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L&I Pain Medication and Coverage After a Surgery: What Should I Expect?

/ L&I attorney / 0 Comments

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.

Conclusions

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.

L&I Claim Overpayment: They Overpaid Me and Want Money Back, Now What?

/ L&I attorney / 4 Comments

The Department of Labor and Industries (L&I) sometimes sends overpayment notices to work injury claimants. Receiving one of these letters can be very stressful. The purpose of the notice is to tell you that you’ve been overpaid. And yes, they want their money back.

The reality for injured workers

When work injury claimants are unable to work, their income is automatically slashed by 40%. Clearly, this creates significant financial strain and stress. After all, the cost of living is always on the rise. Consequently, many workers have no choice. They live from check to check. In reality, many workers use wage replacement benefits in their entirety to pay for housing, food, and family care. Very often, injured workers must dip into their savings to make ends meet.

L&I claim overpayment

It feels like L&I is so stingy with paying benefits that overpayments can’t possibly happen. However, overpayments are very common. Most times, when overpayments occur, it’s not the fault of work injury claimants.

Overpayments can occur for many reasons. For example, because of clerical errors or identity mix-ups. They can also happen due to wrong data or adjudicator errors. One case is when L&I computes the wage rate incorrectly. Another is when L&I pays benefits even after the injured worker is released to work. Furthermore, there are instances where L&I reverses claim closure and must recoup a previous PPD award. That said, I’ve seen many cases where L&I tries to collect an incorrect overpayment. Therefore, it’s always important to double check everything. You must take steps and check if the L&I repayment demand is correct.

Repaying L&I overpayments and the law

Under RCW 51.32.240, L&I has the right to make a claim for repayment or recoupment of an overpayment. However, they only have one year form making of the overpayment to ask for money back. If L&I doesn’t make the claim within one year, then they waive their right to recoup funds.

The one-year limitation doesn’t apply if there are issues of willful misrepresentation. More explicitly, willful misrepresentation is when a person obtains payments or other benefits under the Industrial Insurance Act after knowingly giving a false statement or misrepresentation. It also includes cases where people omit or conceal facts intentionally to receive benefits they shouldn’t get. Willful misrepresentation does happen. Yet, in my experience, L&I sometimes incorrectly accuses workers of willful misrepresentation. This is very common in cases of innocent mistakes.

L&I overpayment after willful misrepresentation

If an overpayment occurs due to willful misrepresentation, then L&I has three years. Here, the timer starts ticking when L&I discovers the willful misrepresentation. Then, they can also demand repayment plus 50% penalty. However, there are examples when L&I doesn’t claim the repayment within 3 years. In such cases, L&I automatically waives the right for repayments.

L&I claim repayment – summary

To conclude, overpayments in L&I claims are more common than you think. L&I has one year to make a claim to recoup overpayments. Although, if there’s been willful misrepresentation, then L&I has three years to make the overpayment claim.

Regardless, L&I sometimes makes mistakes when it comes to assessing overpayments. These mistakes happen because of miscalculations or timing issues. They can also occur when L&I incorrectly blames workers of willful misrepresentation. If you feel that L&I is incorrect, it’s always a good idea to consult with an experienced attorney right away.

Caregiver Work Injury Cases and Occupational Hazards

/ L&I attorney / 0 Comments

I represent many healthcare workers in their L&I claim after a work injury. In fact, healthcare work injury occurrences can be very bad. Over time, I learned that healthcare workers face unique hazards in their workplace. This fact applies to all healthcare employees. From doctors to nurses, therapists, counselors, and support staff. Moreover, the safety issues they handle are unlike any other profession.

Caregiving workers

Caregiver refers to a worker that attends to the needs of another person with limitations. These limitations can arise after an injury, illness, or disability. At work, caregivers perform various duties. For example, they assist with mobility, transfers, and attending appointments. They also help to administer medication, change clothes, and household chores. Other examples include changing linens, attending to personal hygiene, and coordinating with a healthcare team.

Sometimes, caregivers work in pairs or teams. However, it’s far more common to find caregivers working on their own. It’s usually just the caregiver and the individual they are caring for.

Caregiver work injury scenarios

The responsibilities of caregivers cover a wide range of tasks. Therefore, they are often susceptible to injury at work. Some common caregiver workplace injuries include:

1) Low back injuries;

2) Neck injuries;

3) Knee injuries;

4) Shoulder injuries;

5) Slip and fall;

6) Hand and wrist injuries;

7) Elbow injuries;

8) Repetitive use injuries;

9) Contact infections and diseases; and

10) Injuries from combative patients.

Tips to avoid workplace injuries

For caregivers, there are several ways to avoid work injury. First, you must know your work environment. When lifting patients, make sure to use proper techniques and poses. Furthermore, take the time to fully assess every situation and possible outcomes. Think before taking actions. It’s also very important to practice good hygiene and wash your hands regularly. Finally, ask for help when you need it!

You cannot avoid all injuries. But you can try. If you get hurt at work in Washington State, you are covered under the Industrial Insurance Act. However, it’s very important to report your injury in a timely fashion. Make sure to document how the injury happened at work. Most importantly, you should seek proper medical attention without delay.

Workers Compensation - Washington