The Department of Labor and Industries (L&I) decides when work injury claimants receive benefits under their L&I claim. When L&I makes a decision about entitlement, the decision is usually in writing. Frequently, the decision is labeled “Notice of Decision”. However, decisions can also be under “Payment Order”, “Wage Order”, or any other written document. That’s where an L&I claim appeal comes into play.
L&I claim appeal vs claim protest
Any party that disagrees with a written decision can protest or appeal it. For jurisdiction, a protest stays with L&I. However, an appeal takes the disagreement to the Board of Industrial Insurance Appeals (BIIA). In fact, there are many reasons a claim protest may be strategically better than an appeal, and vice versa.
I get questions about protests and appeals regularly. The most common question is: How long will it take to get a decision? Often times, L&I makes decisions following a protest very quickly. Surprisingly, sometimes I receive decisions just days after filing my client’s claim protest. When this happens, it makes me wonder whether L&I really took the time to fully reconsider if the decision is correct. In contrast, I’ve seen cases where L&I protests have gone months and even years without checking or addressing them. Yet, there’s some good news. With some prompting and nudging, the Department of Labor and Industries usually acts on protests relatively quickly.
Workers’ compensation claim appeal in Washington State
L&I appeals are different. First, the Board of Industrial Insurance conducts a mediation process. There, one or more mediation conferences take place, where the parties discuss and try to reach resolution without litigation. Afterwards, if mediation does not produce an acceptable outcome, then the case advances to litigation.
If the parties cannot agree or settle the claim, then it usually takes much longer to get a decision in an appeal. That’s because appeal hearings are essentially a legal proceeding. The appealing party has the burden of proving that L&I’s decision is wrong. This requires that party to present testimonies. Therefore, there can be significant costs associated with an L&I claim appeal under this path. For most benefits, at least some of the testimony must come from experts like doctors, therapists, and vocational counselors. This presentation of testimony takes time.
Board appeal and petition under a work injury claim
Once the parties finish presenting their evidence, the hearing judge reviews and compiles all the materials. Then, the judge issues a written Proposed Decision and Order. The decision contains findings of fact and conclusions of law for each issue in the appeal. Furthermore, any party that disagrees with the Proposed Decision and Order may file a Petition for Review. The goal of the petition is to ask the Board of Appeals to review the decision. Afterwards, if the Board grants the review, it must issue a follow-on Decision and Order. Once again, the Decision and Order comprises findings of fact and conclusions of law.
Work injury client representation and challenges
Personally, it’s important for me that people that suffer an injury at work have realistic expectations. Clients must understand how much time claim appeals can take. It’s particularly important because many injured workers are without money or access to claim medical treatment during the appeal.
I used to tell work injury clients that claim appeals could take as much as a full year. That’s from the time we file an appeal until we receive a decision. Recently, that estimation has changed dramatically. Currently, it seems that the Board of Appeals is backlogged. It appears they have challenges issuing written decisions. Some of my client cases are waiting 150 days or more for a written decision. Therefore, right now it’s very difficult for me to give accurate estimates.
I’m deeply concerned about the length of time for L&I claim appeals. Remember, many work injury claimants do not have access to financial or medical benefits during the process. Many are barely making it through.
I was granted an appeal by the board but no date has been confirmed yet. My injury happened over a year ago. I have no income, had to cash out my 401k, drained my bank account, I had to sell off personal items including a German luger that was past on to me by my grandfather. As of next month I will be living in my car with my 3 cats. I’m 63 years and have worked my entire life and in the last year I have lost everything. If I had to do this all over again I would never of filed a claim.