The Board of Industrial Insurance Appeals hears and decides L&I claim appeals. Usually, the Board makes decisions in standard and routine cases. These decisions are typically straightforward. However, on occasion, a Board decision may require special legal analysis. In fact, certain Board decisions have unusual facts. Therefore, in such cases, the Board sometimes makes new or different interpretations of the law.
A common L&I Board decision – examples
The Board regularly hears workers’ compensation claim appeals. Every day, the Board handles appeals to decide if a work injury claimant has temporarily totally disability. Another common example is deciding whether workers are eligible for more proper treatment under their L&I claim. Additional examples include decisions relating to permanent partial disability (PPD), and total disability or pension.
Significant L&I claim Board decisions
Each year, the Board determines if any of its decisions are “significant”. Under WAC 263-12-195, significant decisions are ones with “analysis or decision of substantial importance to the board in carrying out its duties”. To select these decisions, the Board collects input from its staff. They also ask for input from the public.
Under RCW 51.52.160, the law mandates the Board to publish significant decisions. On top, they must make these decisions available to the public at reasonable cost. Consequently, the Board indexes and summarizes significant decisions on a designated page on its website.
Significant cases and decisions are very important. In fact, there are special legal rules for these Board decisions. For example, take the rule regarding citations. When writing legal arguments, you can only cite cases as “significant” if the Board specifically designated them as such.
My experience with significant L&I Board decisions and cases
In 2021, the Board designated one of my cases as significant. This case involved two things:
1) The application of well-established law to unique facts; and
2) A distinction in the interpretation of the law.
The case includes an important decision about segregated conditions in an L&I claim. But first, let’s set some context and provide background. When L&I makes a decision, it communicates the decision to all the parties. Then, if neither party appeals the decision, it becomes final and binding 60 days later. This means that no party may revisit or litigate the matter later.
In addition, L&I may decide that a specific medical condition does not relate to the L&I claim. With that, L&I issues an order segregating the condition. Hence the term “segregated condition”. However, a work injury claimant can disagree with this order. As before, the worker has 60 days to tell L&I to reverse the decision. But, before we proceed, I must make an important distinction: A medical condition can relate to an L&I claim in two ways:
a) If the industrial injury or occupational disease causes the condition; or
b) If the workplace injury or occupational illness permanently aggravates the condition.
Specific example of significant cases
My experience with L&I claim significant cases comes from my work with Katherine Bard. For context, here is the timeline of the case:
- In 2013, the Department of Labor and Industries (L&I) issued an order segregating lumbar degenerative disc disease from the L&I claim.
- The order became final and binding.
- Bard’s L&I claim closed in 2014. The closing of the claim also became final and binding.
- Next, Ms. Bard reopened her L&I claim in 2015 for worsening of conditions that relate to the claim.
- In 2019, L&I issued a new order. In it, they reconsidered the 2013 order and decided to segregate lumbar degenerative disc disease.
- Finally, L&I determined the 2013 order was correct, to the worker’s detriment.
The L&I order from 2019 was new. Hence, Ms. Bard exercised her right to protest or appeal the decision within 60 days. On appeal, L&I filed a motion for summary judgment. In its motion, L&I argued that Ms. Bard cannot appeal the 2019 decision. Their argument was that the segregation of lumbar degenerative disc disease was final and binding. Furthermore, L&I said it issued the order by “mistake”. Initially, the Board judge agreed with L&I’s argument. Therefore, the judge granted their motion for summary judgment. However, I petitioned the Board to review the judge’s decision. The Board agreed and issued a new Decision and Order (D&O). Eventually, the Board designated Ms. Bard’s case as significant.
My personal significant case and the L&I Board decision
In Ms. Bard’s L&I case, the Board clarified that she cannot argue her injury caused the lumbar degenerative disc disease. Yet, the law doesn’t prevent her from arguing her injury aggravated the disease. Here, we recall that aggravation of a condition happens when:
i. A non-symptomatic pre-existing condition lit up or is now active because of the work injury; or
ii. An industrial injury or work disease worsened a symptomatic pre-existing condition.
In other words, the Board decided an industrial injury can aggravate a condition any time throughout the life of the claim.
Takeaways from Ms. Bard’s significant case at the Board of Appeals
The Board ruled that Ms. Bard cannot argue that L&I’s 2013 decision was wrong. In fact, the Board went a step further. They stated her lumbar degenerative disc disease wasn’t claim related as of 2014, when her claim closed. That’s because the L&I claim closure became final and binding, and the issue wasn’t raised back in 2014. However, the Board allowed to present evidence to prove her work injury aggravated her lumbar degenerative disc disease between 2014 and 2019.
Summary & conclusions
Personally, I believe the Board properly designated this case as significant. It changed how L&I and L&I attorneys look at aggravation of conditions. It also altered our view on final and binding L&I segregation orders. Since then, I’ve had many conversations with workers’ compensation professionals regarding this matter. I explained my thought process. I also elaborated on the facts of the case and the Board’s analysis. Admittedly, I feel proud to have had the opportunity to be part of this case. Moreover, I’m glad it helped clarify important distinctions. The outcome of this case will surely help workers and workers’ compensation cases in the future.
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