I get lots of questions from work injury claimants. Many have concerns regarding L&I medical coverage. This is understandable. It sometimes feels like a mystery. After all, it’s difficult to predict if your L&I claim is going to cover certain treatments. However, I think it’s particularly interesting that most L&I coverage questions come up before and after a surgery.
L&I and pain medication
Usually, L&I authorizes opioid pain medication in the acute phase of an LNI claim. In general, the acute phase comprises the first 6 weeks following the work injury. However, L&I can discontinue opioids if there’s no meaningful recovery progress. On top, they will stop opioid treatment if there’s an adverse reaction or if the patient has substance abuse issues.
Pain medication under an L&I claim after a surgery
Pain management is an important topic for many work injury claimants. Most people want to ensure they won’t suffer from pain following a surgery. Generally, LNI authorizes post-surgical treatment whenever there’s a recommendation from the treating surgeon. Normally, this includes post-surgical checkups and rehabilitative treatment. For example, they cover physical therapy and pain management.
For surgeries, L&I has additional rules. In fact, L&I can authorize opioid pain relievers when it’s consistent with Washington State guidelines. The rule-book containing the guidelines is available here. It’s worth noting that many parties participated in writing these guidelines. They include the Washington State Agency Medical Directors’ Group (AMDG) and expert advisory panels. Other participants are practicing providers, public stakeholders, and senior Washington State officials.
L&I and pain management
In short, the rule-book doesn’t prohibit opioids. With care, and responsibly, it says that opioids can be effective and appropriate in the surgical and post-surgical setting. Therefore, they encourage to prescribe the least invasive and lowest dose regimen to minimize pain.
L&I’s goal is to minimize any negative side effects for the injured worker. This goal is reflective in the opioid prescription recommendations across all surgery phases, i.e., before, during, and after the medical operation. In addition to ensuring the lowest possible dosage to address pain, the guidelines also require proper planning, patient education, monitoring, and follow ups.
In summary, L&I recognizes opioids as a reasonable method for controlling pain. Both acutely and after surgical procedures. Therefore, L&I does authorize the use of opioids. However, L&I requires doctors and work injury claimants to follow Washington State guidelines and recommendations.