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L&I Claim Sprain and Strain: Medical Diagnosis Challenges

In L&I claims, it’s sometimes challenging to identify the root cause for certain medical symptoms after a work injury. Many times, doctors write their initial diagnosis as a sprain or strain. It’s easy for them to just label L&I claim sprain in your file. But how does that impact your claim and condition?

Soft tissue work injury in L&I claims

We frequently see L&I claim sprain or strain diagnosis in chart notes in soft tissue injuries. These workplace injuries usually resolve quickly without permanent effects. As a result, medical treatment for sprains and strains is fairly basic. It involves rest, stretching, and over the counter pain medicine. It can also involve heat or ice to relieve pain, as well as physical therapy. However, sometimes symptoms do not improve. When this happens, the issue may be more severe. In those cases, providers may begin to consider other diagnoses. The process can involve additional diagnostic studies. It can also include more invasive treatment options such as injections or surgery.

In my experience, symptoms in certain areas of the body can be more diagnostically challenging than others. For example, I’ve seen diagnostic challenges happen when a work injury or occupational disease involves the neck or upper extremity nerves. Another area is the low back and hips. It seems that these areas are challenging because the symptoms could come from various sources.

Work injury involving neck and upper extremities

Some common upper extremity work injury or workplace disease symptoms involve numbness and tingling. They can also involve pain in the neck or arms with certain work activity or movement. It seems these kinds of symptoms come from some sort of nerve impingement. However, finding the nerves in question can be difficult. It can also be challenging to determine the level of impingement. For example, some swelling or inflammation could be temporarily causing the impingement symptoms.

Importantly, nerve impingement can be more permanent or severe if it’s coming from a workplace injury or work disease in the carpal tunnel or cubital tunnel. The same is true for a work injury in the middle or thoracic region of the back, or cervical region of the spine. In fact, the cause for the symptoms can sometimes be impingement in multiple areas. Of course, providers can perform a variety of clinical and diagnostic tests to help determine the origin. Yet, the diagnostic and treatment process can be long and frustrating for work injury claimants.

Low back and hips in L&I claim

Another region that can have diagnostic challenges is the low back and hip region. Pain in the low back radiating into a hip or down the leg can come from nerve impingement in the low back (i.e., sciatica). Other reasons can be dysfunction in the sacro-iliac (SI) joint or dysfunction in the hip joint. Additional examples include a tear in a supporting tendon or ligament (such as the labrum).

A traumatic work injury or occupational disease might injure or impact both the low back and the hip. In fact, I’ve seen situations where a work injury claimant doesn’t realize their hip is hurting until their back treatment completes successfully (and vice versa). Sadly, it can be very frustrating to undergo treatment to resolve your symptoms, only to have it reveal other symptoms that were not apparent before.

Work Injury for Temporary Workers: New Law and Historic Legislation

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The Department of Labor and Industries (L&I) has an ongoing safety research project for temporary workers. The goal of the project is to better understand the high frequency of their work injury incidents.

Work injury research project for temporary workers

L&I is working hard to better assess temporary employment injury risk factors. To achieve this goal, L&I is focusing its efforts on:

Measuring the magnitude and incidence of workplace injury of temporary workers compared to standard workers in similar jobs;
Interviewing recently temporary and standard workers with recent work injury to obtain relevant information and ideas for safety improvement;
Interviewing temporary agency and business managers; and
Developing education materials to industries and parties involved in temporary worker employment.

Interestingly, L&I learned that the temporary worker workforce has grown significantly since 1990. In fact, many more industries utilize temporary workers. With this increase, there is a similarly significant rise in the occurrence of workplace injuries amongst temporary workers. This includes particularly hazardous industries like construction and manufacturing.

Temporary worker workplace injury as major concern

L&I is not alone in its research. The United States Department of Labor – OSHA also studies workplace injury occurrences amongst temporary workers. OSHA is concerned that some employers may use temporary workers to avoid meeting safety compliance and protection obligations under the OSH Act. According to OSHA, temporary workers are put in a variety of jobs, including very hazardous ones. These temporary workers are more vulnerable to workplace injury. On top, employers often do not give them adequate safety and health training. Specifically, according to OSHA, both employers and temporary staffing agencies are responsible for these failures. Therefore, OSHA mandates that both employers and temporary staffing companies meet safety and health obligations for temporary employees.

Temporary worker protection in Washington State

The State of Washington recently took a big step to improve protections for temporary workers in our State. Based in part on L&I research and with legislative, business, and temporary staffing agency collaboration, the Governor recently signed SHB 1206. This new law was sponsored by former Washington State Association for Justice (WSAJ) Director, Liz Berry.

The law goes into effect July 25, 2021 and creates new protections for temporary workers. Specifically, it mandates increased communication between temporary staffing agencies and employers regarding safety and training. It also mandates that employers provide safety training to temporary workers. In addition, it requires documentation and record keeping regarding safety inquiries and training. Finally, it forces employers to be transparent about hazards and safety training.

New historic legislation

Based upon my research, this new law affords more protections for temporary workers than in any other state. In fact, many are hopeful that this law will serve as a blueprint for other states to enact similar protections. Hopefully, the adoption of this law will dramatically reduce the occurrence of work injuries among temporary workers. Congratulations to representative Liz Berry, to the Temp Worker Justice organization, to L&I, and to the State of Washington for enacting this historic legislation. To quote Representative Berry:

All Washington workers deserve to be safe at work. This bill will literally save lives and limbs.

Motor vehicle accidents at work: Negligence and Third-Party L&I Claims

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Negligence isn’t typically an issue in a workers’ compensation claim. When a work injury happens, or work illness develops over time, it doesn’t matter who’s at fault. In general, except in very rare circumstances, work injury claimants cannot sue their employer. Similarly, if a worker is injured at work or suffers an occupational disease, the worker is covered even if it’s their own fault.

Negligence in a workers’ compensation claim

However, sometimes negligence does matter. It matters when a negligent third party causes the workplace injury or disease . Here, a third party is someone other than the employer. It also cannot be an employee of the employer, or the work injury claimant. When a third party causes the injury at work or the industrial disease, they may still be liable for negligence. When this issue arises in an L&I claim or self-insured employer claim, then we call it a “third party claim”.

In my experience, most frequent third-party claims involve a motor vehicle accident (or MVA). Workers that drive often in their job are more likely to experience a work-related motor vehicle accident. For example, delivery drivers, truck drivers, bus drivers, and shuttle drivers. I’ve also seen third party claims involving flaggers or construction workers injured by a negligent driver. Third party claims also arise when a defective product causes an injury or disease. For instance, a manufacturer may be liable if a faulty piece of equipment causes the injury or illness. Examples include defective saw blade guards, defective respirators, or defective steel toe boots.

Costs in third-party L&I claim

When a negligent third party causes the injury at work, the work injury claimant can take legal action against the negligent party. This may shift some of the workers compensation claim costs onto the responsible third party. This kind of cost shifting helps reduce (or even eliminate) the cost burden on the L&I industrial accident fund. Therefore, the Department of Labor and Industries (L&I) has a financial interest in the legal action against the third party.

Sometimes, work injury claimants are reluctant to pursue the legal action against the third party. Mostly, it’s because of the time and energy spent on additional legal battles in civil court, outside the L&I setting. When this happens, L&I may pursue the action in the worker’s name, because L&I has its own financial interest. However, there are many cases where the work injury claimant takes on the legal fight. In that case, L&I becomes a lien holder in the legal action against the third party. Depending on the severity of the injury and the strength of the negligence case, it’s often a good idea to pursue the additional legal action.

Dividing the payout among all parties

Since L&I has financial interest, the parties to the legal action cannot reach a settlement without consulting L&I. Eventually, if the case settles or resolves through litigation, the monetary award divides between several entities. First, litigation costs and attorney fees are paid proportionately by the work injury claimant and L&I. Second, the work injury claimant receives twenty-five percent of the remaining balance (unless they agree to a smaller percentage). Then, the remainder goes to L&I but only to the extent they need to reimburse for payout of benefits.

In summary, when a negligent third party causes an injury or disease, they may be liable. Furthermore, the injured worker may bring legal action against the third party. If they do not, L&I can still pursue the legal action (if they choose to do so). Any monetary proceeds of the legal action are divided between attorneys, the injured worker, and L&I. Work injury claimants should get twenty-five percent. Finally, L&I is entitled to reimbursement for the benefits they pay under the workers’ compensation claim.

Workers Compensation - Washington