Many times, the Department of Labor and Industries (L&I) makes incorrect decisions. The same is true in self-insured claims. When this happens, it’s important to file a claim protest. If the L&I claim protest isn’t successful, we proceed to file an L&I claim appeal.
L&I claim protest versus claim appeal
Usually, L&I makes an initial decision. Then, to push back on the initial decision, we file an L&I claim protest. If L&I affirms its decision, we continue to file a claim appeal. A successful protest saves time, frustration, and costs. However, in my experience, the chances of winning an L&I claim protest are not good. Therefore, the purpose of this article is to review best-practices when filing an L&I claim protest.
Filing an L&I claim protest -in writing and on time
Under RCW 51.52.050, any party that disagrees with a decision can protest it. With every L&I decision, your rights to protest and appeal must be printed on the decision paper. And again, the same applies in self-insured employer claims.
A valid L&I claim protest must be in writing. Moreover, you have to file it on time. Workers have 60 days to file a claim protest from when you receive the decision. People often tell me they called their claims manager to disagree with the decision. However, a call to the claim manager is NOT a valid protest. You MUST file every protest with L&I. Even if the employer is self-insured. Sometimes, people accidentally send a written protest or appeal to the self-insured administrator (instead of L&I). Here, L&I considers the date the employer receives the filing as the date of receipt.
You must include supportive evidence in your L&I claim protest
Many L&I decisions involve medical determinations. For example, accepting or rejecting a medical condition. Other examples include causation of conditions and the need for further treatment. Finally, there’s also permanent partial disability ratings, and activity prescriptions.
If you’re protesting a medical decision, it’s important to have recent supportive medical records. Recent medical information is especially important if your attending medical provider disagrees with the decision. In fact, whenever this is the case, it’s important for L&I to review the recent medical opinion of the attending provider. Sometimes, it’s a different treating provider who feels that L&I’s decision is incorrect. Even if it isn’t the attending provider, you must provide this medical information to L&I. Unfortunately, without recent medical opinions showing that the decision is incorrect, you’re unlikely to prevail.
L&I protest for non-medical decisions
Many L&I decisions are for non-medical claim benefits. For instance, wage rate or offset dispute. As before, you’re more likely to win an L&I claim protest if you submit supportive evidence. Often, people are frustrated that the burden is on them. Workers have to track down relevant evidence and file it with the protest. I get it. I sympathize with this frustration. However, gathering and submitting supportive evidence is the best way to win an L&I protest.
To summarize, you must protest or appeal unfavorable L&I decisions. The most common convention is to protest an initial determination. While it can be difficult to win protests, you can increase your likelihood of success. Just follow 2 simple rules: (1) file your L&I claim protest in writing and on time; and (2) gather and submit evidence to support the protest.
Leave a Reply