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L&I Survivor Benefits After Death: How Does L&I Survivor Pension and Other Benefits Work?

/ L&I attorney / 4 Comments

After a work injury or occupational disease, workers with permanent total disability can receive an L&I pension. An L&I pension is like a lifetime annuity. Workers receive pension payments every month. Moreover, L&I pension benefits continue for the life of the worker. Sometimes, work injury claimants ask what happens after they die. Does L&I provide survivor benefits? Are there L&I death benefits? Will their family members receive an L&I survivor pension? Or, can workers pass their L&I pension to their spouse or children? In general, the answer is Yes. However, every situation is different. It always depends on the facts and details.

L&I survivor benefits when death is not related to the L&I claim

Say that the Department of Labor and Industries (L&I) gives you an L&I pension. Additionally, at the time you receive the pension, say that you have a spouse or domestic partner. Then, L&I will provide you with survivor benefits options. In fact, L&I sends you a form so you can choose the L&I survivor benefits you want. The form explains all the different options. It also details the financial implications of each option.

You, the injured worker, can select your L&I survivor benefits. The most common options are:

(1) Full survivor benefits

(2) Partial survivor benefit

(3) No survivor benefits.

In other words, the pensioner can choose to have all, or a portion of their pension benefits pass on to their surviving spouse. These options apply when the pensioner dies from causes unrelated to their L&I claim. Furthermore, when death that is not related to the claim, you can only pass survivor benefits to your spouse (or partner). You cannot pass them to your children or dependents.

Option 1: Full L&I pension survivor benefits

Let’s say you choose full L&I survivor benefits. Furthermore, before death, you receive a certain pension amount every month. The surviving spouse or domestic partner continues to receive the same amount after you die. This option is good for the surviving spouse. However, this option usually results in the lowest monthly payout amount. That’s because L&I stretches your pension payments over the remaining life of both you and your spouse.

Option 3: Partial L&I survivor benefits

Now let’s assume the injured worker chooses partial survivor benefits. As before, the pensioner receives a certain monthly payout during their lifetime. Upon death, the surviving spouse or domestic partner continues to receive approximately 50% of the pension. Here, again, the payments continue for the rest of the spouse’s life.

Option 2: No claim survivor benefits

Work injury claimants can decline L&I survivor benefits. In this case, the spouse must sign and notarize an L&I option form. The form acknowledges that they understand and agree to not receive benefits after the pensioner’s death. Importantly, this option typically results in highest monthly payout. That’s because L&I only pays the pension funds over the life of the pensioner.

Survivor benefits when death is claim-related

Sometimes, a work injury or occupational disease is the cause of death. We refer to these cases as fatal claims. Fatal claims can occur when a worker dies while on the job. However, they can also happen later. For example, when an L&I pensioner dies from claim-related conditions.

Legally speaking, L&I survivor pension benefits for work injury cases that result in death are usually straightforward. While tragic, in most such cases, the work injury is the cause of death. With fatal injuries on the job, employers must report them to L&I. Alternatively, they can report them to the Department of Occupational Safety and Health (DOSH) within 8 hours. DOSH will prepare a fatality memo. Also, under RCW 68.50.103, if the cause of death is uncertain, then they must order an autopsy.

If a worker receives L&I pension payments and dies later, then L&I survivor benefits can be more challenging. That’s because you must show causation. In other words, there must be medical evidence connecting the cause of death to the work injury or occupational disease. Typically, you’ll have to hire a medical expert. Sometimes, it’s even necessary to get an opinion from a forensic pathologist. This entire process can be sad and frustrating for survivors.

How to apply for L&I survivor benefits

Surviving beneficiaries who want to collect L&I survivor benefits must submit a beneficiary application. For work injury, they must submit the L&I survivor benefits application within one year from the date of the death. The rules for occupational disease deaths are different. For those, you must submit within two years of receiving notice from a physician that death was due to an occupational disease.

When applying, you’ll have to provide additional documents. These documents include:

1) Marriage certificate or declaration of domestic partnership

2) A copy of the death certificate

3) Birth certificate for dependent children

4) Letters of guardianship or custody orders (when applicable)

5) For children 18-22 years old – Proof of full-time enrollment in an accredited school.

What happens after L&I approves survivor benefits?

After L&I approves survivor benefits, L&I makes a one-time payment upon death. The amount of this immediate payment is 100% of the average monthly wage in Washington State. On top, L&I provides burial benefits up to %200 of the same average monthly wage. After that, L&I pays monthly survivor benefits when due. The amount of the monthly payments varies. In fact, it depends on who receives the L&I survivor benefits. The payout amounts are different for spouses, children, or other dependents.

L&I survivor benefits payments to a spouse, domestic partner, or children

The first category of payments is when the survivor is a spouse or a domestic partner. Here, the L&I claim entitles the survivor to receive 60% of the worker’s wages. Furthermore, for reference, L&I calculates the worker’s wages at the time of injury. On top, there’s a statutory maximum limit. If 60% of the wages is greater than the statutory maximum, then payments are capped at the limit.

Sometimes, worker’s that die in fatal claims leave behind children. With surviving children, L&I pays an additional 2% of wages per child. This extra benefit also has a maximum limit. Here, the limit is up to 10% of wages. That’s equivalent to paying survivor benefits for up to 5 children.

Survivor benefits and L&I survivor pension for other dependents

On occasion, there is no eligible spouse or domestic partner. Yet, there are surviving minor dependents. In these unfortunate situations, L&I pays monthly survivor benefits of 35% of wages. As before, L&I calculates the wage rate at the time of the work injury. Also, it’s important to note that L&I makes the payments to the guardian of the minor dependents. Plus, the fatal L&I claim pays an additional 15% for every additional child. Once again, this is up to a maximum limit. In this case, the limit is set at 65% of the injured worker’s wages. Finally, if there’s more than one child, then L&I divides claim benefits equally among them.

Moreover, an L&I claim resulting in the worker’s death pays out benefits to other recipients. However, these recipients only qualify if they depended on the worker’s earnings. For instance, dependents such as parents, grandparents, or grandchildren. These dependents can also be brothers, sisters, nieces, and nephews. Here, dependents may receive a benefit equal to 50% of the average monthly support during the year before the injury. This L&I benefit limit caps out at 65% of the worker’s wage. Or, at the maximum benefit level. Whichever is less.

When will my L&I survivor benefits end?

For dependents, L&I payments for survivor benefit may end. More explicitly, L&I stops payments when the dependency naturally ends, had the injury not occurred. Also, for minor dependents, their L&I survivor benefits end when they turn 18. If they are full-time students in an accredited school, then it’s when they turn 23.

For spouses, or domestic partners, the L&I survivor pension benefit is an annuity for life. However, L&I terminates benefits when the surviving spouse remarries. Similarly, L&I stops payments when the domestic partner enters another partnership. When this happens, the surviving spouse or partner has 2 options.

Option #1 – they can choose to receive a lump-sum settlement payment. Either 24 times the monthly compensation, or 50% of the remaining value of the pension. Whichever is less. Or, option #2 – they can decline the settlement. With option #2, the spouse maintains their right to reinstate L&I survivor pension benefits when the new relationship ends. For example, when the new marriage ends because of death or divorce. Or, when the new domestic partnership is over.

Conclusions

In summary, spouses, domestic partners and dependents may receive L&I survivor benefits. These benefits start upon the death of the work injury claimant who’s eligible for an L&I pension. L&I survivor benefits vary depending on the cause of death. Some benefits are appropriate when the death relates to the workers’ compensation claim. Other benefits apply regardless. Furthermore, the extent of the L&I survivor benefits varies depending on the status of surviving dependents.

It’s important to remember that survivors must file an application for benefits. It’s critical to file the application on time. One year for death after a work injury, and 2 years for occupational disease deaths. Unfortunately, if you don’t file on time, you’re giving up all your rights for benefits.

L&I Claim Protest: What Is It and Why It’s Important?

/ L&I attorney / 0 Comments

Many times, the Department of Labor and Industries (L&I) makes incorrect decisions. The same is true in self-insured claims. When this happens, it’s important to file a claim protest. If the L&I claim protest isn’t successful, we proceed to file an L&I claim appeal.

Claim protest versus claim appeal

Usually, L&I makes an initial decision. Then, to push back on the initial decision, we file an L&I claim protest. If L&I affirms its decision, we continue to file a claim appeal. A successful protest saves time, frustration, and costs. However, in my experience, the chances of winning an L&I claim protest are not good. Therefore, the purpose of this article is to review best-practices when filing an L&I claim protest.

Filing an L&I claim protest -in writing and on time

Under RCW 51.52.050, any party that disagrees with a decision can protest it. With every L&I decision, your rights to protest and appeal must be printed on the decision paper. And again, the same applies in self-insured employer claims.

A valid L&I claim protest must be in writing. Moreover, you have to file it on time. Workers have 60 days to file a claim protest from when you receive the decision. People often tell me they called their claims manager to disagree with the decision. However, a call to the claim manager is NOT a valid protest. You MUST file every protest with L&I. Even if the employer is self-insured. Sometimes, people accidentally send a written protest or appeal to the self-insured administrator (instead of L&I). Here, L&I considers the date the employer receives the filing as the date of receipt.

You must include supportive evidence in your L&I claim protest

Many L&I decisions involve medical determinations. For example, accepting or rejecting a medical condition. Other examples include causation of conditions and the need for further treatment. Finally, there’s also permanent partial disability ratings, and activity prescriptions.

If you’re protesting a medical decision, it’s important to have recent supportive medical records. Recent medical information is especially important if your attending medical provider disagrees with the decision. In fact, whenever this is the case, it’s important for L&I to review the recent medical opinion of the attending provider. Sometimes, it’s a different treating provider who feels that L&I’s decision is incorrect. Even if it isn’t the attending provider, you must provide this medical information to L&I. Unfortunately, without recent medical opinions showing that the decision is incorrect, you’re unlikely to prevail.

L&I protest for non-medical decisions

Many L&I decisions are for non-medical claim benefits. For instance, wage rate or offset dispute. As before, you’re more likely to win an L&I claim protest if you submit supportive evidence. Often, people are frustrated that the burden is on them. Workers have to track down relevant evidence and file it with the protest. I get it. I sympathize with this frustration. However, gathering and submitting supportive evidence is the best way to win an L&I protest.

To summarize, you must protest or appeal unfavorable L&I decisions. The most common convention is to protest an initial determination. While it can be difficult to win protests, you can increase your likelihood of success. Just follow 2 simple rules: (1) file your L&I claim protest in writing and on time; and (2) gather and submit evidence to support the protest.

Combine 2 LNI Claims to one workman's comp claim

I Have 2 Or 3 L&I Claims – Can I Combine Them Into One Claim?

/ L&I attorney / 0 Comments

Some work injury claimants have 2, 3 or more L&I claims. In fact, you’d be surprised how many people have more than 1 workman’s compensation claim. Sometimes, you can combine multiple L&I claims into one. In legal terms, when you combine multiple claims into one, we call it “claim consolidation”. When can you consolidate several L&I claims? It depends. You can only combine claims if you meet certain requirements. For one, you can combine claims if they are duplicate L&I claims. Alternatively, you can consolidate L&I claims if they involve a subsequent aggravation.

Duplicate L&I claim

What is a duplicate L&I claim? Say you already have a workman’s comp claim for a work injury or occupational disease. A duplicate claim is when you file a 2nd claim for the same injury or illness. The new claim has the same injury date. And, it contains the same diagnosis or body part.

Sometimes, duplicate claims happen when you file an L&I claim that should be a self-insured employer claim. For example, say your doctor’s office filed a state-funded L&I claim on your behalf. Then, when they discover that your claim needs to be a self-insured claim, they file a second application. The 2nd submission is for the exact same work injury. Another example is when different medical providers file duplicate paperwork. For instance, a worker goes to the ER for an acute injury. After that, the worker follows up with a regular provider the next day. The regular provider may submit an L&I claim. However, they might not realize the ER provider also filed a claim the day before.

Subsequent aggravation resulting in multiple L&I claims

Say that L&I accepts your worker’s compensation claim. Here, under this first claim, L&I accepts coverage responsibility for certain medical conditions. A subsequent aggravation is when you file a new claim for an aggravation of these conditions, when:

1) There is already an open and symptomatic claim;

2) The conditions accepted in the first open claim are susceptible to re-injury; and

3) There weren’t new incidents or additional exposure.

For example, a workplace injury claimant develops a muscle strain lifting heavy objects. The worker files a claim. Moreover, L&I allows the claim and the claim is open. Fast forward, the person is getting treatment. Later, the medical condition gets worse. Eventually, the doctor files a new L&I claim for the worsening condition. Hence, if this happens, the new claim is a duplicate of the original claim.

When should I not combine all my L&I claims?

If the new claim isn’t duplicative and isn’t a subsequent aggravation, then you shouldn’t consolidate claims. In fact, I get calls from work injury claimants telling me their doctor, employer, or self insured third party administrator combined their claims. Every time I hear this – it’s a red flag. Only L&I has the power to consolidate claims.

If anyone thinks that consolidating claims is appropriate, they must ask L&I to do it. The request will be handled by the claim manager. Or, by the adjudicator responsible for the original claim. It’s important for L&I to make a formal decision about consolidation. This way, it gives the parties protest or appeal rights when the consolidation isn’t correct.

Additional examples for consolidating multiple L&I claims

On occasion, work injury claimants simply want to consolidate claims to manage their claims more easily. I certainly understand why they feel this way. Having multiple open claims at the same time can be confusing and difficult. However, unless the claims are duplicative or subsequent aggravations, consolidation isn’t appropriate. It doesn’t matter how much easier it may seem to manage the claims. You simply shouldn’t do it.

To summarize, there are only two circumstances to combine multiple L&I claims. The 1st is when you have duplicate claims. Then, the 2nd is if you have a claim for subsequent aggravation. Most importantly, only L&I can consolidate claims. If anyone else does it, you better contact a worker’s compensation attorney. Finally, by law, convenience alone isn’t a sufficient reason to combine claims.

Workers Compensation - Washington