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.
Hi, I need a attorney because L&I close my claim base on a IME report, without my provider even getting a copy of the report, can. can L&I do that.. Please call.
Antoine- We received your message and email. Someone will be in touch with you Monday.
Ok, I look forward to hearing from someone in your office.
My claim is closing, my previous claim manager said she was sending me to the IME to get a second opinion because she didn’t agree with my doctor, I had two surgeries, one was scar tissue removal,which was said to be an enormous amount, and manipulation of the shoulder. I continued to have pain, everday all day, and swelling of my arm. My wrist has been swollen every since the 2nd surgery, and my surgery arm is bigger than the other. I was in PT, and the therapist suggested I get some deep tissue messages because there was knots and scar tissue, under the skin and in areas a surgeon couldn’t get to, and this is what is causing the pain and swelling, especially when I try to do the heavy lifting. I believe she called it Fashiitis. At any rate, my case worker told me I was going for a second opinion. after a week or so, I began to call and couldn’t reach her for a couple weeks, I finally chose the promt to speak to someone else and was informed, she was no longer my case worker, I now have a guy named Patrick. I left him a message, he called me back and was very cold. I asked him about the report, he said he hadn’t received it, after a whole month. I has a follow up with my surgeon and he hadn’t received it either, he called them and they told him, they mailed it. I don’t think this is right, first of all my 1st caseworker lied to me, and instead of them faxing the report, so my surgeon and I can discuss, they waited until I had the appointment, then mailed the report. I am experiencing more and more pain, swelling, burning in my shoulder and arm. Whatever this is, it needs to be addressed but I feel like they just want to ignore what’s going on, give me a shabby rating and close my case. I think I need representation
I got hurt at work at Walmart and as of today May 8th of 2023 they are closing my L&I but I feel that it shouldn’t be closed because I’m still having back problems because I hurt my lower back from the injury and I’m still having problems with my lower back but my doctor that I was seeing she says there’s nothing more she can do so she is sending them a letter to close it out what can I do
Please contact our office to schedule a complimentary consultation so that we can explain your options. The answer to your question is too long to type here.