheumatoid arthritis, and degenerative disease (i.e., arthritis).

 

In my experience, in workers’ compensation claims, common work activities that seem to contribute to the development of cervicobrachial syndrome include prolonged use of vibratory tools such as jackhammers, repetitive heavy and overhead lifting, and working in prolonged and awkward overhead postures. I’ve seen the condition impact laborers, dental hygienists, aircraft assemblers, steel workers and more.

 

Treatment for Thoracic Outlet Syndrome and Cervicobrachial Syndrome

Going back to L&I claims in Washington State, it is easier to get authorization for thoracic outlet syndrome and cervicobrachial syndrome treatment that follows the L&I treatment guidelines, rather than treatment that falls outside the guidelines. While neurogenic TOS may respond to surgical treatment, L&I favors non-surgical or conservative treatment. That’s because L&I conducted a study of surgical outcomes and the results were bleak.

 

Surgically, it is not easy to access the brachial plexus region. Also, there’s high risk of damaging other important nerves including the phrenic nerve, which innervates the lungs. Damage to the phrenic nerve during surgery can cause permanent asthma and reduced lung function. Therefore, L&I says surgery should only be considered in severe cases of true neurogenic TOS that do not improve with conservative treatment and interfere with work or daily life activity.

 

Conservative treatment options for thoracic outlet syndrome and cervicobrachial syndrome are similar. Treatment focuses on reducing inflammation of the affected muscles and tendons, while simultaneously increasing strength, mobility and overall function. In my recent experience, effective treatment involves the use of Botox injections to calm muscle spasm and inflammation and reduce the impact on the brachial plexus. This conservative treatment is authorized under the 2019 amendment to the L&I medical treatment guidelines.

 

Conclusion and L&I improvements

I’ve worked through many challenging and complex cases involving disputed thoracic outlet syndrome diagnosis. Hence, I was very encouraged by the February 2019 update to the medical treatment guidelines and the inclusion of cervicobrachial syndrome. However, I believe that the administration of workers compensation claims and L&I claims for thoracic outlet syndrome or cervicobrachial syndrome has to improve.

 

According to the L&I guidelines, people with a work injury claim who are diagnosed accurately and early were far more likely to return to work than workers whose conditions were diagnosed weeks or months later. Unfortunately, in my experience, administrative delays make early diagnosis difficult if not impossible. L&I, Independent Medical Examiners (IMEs), and even some attending providers are quick to relegate injuries to mere sprains and strains. As a result, TOS and cervicobrachial syndrome diagnoses are often delayed, sometimes indefinitely.

 

I believe that L&I can do a much better job at encouraging and supporting accurate and early diagnoses. This would dramatically improve outcomes in many L&I claims. Unfortunately, in nearly every case of thoracic outlet syndrome or cervicobrachial syndrome that I’ve encountered, the accurate diagnosis has not been made until more than a year following the original injury or onset of symptoms.

Find a doctor for an L&I claim in Washington State

Every workers compensation claim in Washington State must have an attending provider, which is sometimes referred to as the attending physician or attending doctor. Whether you have a state-funded L&I claim or a workers comp claim with a self-insured employer, you must have an attending physician on the record. This attending doctor sees you regularly throughout your L&I claim and is primarily responsible for medical opinions supporting your entitlement to benefits. These benefits include both medical treatment and coverage, as well as monetary benefits such as time loss compensation. Moreover, the attending physician is usually the person who makes referrals to other treating doctors and specialists.

 

The L&I Medical Provider Network (MPN)

The Department of Labor and Industries (L&I) maintains a list of attending physicians. This list is called the Medical Provider Network or MPN in short. Looking at the list, you’ll see that there are LOTS of doctors on the Medical Provider Network. Some are local and reside here in Washington State and serve patients in your area. Others are out-of-state doctors that serve work injury victims that got hurt in Washington State and later moved out of state.

 

If you got injured at work in Washington State, you can choose your own primary doctor for your L&I claim. Here, the only rule is that your doctor must be a member of the Medical Provider Network. Also, when your attending physician refers you to other doctors and specialists, with very rare exceptions, all those other treating providers must also be part of the medical network. These include physicians, surgeons, chiropractors, naturopathic physicians, podiatric physicians, ARNP providers, PA-C physicians, dentists, optometrists, and so on.

 

Challenges finding a medical provider for your L&I claim

The MPN was enacted by the legislature in 2011. It was implemented and later launched by L&I in 2013. Since then, I have seen a significant increase in difficulties for work injury claimants to find an attending physician. Some challenges that we regularly see at our office include:
(a) Trouble finding willing MPN attending providers in a location reasonably close to the injured worker;
(b) Inability to find a new attending provider if the prior attending provider is no longer available for whatever reason; and
(c) Difficulty finding an attending provider willing to take over if the claim is more than a few months old.

 

The reason for these challenges (in my opinion) is because L&I claims are time consuming, they are riddled with challenges, and they are not lucrative. Being an attending provider is very time consuming. As a doctor, you have to examine the injured worker roughly every 30 days. On top, you must also complete regular administrative paperwork like the Activity Prescription Form or APF. You must also respond to inquiries from the claim manager and vocational counselor. If a work injury claimant has an attorney, the doctors are likely to get inquiries from their workers compensation law firm as well. If that’s not enough, doctors have to complete the relevant paperwork outside clinical practice hours.

 

Being a medical doctor on a claim is time consuming

Being an AP is tough. Members of the MPN are required to follow strict treatment guidelines that L&I says are evidence-based best practices. These requirements limit a provider’s ability to exercise their own knowledge and expertise in formulating opinions and making recommendations. However, claims are contentious. Medical providers often find themselves unable to move a claim forward due to legal disputes. Sometimes, attending doctors must provide a testimony in a deposition to help resolve the dispute. All these activities take time away from other aspects of their medical practice.

 

Finally, while I’m not an expert on rates, I frequently hear medical doctors complain that L&I pay rates are very low. So, combining the extra time and frustration providers put into these claims, they also get paid at a bottom dollar rate. Consequently, I’ve seen some good doctors still willing to help and take on L&I claim cases, but they limit the number of L&I patients they treat at any given time.

 

L&I is not helping

Since the MPN was launched in 2013, I’ve seen L&I do nothing to help incentivize medical providers to treat injured workers. Furthermore, L&I makes injured workers jump through hoops before willing to assist in finding a willing attending provider. I represent many injured workers currently looking for a new attending provider because their previous doctor recently retired. With claims that are years old, it’s nearly impossible to find willing attending physicians in the Medical Provider Network.

 

Finding a doctor for an L&I claim can be tough

The first step in obtaining a new attending provider is using the L&I Find a Doc search to identify potential providers. At first, the prospects look promising. For example, searching all providers within 15 miles of our Port Orchard office yields 1,819 options. Removing specialties such as dentistry, we still see 617 providers in general practice, orthopedics, internal medicine, occupational medicine and the like. With 617 options to choose from, you’d think it would be easy to find a willing provider. I can tell you from first-hand experience – it is extremely difficult, daunting, and disheartening.

 

Injured workers must call the providers to determine if the doctor is willing to see them. In most cases, the answer is a simple No. However, before saying no, some providers ask for medical records or access to review the claim file on Claims and Account Center (CAC). In those cases, it can take weeks to get an answer. Usually, this process continues for months.

 

In our office, we ask our clients to maintain a journal to document the providers they call, when they call, and the provider’s response. In several cases, we have clients who called hundreds of providers without any success. During that time, the Department is often threatening to terminate benefits.

 

Conclusions and final notes

L&I requires that injured workers have an attending physician. Yet, L&I fails to adequately incentivize or encourage medical providers to take on workers’ compensation claims. As an L&I attorney representing work injury claimants in Washington State, it makes the life of my clients very difficult. It’s hard for injured workers to find doctors that are willing to see them. And, throughout this entire process and struggle, L&I almost always threatens to terminate benefits.

 

Workers compensation attorneys like me report these issues with the MPN all the time. However, when an injured worker asks L&I for help to find a doctor for a claim, L&I forces the work injury claimant to prove they aren’t able to find a doctor on their own. This is just another example of how L&I is not making injured workers a priority.

L&I claim for head injury and traumatic brain injuries (TBI) in Washington State

As an L&I attorney representing injured workers, I see all kinds of work injuries and specific problems that arise. That includes L&I claims for head injury and L&I claim issues for traumatic brain injuries (TBI). Workers compensation clients suffering from head injury or brain injury can be very difficult to work with. But often, they are also the ones that need my help the most.

 

What is a traumatic brain injury?

The CDC defines TBI as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury“. The CDC reports that everyone is at risk for TBI. However, children and the elderly are particularly vulnerable. TBI is considered a serious public health concern resulting in death and disability for thousands yearly. Not all bumps, blows, or jolts to the head result in a TBI. However, if a TBI does occur it can vary in severity from mild to severe.

 

Mild TBI cases, often referred to as a simple concussion, usually resolve fairly quickly. More severe cases may involve extended periods of unconsciousness or amnesia following the injury. According to the CDC, TBI symptoms may affect a person’s ability to think, ability to remember, and their physical well-being. Furthermore, it can also affect one’s emotions, mood and sleep. Some symptoms may appear quickly. Others may take days or even months to appear.

 

L&I claim for head injuries or brain injury

An L&I claim for TBI or head injury can be a very challenging case. In fact, as an L&I attorney, these cases are probably the most challenging ones I handle. This is due to a variety of things:

(1) The symptoms are largely subjective – There isn’t much objective medical evidence available to support the extent of the injury.

(2) Head injuries are often accompanied by physical injuries impacting other parts of the body. Those other injuries often take priority, and the head injury is overlooked.

(3) Significant efforts are being made to research and understand head injuries, especially related to professional athletes. However, in L&I claims and workers’ compensation setting there seem to be significant medical delays in TBI diagnosis and treatment.

(4) Fourth, it seems to me that there is an institutional resistance within the L&I claim administration system to accepting and authorizing necessary and proper treatment for TBI.

(5) Finally, due to the nature of the injury itself, clients who have suffered TBI are often difficult to work with.

 

Subjectivity in L&I claims for head or brain injury

In the L&I workers’ compensation system, if the work injury claimant makes statements or complaints to a medical provider, then those statements are considered subjective. On the other hand, objective findings of disability are those that a medical provider can see, feel or measure. It is widely acknowledged that mental health conditions such as depression and anxiety lack objectivity. Most other injuries in the L&I claim system require objective evidence to substantiate the extent of disability. Head injuries and TBI are complicated because it is a physical injury, but the extent can’t be seen, felt, or measured.

 

Usually, a TBI diagnosis is based on the worker’s description of how the injury occurred and their subjective symptom complaints. Common symptom complaints that I see all the time include difficulty thinking clearly, headaches, blurred vision, irritability, and sadness. Other symptoms include excessive sleeping, difficulty sleeping, noise sensitivity, concentration problems, problems remembering, lack of energy, nervousness, anxiety, and dizziness. Doctors simply cannot objectively verify these symptom complaints. Especially when the onset may be days or months following the injury.

 

Lack of Priority for L&I claims for TBI

TBI generally occurs from a blow to the head, or a jolt or a bump. Consequently, it is not uncommon for other physical injuries to occur in addition to the head injury. For example, someone may have fallen from a ladder breaking their arm and hitting their head. In most cases, the initial medical treatment is so focused on the arm injury that the head injury is ignored or overlooked. If the worker was working alone, they may not recall whether they lost consciousness. In fact, they may have significant difficulty recalling the details of the injury entirely.

 

According to the CDC, TBI symptoms are challenging to sort out. It is not uncommon for symptoms to be overlooked by the person injured, their family, friends, and even doctors. I have seen many severe TBI diagnosis made long after the original work injury. In my experience, this creates difficulty for getting the condition accepted under the claim.

 

L&I claim for head injury often result in medical delays

From my experience as an L&I attorney, it seems that many of the providers within the Department’s Medical Provider Network (MPN) overlook the importance of making an early and accurate TBI diagnosis. There seems to be a lack of urgency in making appropriate referrals for TBI diagnosis and treatment.

 

For example, I have seen cases where a blow to the head has been reported as the primary injury and wasn’t referred for MRI for more than a year. I’ve also seen work injury victims discharged from medical care and released to return to work without restriction, based on resolution of their other physical injuries, despite having numerous ongoing symptoms consistent with TBI. Unsurprisingly, the lack of attentive medical care leaves work injury claimants, who are already struggling with the symptoms of their TBI, feeling scared, hopeless, and angry.

 

Institutional Resistance within the Department of Labor and Industries (L&I)

From my perspective, L&I claim administrators tend to view the conditions causally related to an injury very narrowly. Generally, the administrator accepts the initial diagnosis on the accident report. It can be very difficult to add another condition to the claim later.

 

In some head injury and TBI cases, the initial diagnosis may include “concussion”. However, it is not uncommon for the head injury not to be reported at all on the initial paperwork. If the person suffering a work injury develops symptoms, or if the TBI diagnoses appears sometime later, then adding the condition to the L&I claim is often met with administrative resistance.

 

L&I attorney dealing with TBI work injury clients

As I’ve already noted, there are many symptoms for TBI. Side effects such as difficulty thinking clearly, irritability, sadness, and concentration problems, can be very challenging. Other issues such as problems remembering, nervousness, and anxiety, don’t make things easier. Add these kinds of symptoms to the normal stress of a workplace injury including financial instability and recovery uncertainty – clients who have suffered a TBI are often challenging to represent.

 

In my experience, they have good days and bad days. They aren’t always good at recalling past conversations, keeping appointments, or following through with requests. But I am always reminded that these are the people that need me the most. And I never discount this fact. On the positive side, our office has vast experience representing injured workers who have suffered a TBI. Because we understand the symptoms and their impact on our clients, we always do our best to help those clients understand the current status, difficulties, and needs of their claim.

 

L&I attorney and TBI workers compensation claims – additional resources

Remember, just because TBI claims are difficult does not mean they are impossible. The good news is that TBI is a condition that’s undergoing significant research by the medical community, professional athletic organizations, and the CDC. Every year it seems that new developments are made, to better understand the diagnosis and treatment. In fact, the CDC has several resources available related to TBI. One of those resources is the “Acute Concussion Evaluation” or ACE forms available for medical providers. The CDC also has a program called “HEADS UP” designed to help parents, sports and school coaches, as well as health care providers minimize and respond to the risk of TBI.

 

If you suspect that you, a friend, or family member sustained a TBI in a workplace injury, I would encourage you to review the helpful Brain Injury Basics information on the CDC website. If a TBI is complicating your workers’ compensation claim, don’t delay in consulting with an experienced L&I attorney who can help you understand your rights and determine if you need representation. You must ensure you receive appropriate benefits in such a challenging claim and difficult times.

The new L&I website and L&I claim portal

The Department of Labor and Industries (L&I) has revamped its website and the new site is now available publicly. You can have a look at https://www.lni.wa.gov/. According to L&I, the goal is for the new site to be more accessible with simplified and mobile friendly navigation, as well as larger and more readable fonts. Other goals include easier access to sign in to secure online services, and a clean and streamlined look.

 

The new L&I website: Updates and changes

While the website address has not changed, they have restructured some internal pages. Because of that, the L&I news release indicates users may have to update bookmarks and favorites. For Spanish-speaking work injury claimants, L&I says that its Spanish website is still up and running. As of the time of this writing, the links to the Spanish L&I claim site are broken and are not working, as are other sections of the site. However, the English site still contains help links for people with limited English language abilities.

 

If you follow my posts, you know I use the L&I website all the time. In my opinion, it is filled with useful information, news bulletins, and important links. For this reason I’ve been both eager and apprehensive for this website upgrade. Today I spent some time exploring the new site. I’m not surprised to discover that it is going to take me a while to get good at using the new site. On the old site, I regularly used the search feature to find specific forms, data, or to research aspects of claim administration. I am a little concerned that the search feature on the new site isn’t as efficient as the old site. I’m also concerned that many of the old information and links are no longer available on the new L&I website.

 

Searching for L&I forms and links

For example, as a test I searched for both WSF (which is the term for Work Status Form) and WVF (for Work Verification Form). It is a very common form that our injured worker clients fill and file all the time with L&I to keep their time-loss benefits going for their L&I claim. Unfortunately, for both “content” and “forms & publications”, the new site did not return any results. When I searched for Work Status Form, it returned over 800 results. The form wasn’t one of the top results. Finally, I put my search term “Work Status Form” in quotes. Alas, that returned 3 results, one of which was the form.

 

Therefore, for the record, this is the new link for the Work Status Form. Another important form, the Activity Prescription Form (or APF) can be found in this APF link. This simple exercise suggests that it is going to take time before anyone will be able to effectively navigate the new website. I have to say that they did succeed to make the site look clean with streamlined content. Also, it did work well on mobile.

 

L&I claim and Account Center

For the L&I Claim and Account Center portal, where anyone can view the status of an L&I claim, there hasn’t seem to be any changes for right now. However, the link for Claims and Accounts Center has changed and it is now https://secure.lni.wa.gov/home/.

 

L&I is accepting questions, comments and concerns about the new site. Here, feedback can be submitted to WebFeedback@Lni.wa.gov. I think that injured workers and people with L&I claims should spend some time to go over the site and provide feedback. As it stands right now, while new and exciting, the fact remains that older links are not working and a lot of great information that was there before is no longer available.

L&I claims for back injury and spinal injury or disease

Back or spinal injuries and illnesses are one of the most common conditions I see as an attorney representing people injured at work. I thought it might be helpful to share some basic information about the topic of back injury or spinal injury in the workers’ compensation setting. However, I am not a doctor and nothing in this post is intended to be medical advice. Simply put, the goal of this write-up is to help injured workers understand some of the terms and issues that may arise.

 

Back injury in workers’ compensation claims

The spine has roughly three regions:
(1) The cervical or neck region, which includes the cervical vertebra C1-C7;
(2) Thoracic or mid-back region where the T1-T12 vertebra are located;
(3) The lumbar area (L1-L5) and sacral back area (S1 through S5), which is also called the low back region.
In my experience, the most common region where work injuries and illnesses occur is the low back. The second most common is the neck. Mid-back injuries and illnesses do occur, but they are much less frequent.

There are two types of claims when it comes to a back injury in a workers’ compensation claim: Industrial injury claim and occupational disease claim. An industrial injury is a sudden and tangible event. Often, back injuries at work involve lifting or a combination or lifting and twisting with the sudden onset of pain or other symptoms. In contrast, occupational diseases are illnesses that develop as a result of the “distinctive conditions of employment”. Usually, they develop over time and it can be difficult to determine if work activities are a contributing cause.

 

Back injury treatment under an L&I claim

People who injure their backs at work are usually treated conservatively in the beginning. This means resting while taking over-the-counter medication to control pain and inflammation. Normally, that’s all that is needed to recover from a basic sprain or strain, or soft-tissue type of injury. In these cases, symptoms can improve within days or weeks after the injury. If symptoms don’t improve, additional treatment may be needed including but not limited to diagnostic imaging such as X-ray, cat scan (CT), or MRI. In some cases, physical therapy and massage therapy can help as well.

More severe injuries involving acute spinal fractures, injuries to spinal discs, and injuries impacting nerves require more invasive treatment. Our office represents many injured workers with significant back injury or illness diagnoses. Among others, we regularly see conditions such as spondylosis, spondylolisthesis, radiculopathy, nerve impingement, instability, disc bulge, disc herniation, stenosis, degenerative disc disease, and even thoracic outlet syndrome. The most common treatments for many of these severe cases are back injection and surgery.

 

Proving causation for back injuries in workers’ comp claims

From a legal standpoint, our experience shows that the more severe the back injury, the more challenging causation becomes. In fact, proving causation can be very difficult because all of us experience “degenerative” changes in our back and spine as we age. Some people call it arthritis and others call it degenerative changes. Furthermore, not all people experience the same symptoms from spine injuries, arthritis, or degeneration.

To complicate things even further, there is also a pretty lengthy medical study of spine disease called the “Twin Spine Study”. The study concludes that genetics is the most significant factor impacting back or spine health. Because of this, more severe aspects of back injuries or illnesses in workers’ compensation are often attributed to genetics or aging and not the injury or work exposure.

 

Conclusion

So, what’s the takeaway? If you are working a physical job that impacts your back or spine, then take a few extra steps of caution to try and minimize the likelihood of back injury. Wear protective gear when you can and if applicable. See a chiropractor on a regular basis to help with spine movement. Exercise your core and back muscles regularly to help ease the impact on your spine. And, if you are hurt on the job, go see a doctor immediately and have them file an L&I claim for back injury. But most importantly – be safe out there!

Older posts