One of the most common questions I get from people with an L&I claim or a workers’ compensation claim is: “How do I settle my claim?”. To answer their question, I usually have to explain how L&I claims work in Washington State. That way, I may have a better understanding of what the person really means by “settlement”. In most cases, the work injury claimant is just looking for a fast track end their L&I claim. In other words, they are just hoping for a monetary payout in exchange to the claim. Unfortunately, it doesn’t always work this way.
Workers’ compensation claim settlement – How do I settle my L&I claim?
There are two types of work injury claims in Washington State. First, there are L&I claims – the Department of Labor and Industries (L&I) administers these claims. Second, we have self-insured employer claims, where a Third-Party Administrator or TPA handles the claim. Monetary payouts are not available for your L&I claim but it might be an option for a self-insured claim. If you want to receive a monetary payment for your self-insured employer claim, you must understand the consequences.
In practice, if you agree to a monetary payout, it means that you are giving up your work injury claim in exchange for some money. By giving up, I mean that you are agreeing to allow the insurance company to reject your workers’ compensation claim or close your claim. This is a quick way to resolve claims. It is sometimes referred to as “sidebar agreement”. It’s important to note that only a very small portion of workers’ compensation claims reach resolution this way. And with that in mind, work injury claimants should first speak to a workers’ compensation attorney before making this decision.
Structured settlements for a workers’ compensation claim
Another type of settlement is called structured settlement or CRSSA. Generally, it resolves all future benefits under your workers’ compensation claim. If you have a work injury claim and you are 50 years old (or older), then you can consider this L&I claim settlement option. In addition, to qualify, your claim must be approximately 6 months old. Under CRSSA, you typically agree to close your L&I claim or workers’ compensation claim. In exchange, the claim administrator will pay you a certain sum of money and you will receive partial payments over time. Most importantly, under this option, you may still be eligible to receive additional treatment if the medical condition that relates to your L&I claim gets worse.
In my experience, self-Insured employers are often open to CRSSA claim settlement because it’s a way for them to resolve a claim. On the other hand, L&I claims will consider CRSSA once the work injury claimant reached maximum medical improvement. However, in my recent experiences with L&I, their CRSSA offers rarely make sense. Especially when you take into consideration the benefits that people with a workplace injury claim are giving up. For this reason, I strongly advise work injury claimants to speak to an L&I attorney before they agree to a CRSSA.
Permanent Partial Disability or PPD
Generally speaking, when clients ask about claim settlement, they are really asking about Permanent Partial Disability or PPD awards. L&I usually gives a PPD award at claim closure. Only an attending provider or an IME provider can perform a rating exam to determine the PPD impairment. These definition of PPD ratings include a certain percentage and a category. Furthermore, the value of the PPD rating is based on the date of injury.
In some cases, PPD awards can be very straightforward and do not require the involvement of a workers’ compensation attorney. For example, when you reach maximum medical improvement and return to work. However, L&I can also choose to close your claim without paying you a PPD award, even if you are unable to go back to work. In that case, it’s extremely important to speak with an experienced attorney to learn your rights and options.
Final Thoughts and Conclusions
To summarize, there is a lot more to workers’ compensation claim settlement than what most people think. I know that work injury claims can be tough, long, and cause people a lot of stress. However, taking the easy way out isn’t always worth it in the end. It could mean that you’re giving up benefits that you’ll require at a later time under the Industrial Insurance Act. Therefore, I always recommend that folks consult with a workers’ compensation attorney before “settling” their claim.