What happens after my L&I claim closes? I get this question all the time. It’s one of the biggest points of stress for people after a work injury in Washington State. Moreover, this stress is particularly high for people that know they will incur additional medical costs after their L&I claim is closed. In this write-up, I’m hoping to enlighten workers about claim closure and who pays for future medical expenses.
Paying for medical expenses after L&I claim closure
Under WAC 296-20-124, the Department of Labor and Industries (L&I) will not pay for services after a workers’ compensation claim closes. However, L&I and self-insured employers are responsible to pay for services that relate to the claim reopening application. Furthermore, there are a couple of other important exceptions.
Workers’ compensation claim closure and payment exceptions
The first exception is for certain periodic medical exams. Here, L&I and self-insured employers must pay for certain periodic medical surveillance examinations. For example, these exams are very common in cases involving asbestos diseases. Generally, doctors recommend these exams under the medical protocol whenever they need to perform routine medical monitoring or maintenance.
Another exception is for medical equipment replacement. Under WAC 296-20-1102, L&I may cover repair or replacement of prosthetics, orthotics and other special equipment. However, after L&I claim closure, you need to get pre-authorization from the prescribing medical provider. Explicitly, your doctor needs to provide a document to L&I to explain the need to replace or repair the item. For example, your doctor will have to explain that the medical device incurred damages, broke, or is worn out. Finally, note that crutches, cervical collars, and lumbar and rib belts (as well as other low-cost orthotics) don’t require preapproval. Of course, there are also limitations on the kinds of items that L&I will cover. As an example, L&I will not cover inversion traction equipment, vibrators or heating pads. They will also not cover home furnishings, hot tubs and exercise equipment.
In my opinion, I always think it’s a good idea for people with a work injury claim to plan for their L&I claim closure. In part, they should discuss medical expense (and other) concerns before claim closure becomes final. On top, there are special considerations when medical surveillance exams or equipment repair applies in your L&I claim. In such cases, I recommend that claimants, medical providers and L&I get on the same page regarding process and procedure after claim closure.