Medical-Only L&I Claim and Workers’ Compensation Claim in Washington State

Sometimes claims for workplace injury are called “medical only” claims. Often, work injury claimants do not understand what it means to have this kind of claim. Yet, it’s important to understand the difference between “medical only” workers’ compensation claim versus “compensable claim”. It is important because the type of claim impacts the benefits you might receive. Hence, if your L&I claim has the wrong type, then you might miss out on important benefits.

 

What is a “medical only” workers’ comp claim?

As the name suggests, when an L&I claim is medical-only, then L&I or the self-insured employer only pays for medical expenses. Therefore, you don’t receive other benefits such as time-loss compensation, loss of earning power, or permanent partial disability. You also can’t get total permanent disability or death benefits.  When a workers’ compensation claim pays out these other benefits, it is called “compensable claims”.

 

From my perspective, “medical only” claims are appropriate when doctors can treat the workplace injury or occupational disease quickly. Practically, this type of L&I claim works when there’s no interruption to your employment or wage-earning ability. For example, a workplace accident claimant who sustains a cut at work may need urgent medical attention. The person is rushed to the hospital to clean and bandage or suture the wound. If all goes well, the injured worker may miss less than a day of work. The injury will heal, and it will have no limiting impact on the worker’s ability to do their job. Under these circumstances, a “medical only” workers’ comp claim is appropriate. The insurance covers the medical expenses for the work injury. From here, there’s no need for other benefits under the claim.

 

Employer tactics under a workers’ compensation claim

People that suffer an injury at work should know that L&I provides incentives to employers with no claims (or with “medical only” claims). Businesses that prevent workplace injury occurrences earn a “claim-free discount” from L&I. Here, the condition is to not have a “compensable claim” during a 3-year period. Employer discounts range anywhere from 10-40% off the base rate for their business. Consequently, some businesses and employers go to great lengths to ensure zero compensable claims on record.

 

Some employers reduce compensable workers’ comp claim volumes by increasing workplace safety. Others provide employees with accommodations and flexibility to not interrupt the worker’s employment. I applaud such employers because it’s a win for both the worker and the employer.

 

Unfortunately, some employers try to limit compensable claims unfairly, to the detriment of the worker. In these cases, employers can argue that injuries are less significant than they are. Another strategy is when the employer creates a job to keep the work injury claimant working, regardless of their medical condition. For example, some people have been paid their regular salary to watch safety videos while recovering from injuries. This isn’t necessarily a bad thing, unless the employer has ulterior motives.  For example, when employees have a workers’ compensation claim, some employers work hard to find basis to fire the work-injury claimant for cause. When an employer fires a person with a workers’ comp claim for cause, they are not eligible to receive benefits like time-loss compensation benefits.

 

Summary and conclusion

To summarize, a medical-only workers’ compensation claim is appropriate after a simple injury at work. Remember, such workplace injury must not have long term impact on your physical abilities or future employment. However, if you suffered a more severe illness or injury, then the Industrial insurance Act (RCW 51) providers other claim benefits. Moreover, these other benefits are important when your work injury has real impact on your functioning and employability.