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Report of Accident (ROA) Form: How to File an L&I Claim

If you suffer an injury at work or develop an occupational disease, you need to file a claim right away. The best way to file an L&I claim is to see a doctor. There, you will fill out a Report of Accident (ROA) form. You must complete the ROA form to file the claim.

Filling the Report of Accident form

The Report of Accident form is long. It asks for a lot of information. Many workers rush when they complete the form. They end up giving inaccurate or incomplete information. This can cause a lot of problems and delays down the road. Therefore, it’s important to take your time. You must fill out the form completely and accurately.

The ROA form has 2 main sections. The first is Worker & Employer information. The second is for Health Care Provider information. Your doctor fills out the Health Care Provider section. You don’t need to worry about that part. However, you must fill all 43 boxes of the Worker and Employer section.

Sections in the ROA form

The first 9 boxes ask for basic information. For example, your full legal name, gender, and social security number. It also asks for your phone number, birth date, and home address. Also, you’ll need to provide your height, weight, and mailing address.

If you don’t have a social security number – it’s okay to leave it blank. Make sure your address and phone number are correct. This is how the Department of Labor and Industries (L&I) communicates with you. L&I will send you important documents and information over time. Hence, it’s critical to provide accurate contact details. If your contact info changes, you must notify L&I right away.

Answering questions about your family

Next, there are boxes 10 and 12. Box number 10 is small. Many work injury claimants overlook it. However, it’s a very important box because it asks about marital status. Are you married? Do you have a registered domestic partner? If so, then you can potentially receive higher time-loss compensation payments. To get a time-loss compensation increase, you must fill out box #10. You must also include the name of your spouse or domestic partner in box 12.

Box #11 and box #13 ask about dependent children. Usually, they refer to biological or legally dependent children. Kids must be under the age of 18 and living at home. Sometimes, L&I will consider children over 18 under certain requirements. If you have dependent children, you might be eligible to higher time-loss compensation. To get the increase, you must list all dependents on this form. Otherwise, L&I won’t take them into consideration when they calculate your payments. Box 13 asks for the full legal name of the children’s legal guardian (if it isn’t you).

Work injury details in the Report of Accident form

L&I asks you to describe the work accident or workplace illness in boxes 14 through 28. They use this information and the initial medical records to allow or reject your claim. It’s critical that you fill these boxes completely and accurately. Don’t guess anything. Especially not important dates. Look at your calendar and text messages if you have to. Go back and review your emails. Talk to friends and family members. It’s imperative that you enter the correct facts.

Employer and wage information

In boxes 29-39, L&I asks for your employer and salary info. L&I uses this data to calculate your wage replacement benefits and payments. Of course, L&I will verify the information with your employer. If you don’t fill boxes 29-39, it might cause delays with your payments.

Box 29 asks if your employer pays your healthcare benefits. If you get any healthcare coverage through your job, then you must check “Yes”. Even if it’s through union agreements or a partial health coverage. If your employer stops your healthcare coverage after your work injury, L&I still includes the value of the healthcare benefits when calculating your compensation rate.

Your employer info goes into boxes 30-34. L&I has to communicate with your employer. You must fill the employer info accurately because it reduces delays in claim processing. In box 35, list your job title at the time of injury. Boxes 36-39 ask for your rate of pay, hours per day, and days per week. They also want to know about all your sources of work income. For example, earnings from piecework, tips, overtime, commissions, and bonuses. Some workers have a complex pay schedule. In those cases, you must collect pay stubs for up to 12 months prior to the injury. Give them to L&I. It’ll help them calculate your wage rate. You can also do it later. In fact, you can send them paystubs after you file the initial ROA form.

Other details in the Report of Accident form

Some people work more than one job. If you suffer an injury at work, you must tell L&I about all your jobs. You’ll do it in box 40 and 41. They must consider all income sources to calculate your benefits. For instance, say you’re unable to perform all your jobs. In that case, L&I will compensate you for all your earnings from all jobs. Not just the job of injury. There are also other considerations with occupational disease claims. For example, L&I needs to know if there are work activities with other employers that contribute to your condition.

Finally, date your Report of Accident form and sign it in box #42. Then, after you sign it, return it to your medical provider. Your doctor will submit the Report of Accident to L&I.

What else should I do when filing a claim?

When you file your claim, there are other steps you must follow:

1. Look at the top right corner of the Report of Accident form. You’ll see your claim number. It’s pre-printed on the form. It begins with two letters with five numbers after. Next, take a picture or write down your claim number. Keep it safe. Sometimes, paperwork can get lost. Having your claim number is the easiest way to check the status of your L&I claim.

2. Give L&I access to your employment records. The Employment Securities Department (ESD) maintains your records. These records can help L&I calculate your wages and benefits.

3. Don’t hesitate to call L&I at the Injured Worker Hotline. In fact, you can call them any time you need help. The L&I Hotline number is 1-800-547-8367.

Attorneys cannot help until you file a claim

Most attorneys can’t help you until you file your claim. However, they can help after you file the L&I claim. For example, if you have issues with claim allowance or wage rate, then it’s important consult with an L&I attorney. L&I can calculate your wages in several ways. A workers’ compensation attorney can help determine if the calculation methods are appropriate. Or, if they used the method most beneficial to you. Attorneys can also help if L&I denies or rejects your claim.

Late L&I Claim Filing: What Happens If I Delay Or Wait Long to File an L&I Claim?

/ L&I attorney / 3 Comments

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.

Conclusions

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.

L&I Surveillance: I Think I’m Being Watched – What Should I do?

/ L&I attorney / 0 Comments

Surveillance in an L&I claim is relatively common. In fact, work injury claimants encounter surveillance in both self-insured claims and state-funded L&I claims. It isn’t against the law. Private investigators usually conduct the surveillance. Moreover, they know exactly what they can and cannot do under the law.

Willful misrepresentation in a workers’ compensation claim

The Department of Labor and Industries (L&I) is the administrator for state-funded claims. Here, surveillance is more likely to occur after someone reports fraud relating to a work injury claim. For example, when a person receives workers’ compensation benefits but appears able to work. Another example is when the injured worker is working while collecting time loss compensation.

Under the Industrial Insurance Act, there is no such thing as fraud. There’s only willful misrepresentation. The relevant law for willful misrepresentation is RCW 51.32.240. In short, it’s willful misrepresentation to receive payments or other benefits in greater amounts than a person deserves. Simply put, it refers to making a false statement, misrepresentation, omission, or concealment of facts to deliberately obtain or increase benefits. Moreover, it also includes willful failure to disclose work-type activities.

L&I claim surveillance

Fraud isn’t part of the workers’ comp ecosystem in Washington State. However, the word “fraud” is a trigger to describe people that abuse or take advantage of the system. In fact, L&I encourages the public to report potential fraud. L&I takes these reports very seriously. For one, they built an entire fraud investigation unit. There, investigators frequently take statements and conduct surveillance. Hence, one of the easiest ways to “avoid” surveillance is to not give L&I reasons to suspect you.

Still, I’ve seen cases where people file reports against work injury claimants even when they’ve done nothing fraudulent. Luckily, surveillance in these instances reveals nothing more than workers trying to get through everyday life the best they can. Of course, I’ve also seen surveillance showing that an injured worker is lying about their injuries and limitations. I’m always very disheartened when I see blatant willful misrepresentation. This kind of behavior negatively impacts all workplace injury claimants.

Self-insured claims and surveillance

With self-insurance, there’s a third-party administrator (TPA) that manages the claim. In my experience, surveillance occurs much more frequently in self-insured claims. What’s more, third-party admins can request surveillance even when there’s no accusation of fraud. Many times, the surveillance is useless. Usually, the film shows workers doing nothing more than struggling to get in and out of cars. Or attending appointments and spending a lot of time at home. Consequently, we only find out about the surveillance later during the discovery phase when the case goes to litigation.

Workers’ compensation surveillance and bias

However, sometimes injured workers are surveilled doing normal things. For example, going for walks, grocery shopping, and taking out the garbage. I commonly watch tapes showing workers doing yard work, attending family outings, going out to eat, or walking their dog. Sometimes, attorneys or claim administrators share the footage with treating doctors and independent medical examiners (IME). They do it to demonstrate that the work injury claimant is more physically capable than they lead on.

Depending on the film, this can be very effective in getting doctors to ease up or even remove physical restrictions. Sometimes this is very appropriate. Yet, many times the surveillance video doesn’t present a complete picture. Often, it shows things out of context. This typically leads to significant disagreements and litigation. There’s no easy way to prevent surveillance in self-insured claims. Therefore, it’s always best to ensure that you are being open and truthful. Describe your abilities and limitations to doctors honestly.

Takeaways and final notes

To summarize, surveillance is a standard practice in L&I claims. It’s legal and it happens all the time. It’s common in both self-insured and state-funded claims. When surveillance reveals behavior that’s consistent with doctors’ reports, then nothing will come of it. However, there are cases when a work injury claimant engages in activity beyond what they report. In such instances, the claim manager will likely use the footage to terminate benefits. In particularly egregious cases, claim handlers will use the surveillance records to push for willful misrepresentation charges.

If you suffer an injury at work and have a claim – it’s best to assume that someone is watching you. Therefore, your outward behavior must match your reports. Finally, it’s important to be honest. Describe your workplace injury and limitations honestly to doctors. Report the injury conditions in simple words the best way you can and you’ll be fine.

Workers Compensation - Washington