People regularly call my office asking for advice about their L&I claim. Many times, they ask about common mistakes. More correctly, they want to know what mistakes to avoid. By far, the biggest mistake I see is when work injury claimants wait too long to file their claim. In the legal setting, we refer to it as “delayed claim filing”.
Do not delay your L&I claim filing
If you wait and delay claim filing, it can cause many issues. The most significant issue is – raising red flags for L&I and claims administrators. It’s unclear to them if your claim is even valid. I mean, if the claim is legitimate, then why wait so long to file? However, there are other problems with filing late. Follow-on issues include insurance coverage problems, delay in medical treatment, and difficulties in obtaining benefits.
By law, you have one year from the date of your work injury to file a claim. For an occupational disease (OD) claim – the limit is 2 years. In OD claims, the clock starts ticking when a medical professional notifies you (in writing) about your occupational disease.
Is your L&I claim valid?
Just because you have one to two years to file a claim, it doesn’t mean it’s wise to wait that long. If you wait, you’ll have to face claim validity questions. In my experience, this happens almost every time when employees don’t file a workers’ comp claim right away. It doesn’t matter if you wait one month or eleven months. Every time, filing delays call into question whether there was an injury in the first place.
Naturally, you can expect any logical person who suffers an injury to get immediate medical attention and file an L&I claim right away. That’s the though-process that claim managers follow. On average, out of ten claims that L&I rejects, at least eight involve filing delays.
Good reasons for waiting to file a workers’ compensation claim
Sometimes, work injury claimants have good reasons for filing late. Common reasons I see frequently include:
1) Not wanting to upset the employer;
2) Thinking the injury is minor and will resolve on its own; and
3) Begin afraid of the workers’ compensation claim system.
All these reasons are very understandable. They make sense. However, it’s best to not delay. None of these reasons are worth risking L&I claim rejection. Therefore, it’s best to report your injuries right away. Even if they are minor work injuries. It’s important to seek immediate medical attention and file a workman’s compensation claim promptly. Even if the injury turns out to be minor. It’s far better to have a claim than to litigate later after claim-rejection.
Filing a claim late can result in insurance coverage issues
Another common problem with waiting too long to file a claim is insurance coverage. Sometimes, when workers have an accident on the job or develop a workplace illness, they get medical attention right away. However, they may use private insurance to cover the treatment rather than filing a claim. Initially, it might seem easier and less burdensome. But later, it can cause confusion and complication. Especially if you file a claim afterwards.
Private insurance carriers aren’t happy when they learn they’ve been covering treatment for a work injury. After all, L&I or self-insured employers are responsible for workplace injury insurance coverage. Moreover, L&I or the self-insurer won’t have the medical records for your early treatment. Later in the process, they may disregard your early treatment when deciding to allow (or reject) the claim. Finally, switching billing from private insurance to workers compensation can create headaches for medical providers. Filing a claim without delay avoids these kinds of issues.
Medical treatment delays after a late L&I claim filing
Filing late can also mean treatment delays. These delays can occur when there are questions concerning the validity of the claim. For example, if L&I rejects your claim, you might have to file an appeal. After that, the appeal litigation process can take a long time. In fact, it may take more than a year to get a final decision. Even if they allow the claim without litigation, there’s still a risk of other delays. For example, treatment delay when switching between insurance carriers. Again, filing a claim without delay can dramatically reduce the likelihood of unnecessary delays.
Getting workers compensation benefits after filing a claim late
Work injury claimants can receive a variety of benefits. Medical treatment is one. However, there are many others. For example, wage replacement benefits such as time loss compensation or loss of earning power benefits, or vocational services. Securing these benefits can be challenging regardless of when you file the claim. In addition, if you file late, then you must obtain these benefits retroactively. However, it’s always difficult to obtain retroactive benefits. Sometimes it’s even impossible. This is another reason why workers must file an L&I claim right away.
In summary, there are many reasons for filing a workers’ compensation claim right away. Avoid delays and don’t wait long. It doesn’t matter what your reasons might be. There’s high likelihood of running into claim problems later. It’s not worth it. You must always submit an incident report at work. Then, go see a medical provider and explain your work injury or work-related condition. Medical providers will have the appropriate accident report forms. On top, they will complete and handle the provider’s initial report.