People with an L&I claim in Washington State tend to have lots of questions about claim closure. Some of the most common questions I get are: Why is my claim closed? What does closure mean? What if my condition gets worse after my workers’ compensation claim closes? Did I get everything I was supposed to? What if I disagree with L&I closing my claim?
Every L&I claim is unique
Every work injury and workman’s comp claim are unique. As a result, people have different questions about their specific situation. Therefore, it’s very difficult to give general answers that apply to everyone. Sure, there are some high-level pieces of information that apply to all. However, a general answer might not fit your L&I claim circumstances. Either way, it’s always a good idea to consult with an L&I attorney or a workers’ compensation attorney before your claim closure becomes final.
My claim closed – What does closure mean?
The Department of Labor and Industries (L&I) closes claims after treatment completes and after they determine your return to work or employability status. Once a workers’ comp claim closes, work injury claimants cannot receive any more benefits under the claim. Specifically, your L&I claim no longer pays for medical treatment and medication. Furthermore, L&I stops paying benefits like time loss compensation and loss of eating power (LEP). Finally, L&I stops providing services such as vocational counseling or guidance. However, if L&I decides you are permanently and totally disabled, you will receive monthly L&I claim pension benefits after the claim closes.
What if my condition gets worse after my claim closed?
The most common concern I hear from clients is about worsening medical condition. Here, there are some good news – You can reopen an L&I claim! To do it, you must show objective worsening that relate to the medical conditions under your L&I claim. Practically speaking, you must show that you need further medical treatment. Alternatively, you can show that your disability is worse than before. Then, there are slightly different rules for mental health conditions. For example, with mental health claims, objective worsening isn’t a prerequisite. Yet, it’s still mandatory to have an expert medical opinion on worsening before L&I reopens your claim.
If you reopen your workers’ compensation claim after 7 years, then you might be able to receive all types of benefits. After 7 years, you can still reopen your L&I claim, but only for medical treatment. Even then, you can ask the L&I Director to exercise discretion and grant additional benefits.
Did I get everything I deserve?
This is the most challenging claim closure question to answer. Every work injury has different circumstances. Consequently, there are different benefits under every claim. Benefits can include medical treatment, time loss compensation, and loss of earning power. There can also be vocational services and retraining benefits. Sometimes, permanent partial disability awards and permanent total disability might apply. If you’re not sure you received the benefits you deserve, you should speak with a workers’ compensation attorney.
What if I disagree with closing my claim?
Many work injury victims disagree with their workers’ comp claim closure. If you are one of them, you must protest L&I’s decision within 60 days. However, if L&I affirms its decision, you can submit an appeal to the Board of Industrial Insurance Appeals (BIIA). If you do, make sure you have strong medical (and sometimes vocational) evidence to show that claim closure is wrong.
I had a work injury in may 2021. Did a surgery with mesh. Now I’m having some problems and already file a protest via claim manager and also with the board L&I. I spoke with the surgeon and he said to have an IME done also physical therapy and I never received a PPD Award after the surgery. They did close my claim and I’m fighting to reopen it. Which I think they are doing it as we speak but had a C Scan done and I’m having still some issues and had pain possible nerve damage and is painful.
It sounds like you are doing all the right things. Please keep doing them. If they are not willing to re-open your claim, please give our office a call. Regarding the PPD – again, feel free to give our office a call. We might be able to take a deeper look at what’s going on with the claim and see if you can take actions to get the PPD.
How long does it take for your claim to close?
I am at MMI and my C. M. is acting like it’s a problem closing out my case.
Without knowing more information about your case, in short, claims will close when they are ready to close. There can always be things delaying claim closure. It’s really difficult for me to answer your question without knowing more about your claim. Please give our office a call and we can talk through it or dive deeper if needed.
After my claim closes will I receive paper work rating on my claim.
I hope I’m understanding your question correctly, but in general it’ll depends on how your claim will close. If you have residual medical conditions, also known as Permanent Partial Disability (PPD), then you will be rated (also known as PPD rating) and receive a PPD award. More information on this is available here:
https://recklaw.com/lni-claim/permanent-partial-disability/
https://tarareck.com/ppd-rating/
https://tarareck.com/permanent-partial-disability-ppd-in-workers-compensation-l-and-i-claim/
I hope this helps.
I have had my claim closed after the IME even though the drs. wrote that my back has a herniated disc. About ten years ago I had a ruptured disc that L&I paid for a surgery but I don’t feel like it healed correctly. They gave a check and never talked to me about it again. Now ten years later I have another injury in the same place with the MRI showing a herniated disc and they just notified me today they are closing my case. I don’t know what to do
Hi Charles. It sounds like you may have a somewhat complex overlap between two claims happening. Please contact our office to schedule a consultation so that we can discuss this in greater detail.
I have a disc bulge. now my Dr. wants me to either go to SIMP or close my case with restrictions. what is better?
It depends. Have you returned to work?
My L and I claim is closed. I had my IME, but haven’t heard about the rating yet. its been 2 weeks. I was told at the time that I’ll receive a higher rating because my injury involved a bad fracture and required a right reverse total shoulder with bone grafting. No rotator cuff. Will I receive a settlement??
Generally IME reports are available roughly 14 days after the IME exam. If the doctors provide a rating, you will be entitled to the monetary award associated with that PPD rating. The PPD award schedule can be found here: https://www.lni.wa.gov/claims/for-workers/claim-benefits/permanent-partial-disability
I understand that once you receive claim closure letter it’s 60 days and it’s final. How long after that is it you get your ppd paid.
The process can vary if your claim is self insured versus state funded. If state funded, then the PPD is generally awarded in the order that closes the claim. Depending on the size of the PPD award, it will be paid at the same time the closing order is issued or an initial installment will be paid and L&I will notify you of the payment schedule. Once the closure becomes final and binding after 60 days, you can ask for your remaining PPD to be paid out in a lump sum rather than installments. If your claim is self insured, the closing order will direct the amount of PPD to be paid and the self insurer will pay it. Usually you can expect the PPD to be paid within a month but there is no absolute schedule.
I have question about workers compensation benifits .I am receiving the L&I claim and get paid every two weeks..I got approved from SSDI benifits due to my health problem adding up my work injury at work become won’t able to go back to work anymore. my company closed down and I was transfer to Lanor Industries I got pay twice a month. The problem my injury at work never have take care of .Labor Indistries denied doctor request for hand therapy .I had this pain for the last 17 months of my injury at work .Now I have to report it that my SSDI benefits will start end of this month .
I don’t know what will happen to my workers Compensation benifits .I don’t know if will stop and closed my claim .I really don’t know what to do if I have to apply for pension benifits or hire a lawyer.I am disable and cannot handle too much on my head .There someone can tell me what will happen or things I can do to take care of the injury My medical bills is already overwhelming alone and can’t find someone to tell me how to get help.. Thank you and looking forward to hear from someone.
You have a lot going on. It is probably best if you schedule a consultation so that you can get your questions answered, understand your options, and decide if you need/want an attorney.