Workers Compensation - Washington

Tara Reck, Managing L&I Attorney at Reck Law PLLC - Workers' Compensation Attorneys

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Over Seven Claim: My L&I Claim Closed More Than 7 Years Ago – Can I Reopen It?

You can always reopen an L&I claim for medical treatment. Even if you have an old claim. It doesn’t matter how old the claim is. However, if your claim closed over 7 years ago, it will impact your L&I claim benefits. While L&I covers medical treatment, you might not receive other benefits under the claim.


What is an over-seven claim?

The term “Over-Seven Claim” is commonly used by workman’s compensation professionals. That way, we all know what we’re talking about when we use that phrase. The term refers to an L&I claim or self-insured employer claim that closed over seven years ago (or ten years for eye claims).


To reopen an over-seven claim, the requirements for reopening are the same as all claims. This is true for old claims as well. However, once reopening is complete, there is special treatment for over-seven claims. Here, in this article, we’ll first discuss the reopening process and then talk about L&I benefits and limitations.


How to reopen an old over seven claim

To start, you must first file an Application to Reopen Claim. If you look at it, the form requires information from both the work injury claimant and their medical provider. In turn, after L&I receives your reopening application, L&I has sole authority to decide what to do next. This is true for both a state-funded L&I claim and self-insured employer claim. In other words, the Department of Labor and Industries (L&I) determines if there’s merit to reopen your claim.


A work injury claimant can submit a request for reopening without supportive medical documentation. However, without medical evidence, L&I won’t be able to determine whether reopening is appropriate. Therefore, it’s typically best for the injured worker and their doctor to work together on the claim reopening application. Collaboration with your medical provider is very important.


Medical criteria to reopen an old claim in Washington State

The following explanation applies when reopening any claim. Not only an old workers’ compensation claim.  To meet the criteria for reopening, you must show an aggravation or objective worsening of your conditions. Remember, these conditions must relate to the work injury. Furthermore, you must show that the aggravation or worsening happened since the latter of: (1) The last date the claim closed; or (2) The most recent date L&I issued an order stating the claim will remain closed.


For aggravation, you must show the following:

  1. A causal connection between the accepted condition at the time of claim closure and the current condition;
  2. A medical opinion stating that the condition is worse than before; and
  3. Objective medical findings to support the medical opinion.

Sometimes, the requirement to provide objective medical evidence doesn’t apply. For example, in case of mental health conditions.


Showing aggravation and worsening of conditions

L&I can give your medical provider a copy of the closing medical records. If you need it – ask for it. These records can help your doctor assess if your condition is getting worse. Also, L&I can authorize additional diagnostic testing if it helps in deciding on reopening. Finally, L&I also has the right to compel the work injury claimant to attend an Independent Medical Examination (IME). The purpose of the IME exam is to determine if reopening is appropriate.


L&I benefits after reopening an over-seven claim

You can apply to reopen an old over seven claim any time, to receive medical benefits. After filing the reopening application, several situations may arise. First, if the claim doesn’t meet the criteria for reopening, L&I will issue a decision denying the reopening. Second, if the claim can be reopened and time-loss is not an issue, L&I will issue an over seven reopening order and notice for medical benefits. The notice informs the work injury claimant that their claim is reopening only for medical treatment.


Of course, medical benefits are just one kind of benefit that L&I provides to workers after they get hurt on the job. Typically, workers’ compensation professionals refer to other benefits as “disability benefits”. The most common disability benefits include time-loss compensation (TLC), loss of earning power benefits (LEP), permanent partial disability awards (PPD), and pensions (TPD). Simply put, work injury claimants with an old over-seven claim don’t receive disability benefits. Even after L&I reopens their claim. With one exception.


Requesting disability benefits for an old over-seven claim

The director of L&I has discretion to grant disability benefits in an over-seven claim. A worker with an old claim can ask for disability benefits any time during the reopening process. Or, they can ask for disability benefits after L&I reopens the claim. If you’re requesting disability benefits in an over-seven claim, the claims manager or claim adjudicator must prepare a briefing paper. Later, they will hand the briefing paper to the L&I director for consideration.


By law, RCW 51.32.160(1)(a) grants the Director the authority to readjust the worker’s rate of compensation on their own motion. Once the Director exercises discretion to approve or deny benefits, L&I will issue an order and notice. The order will notify the work injury claimant of the Director’s decision.


How likely am I to receive benefits for an old claim?

On occasion, the Director will exercise discretion to grant additional disability benefits in over-seven claims. However, this is an exception. It isn’t a rule and it’s not very common. In fact, Washington State Courts said that the meaning of the words “may adjust the rate of compensation” in RCW 51.32.160(1)(a) empowers the Director to modify the value of a worker’s disability benefits. Hence, the Director has the “discretionary authority” to determine the worker’s eligibility for disability benefits.


As always, any party can protest or appeal L&I decisions. This also includes the Director’s decision to grant or deny disability benefits. However, we must remember that for an over-seven claim, the decision to grant or deny disability benefits is discretionary. Consequently, Washington State Courts determined that the standard of review on appeal is “Abuse of Discretion”. In other words, the appealing party must show that the L&I Director abused his discretion in making the decision. For that, they have to convince the Board of Appeals or a higher court that no reasonable person would have made the same decision. Therefore, most lawyers would agree that abuse of discretion is difficult (if not impossible) to prove.


Summary and conclusions

In summary, you can reopen a workers’ compensation claim as long as certain criteria are met. The criteria for reopening are the same for all claims. It doesn’t matter if a claim closed long ago. The age of the claim is also not important.


If your L&I claim closed less than seven years ago, you can reopen it for both medical treatment and disability benefits. However, if you claim closed over seven years ago or more (ten years for eye claims), you can only reopen it for medical benefits. In over-seven claims, the Director of L&I can exercise discretion to grant or deny disability benefits. But, if the Director denies disability befits in an old over-seven claim, it’s very difficult to successfully appeal and reverse the decision.


L&I Help: Where Can I Get Help For My L&I Claim?

Many work injury claimants struggle with their L&I Claim. It’s difficult to understand how claims really work under the hood. What’s going on in your L&I claim, where the claim is heading, and so on. Moreover, many workers don’t know what to do when things don’t go well. What’s worse, when they run into difficulties, they don’t know where to turn for L&I claim help. Obviously, one answer is to talk to an experienced workers compensation attorney. However, in many cases, you don’t need an attorney. There are other resources available out there. These resources can help work injury claimants understand their workers’ compensation claim. On top, they can help you understand the benefits available and your rights. The purpose of this article is to provide a list of the best resources for L&I help. You can use these resources to find help and navigate your L&I claim.


Getting L&I help from your employer

Not all employers have resources to help injured workers. However, many employers do. Often, they can help employees understand what to do after an injury on the job. First, check if you have an organized employer that has policy and employee manuals in place. If you do, it’s likely your employer also has resources for when employees get hurt at work.


If you think your employer may have these kinds of resources available, then ask for them. In fact, even if you don’t know whether your employer might have such resources, it does not hurt to ask. Most likely, employer resources won’t have thorough information. However, they can be a good starting point for understanding your claim. They are also good to get a feel for how your employer will react to your claim.


Union representatives

Are you part of a union? If so, then your union probably has resources and support to help you navigate your L&I claim. If you suffer an injury at work, or develop an occupational disease, you should reach out to your shop steward. Your shop steward can give you information about your L&I claim and your rights as a work injury claimant. Furthermore, they will also tell you about any assistance the union can provide as you navigate your claim.


L&I mailers

Early in claims, L&I usually sends work injury claimants brochures or pamphlets. These brochures contain useful information about L&I claims. Read the information in the brochures carefully. Also, keep the brochures and pamphlets someplace safe. This way, you can refer to them later during your workers’ compensation claim.


If you misplace a pamphlet, you can find it here. L&I sends other informational pamphlets at various stages of the claim. They explain the benefits you may be getting. They can help you understand your L&I benefits and other aspects of the claim.


The L&I website

The Department of Labor and Industries (L&I) offers a website with tons of information. Admittedly, it can take some time to get used to the website. But, once you do, it offers a wealth of data. In fact, many experienced workers compensation attorneys like me use resources on the L&I website frequently. A good starting place is the “Injured? What you need to know” web page.


L&I help from claim managers and L&I representatives

Many work injury claimants fear their L&I claim manager. It’s true – your claims manager isn’t your advocate. Yet, they can still be a very helpful resource. For me, I find that workers are reluctant to ask their claims manager questions. Some claims managers are better than others at answering questions. But like I said before, it never hurts to try!


Claim managers and other L&I representatives have a lot of knowledge and information about claims. If you ask a question they can’t answer – they will tell you. However, there are many questions that are absolutely appropriate to ask. And remember, if you don’t ask – you’ll never get an answer. In fact, many work injury claimants call my office to schedule a free consultation and ask questions about their L&I claim. Usually, workers can solve their own problems for which they are calling me, and get the answers, by simply asking L&I.


Office of the Ombuds for self-insured injured workers

This section applies to workers with a self-insured employer claim. The Office of the Ombuds advocates for work injury claimants who suffered a workplace injury while working for a self-insured employer. The Office of the Ombuds can answer many questions. Moreover, they can explain your rights as work-injury claimants. In addition, their website contains a lot of useful information for employees. Personally, in my experience, the Office of the Ombuds is also good at letting claimants know they need to speak with an experienced workers compensation attorney. They know how to tell when an issue rises to the level of needing legal intervention.


Project HELP

Project help is an organization that provides assistance for L&I claim matters. They offer L&I help, information, and education. It’s a collaboration between the Washington State Labor Council, AFL-CIO, and Washington State L&I. The Project HELP website is another great resource for understanding basic L&I claim procedures. It also provides education and resources for addressing some of the more common issues that arise in claims.


Project HELP also offers education to a variety of professionals in workers compensation. They host an annual Meeting of the Minds educational seminar. I appreciate everything that project HELP is doing. They indeed provide L&I help, as well as resources and education. However, as an attorney who represents work injury claimants, I think it is important to recognize that Project HELP is closely tied to L&I. It’s not a substitute for experienced legal representation when workers need that level of intervention.


L&I help from an experienced workers compensation attorney

Like me, there are many competent and experienced L&I attorneys in Washington State who represent work injury claimants. There are many L&I claim cases that do not require legal intervention. But then again, there are some that do. The two most common circumstances that warrant legal intervention are: (1) When workers need competent advocacy; and (2) When you need to file an L&I claim protest or appeal.


Sometime, work injury claimants are unable to effectively advocate for themselves. That’s one reason they need an attorney. To do that advocacy for them. Additionally, L&I can make a decision that is averse to a work injury claimant. In turn, workers must decide whether to accept, protest or appeal the decision. Analyzing the need to protest or appeal is something that every L&I attorney does daily. Furthermore, if you need to protest or appeal, an experienced L&I attorney knows the exact requirements to meet the burden of proof and prevail.


For advice, most workers compensation attorneys offer complimentary consultations. In my opinion, if you are in doubt and not sure if you need an attorney, make the call and schedule a free consultation. Personally, I rather consult with a work injury claimant and tell them they don’t need my help, than consult with them when it’s too late. In many cases, the damage in their L&I claim has already been done. Then, it’s already too late to fix it.


Does L&I Pay for Pain and Suffering?

There’s no question that a work accident, injury, or occupational disease impacts the life of workers. Understandably, many work injury claimants want to know how they will get compensation for pain and suffering. Especially payments for pain and suffering under their L&I claim. Can workers get L&I compensation for pain and suffering? The short answer is No.


L&I doesn’t pay for pain and suffering

In Washington State, the Department of Labor and Industries (L&I) doesn’t pay work injury claimants for pain and suffering. Why? It has to do with 2 main reasons. The 1st reason is how L&I calculates damages. For the 2nd, we need to understand how the modern workers’ compensation system developed and how it works.


Pain and suffering is a type of “damage”. Think about it this way. When you have a work injury – you hurt a body part. Moreover, you might have PTSD or trauma from your work accident. Moreover, you’re very likely to experience pain and suffering. These are examples of damages. All these damages can be a result of a workplace injury.


Filing a lawsuit – Special versus general damages

Generally, when one person or entity causes injuries to another, the injured person can sue for damages. We call the person (or entity) that caused the injury the “Defendant”. The person suffering from the injury is the “Plaintiff”. Together, we refer to the Plaintiff and Defendant as the “Parties” to the lawsuit.


If the Plaintiff successfully proves the Defendant is responsible for the injury, then the Plaintiff may receive compensation for damages. In law, we refer to “damages” as a remedy. The idea is that “damages” remedy harm by compensating the Plaintiff. More specifically, “damages” can be special or general. Special damages are things that have a set money value. For example, automobile repairs or the cost of medical treatment. However, some damages don’t have exact monetary amount. We call them general damages. Monetary compensation for things like pain and suffering is a type of general damage.


How to sue for pain and suffering damages

How much is your pain and suffering worth? Sadly, there’s no precise way to say. Often, we ask the jury to “award” damages by deciding how much they feel the Plaintiff’s pain and suffering are worth. For that, juries must be able to assign a dollar amount to pain and suffering. Then, jurors listen to the facts of the case to determine fault.


In trial, the Plaintiff presents fact and evidence to show that the Defendant is “at fault”. The Plaintiff has to show how much harm they suffered because of the Defendant’s negligence. At the same time, the Defendant can present evidence showing they were not to blame. Moreover, they can raise certain defenses and show that the Plaintiff was responsible for their own harm.


Sometimes, the Defendant successfully shows the Plaintiff was at fault for their own harm. In such cases, the Plaintiff may receive little or no damages. But, if the jury agrees that the Defendant was responsible for the Plaintiff’s harm, they can award damages. Usually, attorneys representing the Plaintiff and Defendant argue to the jury with differing numbers. They try to show what they think the damages award needs to be.


Can I sue L&I for pain and suffering?

This legal process doesn’t apply in workers compensation claims in Washington State. Under workers comp, there is no Plaintiff and Defendant. There may be disputes that arise over what L&I benefits apply in different work injury claims. However, we usually refer to the parties as the Petitioner and the Respondent. The reason is that our modern worker’s compensation system originated with something called the “grand bargain”.


In the grand bargain, workers gave up the right to sue employers for a work injury or industrial disease. In exchange, workers receive no-fault coverage. Before the grand bargain, workers used to sue employers for causing a work injury or sickness. Just like when a Plaintiff files a lawsuit against a Defendant. But then, employers can avoid paying for a work injury. They do it by raising a defense and showing the worker was responsible for their own workplace accident.


Workers cannot sue employers for work injury damages

This kind of system leads to a lot of disputes, litigation, and delays. The idea behind the grand bargain was to streamline and simplify the process. That way, work injury claimants receive “sure and certain” relief when they suffer an injury on the job. Furthermore, workers no longer need to worry about employers accusing them of causing their own injury at work. Similarly, employers no longer have to worry about workers filing lawsuits for damages.


On that basis, the Washington State Industrial Insurance Act applies regardless of fault or negligence. When deciding on L&I benefits, there is no consideration of fault or negligence. Neither by the employer or by the worker. It doesn’t matter why the work accident happened. The cause of the work injury is not important. If a worker has an allowed L&I claim, they will receive the appropriate workers compensation benefits.


Workers’ compensation benefits are important for recovery

L&I benefits help work injury claimants recover from their injuries. When applicable, they also help workers to return to work. On top, in theory, they help workers and families pay bills and get by until workers are back on their feet. More specifically, L&I benefits include things like:


  • Wage replacement benefits. For instance, time loss compensation or loss of earning These benefits help cover expenses while recovering from an industrial injury or disease. The law and L&I designed these benefits for people unable to work. They are also very useful for workers experiencing a reduction in wage earning capacity.




  • Permanent partial disability awards. L&I can provide a PPD award It happens when L&I doctors determine the work injury claimant has permanent residuals. The permanent condition must be because of their industrial injury or work-related disease.


  • L&I pension benefits. Sometimes, workers are unable to return to work because of their work injury. In fact, a worker can have severe disability because of their injury at work. Therefore, the L&I pension benefit is available for workers that are permanently incapable of returning to work.


There are no L&I benefits for pain and suffering

Different L&I benefits apply in different L&I claim cases. What benefits apply in your case? It depends on the facts of your workplace injury. However, it’s not a function of fault or negligence. Therefore, in our modern workers compensation system, work injury claimants do not receive general damages. Including general damages for pain and suffering. In Washington State, workers cannot get damages for pain and suffering from their employer or from L&I. Even if they have a severe work injury. Additionally, it doesn’t matter how complex and frustrating their L&I claim may become.


L&I attorney can help

I get many calls from angry work injury claimants. Many of them want the system to hold their employers accountable. They want to go after employers for creating an unsafe work environment. Some complain about employers failing to properly train workers. On top, they bring up a multitude of other bad employer behaviors. I also get many calls from workers that want to hold L&I accountable. They want to sue L&I for claim delays, stress, and frustration.


Personally, I can certainly understand the anger. Yet, the reality is that there is no punishment for this kind of “bad behavior”. The best remedy is advocacy. It’s important to take steps to ensure your L&I claim is moving forward appropriately. On occasion, this is something that work injury claimants can easily do on their own. However, this kind of advocacy is also something an L&I attorney experienced in workers compensation can assist with.


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