Workers Compensation - Washington

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

Reopening L&I Claim or Self-Insured Employer Claim in Washington State

Reopening an L&I claim

You may have heard that L&I claims can be reopened after they close. This is true, but there are a few important things to remember regarding claim reopening. First, a claim can be reopened any time following claim closure for additional medical treatment. However, for an injured worker to receive additional monetary benefits such as time-loss compensation, loss of earning power benefits, increased permanent partial disability or permanent and total disability, the claim must be reopened within 7 years of the original claim closure. After 7 years, only medical treatment will be provided if the claim is reopened. The only exception is when the Director of L&I exercises discretion to grant additional benefits.

 

Second, the reopening of a claim is not guaranteed. If an injured worker or provider believes that a claim should be reopened for whatever reason, a reopening application must be filed documenting the basis for reopening. L&I will carefully evaluate the evidence to determine whether reopening is appropriate. If L&I feels that it is not appropriate, reopening of the claim will be denied. Like any decision, the decision to deny reopening can be protested or appealed for physical conditions.

 

Conditions to reopen a workers’ compensation claim

For the reopening of a claim to be granted there must be an objective worsening of a claim related condition between the time the claim last closed and the time the application to reopen is filed. In workers’ compensation, we refer to these dates as the terminal dates. The first terminal date is the date of the most recent claim closure. The second terminal date is the date the application to reopen is filed. Findings of disability that can be seen, felt, or measured by an examining physician are called objective findings.

 

Therefore, whether there has been an objective worsening of claim related conditions between the relevant terminal dates often involves a comparison of the objective medical findings at or around each of the two dates. However, if L&I denies an application to reopen, a medical opinion regarding the objective worsening will be required to prove that the decision to deny reopening was incorrect.

 

Conclusions and recommendations

If you want to reopen your L&I claim, you should have your current findings and compare them to the objective findings from the time of most recent claim closure. It is also important that your medical provider clearly explains in what ways there has been an objective worsening. Non-physical conditions such as mental health conditions do not require objective worsening for reopening to be granted. These kinds of conditions inherently cannot be seen, felt or measured. However, for reopening to be granted, a medical opinion concerning worsening of the non-physical condition between terminal dates will still be necessary.

4 Comments

  1. I was in L&I like 14 years ago I did a carpal tunnel surgery in my right palm the doctor said after 10 years we need to do the surgery in your left hand now it’s worsen how can I reopen my claim? And I never have a compensation for pain and suffering in my right hand. Please help. Thank you

    • blank
      L&I attorney

      February 2, 2020 at 8:50 pm

      Claims can be re-opened for medical treatment even if they were closed more than seven years ago. You will need to see your doctor and have them file a re-opening application based at least in part on objective findings that your claim related condition has worsened since your claim last closed. Because your claim closed more than seven years ago you will have to request that the Director of L&I exercise his discretion to grant you monetary benefits like time loss compensation, if you end up needing those. However on its most basic level you can reopen your claim to have the medical treatment covered.

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    Bethany C Simms

    March 4, 2020 at 6:04 am

    My husband had an approved claim for a back injury at work (2016), resulting in a slow leaking disc. This was documented with an MRI of the spine. He eventually tried injections, which temporarily relieved the pain. He had radiculopathy, numbness, tingling, and loss of dorsi/plantarflexion in the affected leg at the time. The claim was closed, partially because he felt somewhat better for a short time, and also because he moved and did not stay in contact to appeal the closing of his claim. Later as the disc continued to leak it became much worse and required surgery. He was unable to work, sleep, and could barely walk to the bathroom. The MRI at this time (December, 2018) showed the same disc had further leaked and was pressing on his nerves. He had the same symptoms as before. He had surgery January of 2019. Would the MRI be objective proof of an extension of the same injury?

    • blank
      L&I attorney

      March 11, 2020 at 9:47 pm

      I am sorry for the delayed response. Your question is whether the MRI taken in December 2018 could be considered objective proof of an extension of the same injury? My answer is, it depends. An MRI is certainly an objective medical finding under the legal definition of the term. However, in order to prove that there has been a claim related objective worsening of your husband’s condition, you will need the opinion of a medical doctor who has compared the two MRIs and who states that the findings on MRI are claim related and have objectively worsened since the claim was initially closed.

      Based on the information you provided, I would strongly encourage your husband to file a reopening application on his claim if he has not already done so. If you run into any administrative issues, please do not hesitate to contact our office for a free consultation.

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