Have you been injured at work? Did you file an L&I claim with the Washington State Department of Labor and Industries (L&I), or are you still waiting for your award or even treatment? Have you found yourself asking why an L&I claim takes so long to close? As with any legal process, it takes time and patience. Keep reading to learn more about the workers’ comp claim process, what can cause delays, and how you can keep moving forward.
How Does the L&I Claims Process Work?
The L&I claims process can be extremely complex and time-consuming, even when you’re not the injured or ill party. Follow the steps below to ensure that your L&I claim is closed quickly and in your best interests:
1. File your claim: You can file your on the L&I website via the File Fast tool, by calling the L&I office at 877.561.3453, or at your doctor’s office.
2. Complete an Independent Medical Examination (IME): An IME is conducted by an approved L&I provider and may be requested by your Claims Manager. If you receive a favorable IME report, your L&I claim will be approved and you will receive a written order from L&I explaining your benefits.
3. Receive your benefits: You will receive benefits which may include medical benefits and limited wage-replacement.
4. Claim closure: Your L&I claim will close when you have met maximum medical improvement (MMI) and your treatment is successful and complete.
5. Reopen your claim: If your workplace injury or occupational illness worsens, you and your doctor may apply to reopen your claim.
6. Denied claims: You, your employer, and your doctor all have the right to protest any decision made about your workers’ compensation claim. If your claim is denied, call your doctor and the L&I attorneys at Emery | Reddy, PLLC to reopen it and get the care and compensation to which you are entitled.
What Is the Claims Investigation Process?
Your Claims Manager will investigate your L&I claim with a fine-toothed comb, often causing delays when it comes to receiving your workers’ comp award. Your Claims Manager will need to review all necessary documents and make sure everything is up to regulation.
Due to the amount of fraud that finds its way into L&I claims, this process can be stringent and lengthy. The Claims Manager will need to verify that you were indeed injured and that the severity of the injury meets L&I guidelines. They may also request that you undergo an Independent Medical Exam (IME).
Why Is My L&I Claim Taking So Long to Resolve?
L&I claims usually take a few years to resolve. There are many reasons your claim could be delayed, including but not limited to:
- Legal delays: Your award could be delayed due to court system delays or a lack of resources when it comes to settling the massive number of appeals being considered.
- Fraud prevention: L&I Claims Managers need to go over claims meticulously to ensure no fraudulent claims result in a settlement. Many suspicious claims make it through the system, creating a need for a careful and stringent screening process.
- Medical reporting delays: The delay could be coming from your attending provider. For various reasons, your doctor could be taking their time to provide their report to L&I. They could also be waiting until your condition reaches maximum medical improvement (MMI).
- L&I delays: Remember that Labor and Industries is running a business. Often, they are focused on what is best for L&I, which isn’t always paying a claimant.
- Employer dispute: Any dispute coming from your employer regarding your case could result in a delay.
While it might seem like there are a lot of reasons your workers’ comp claim could get delayed, don’t get discouraged. You can do your part to avoid any potential setbacks. One of the biggest ways to expedite the process is to work with an experienced legal team. An experienced L&I lawyer knows the process and what routes to take to get results. They can help you organize your case, collect necessary information and documents, and ensure everything is filed and prepared on time.
You can also do your part to review your case and make sure reports and claims are filed on time. Double-check to make sure you meet deadlines on time and that you have followed the rules and regulations in place.
What If Your L&I Claim Is Denied?
You, your employer, and your doctor all have the right to protest any decision made about your workers’ compensation claim. L&I must receive a written protest within 60 calendar days of the date the decision was received (15 days for decisions about vocational benefits) or the decision will become final.
You may also appeal directly to the Board of Industrial Insurance Appeals (BIIA). The decision becomes final if your written appeal is not received within the following legal time limits from the date you received the decision:
- 60 days to appeal a claim decision or a payment decision
- 20 days for providers to appeal a billing decision that reduces the amount paid, or demands repayment
HOW IT WORKS
Watch This Video to Learn More about the Protest and Appeal Process
Reopen a Claim
If your workplace injury or occupational illness objectively worsens, you and your doctor may apply to reopen your claim. There must be medical evidence from an L&I-approved provider stating that after your claim closed, the condition caused by the original workplace injury worsened and needs more medical attention. The amount of time that you have to reopen your L&I claim depends on the benefits you are seeking:
- For medical treatment only, you may apply at any time.
- For both wage replacement benefits and medical treatment, apply within 7 years of the date your claim was first closed (10 years for eye injuries).
- If your claim has been closed for more than 7 years, you may apply for medical benefits. However, only the L&I Director may grant additional disability benefits such as wage replacement or disability awards for these claims.
L&I Claim Approval
If your L&I claim is approved you will receive a written order from L&I explaining your benefits. You have the right to a variety of L&I benefits to help pay for treatment costs and replace lost wages during the recovery period.
Getting Your L&I Benefits
Workers’ compensation benefits will cover your medical bills and treatments. If you are eligible for additional benefits, the Seattle L&I attorneys at Emery | Reddy will help you proceed with seeking wage replacement, return-to-work help, pensions, or disability compensation if necessary — things that L&I won’t offer you unless you fight for it. Remember, they will often do as little as possible to get you back into the workforce.
Closing the L&I Claim
An L&I claim closes when an L&I-approved provider certifies the following:
- The worker is at maximum medical improvement (MMI).
- The worker has been released to work.
When Should I Start to Receive Workers’ Compensation Payments?
Workers’ comp awards are paid out once the claim is closed, though the total compensation amount awarded upon claim closure depends on the size of the claim. L&I award amounts vary widely and typically fall into three categories:
Permanent Partial Disability (PPD) Award
You may be rated for a PPD award before L&I closes your claim if you have completed treatment and are able to work but have suffered a permanent loss of function, and a qualified doctor provides L&I with a PPD rating. Time-loss and medical benefits will end when you receive your disability award unless the L&I claim is reopened.
L&I Disability Pension
An L&I disability pension is a special category of pension only awarded to the most severely injured workers. If you are eligible for an L&I disability pension, you will receive a non-taxable payment every month for the rest of your life.
Under Washington state law (WAC 296-14-150), gainful employment is defined as a regular occupation for income, salary, or wages. If your doctor or vocational counselor says that you cannot ever work again because of a job-related injury or illness, you may be eligible for an L&I disability pension.
Claim Resolution Settlement Agreement (CRSA)
A CRSA is an L&I settlement option where all parties agree to close an injury claim for a specified amount. When agreeing to this workers’ comp settlement type, the injured worker exchanges all future benefits, except medical, for the payment.
Self-insured employers are more likely to use CRSAs. The most common reason for this is to save money and will, unfortunately, make it more difficult for you to get your compensation. The SIE will do everything in their power to deny it. However, they still need to follow L&I’s rules for self-insured companies. If you disagree with their decision, you have the right to appeal. Contact an experienced L&I lawyer for help as soon as possible to help with the process.
Who Is at Fault for a Workplace Injury?
L&I is a no-fault system, ensuring compensation for any workplace injury. However, if a third party is involved in causing the injury, you may be able to pursue legal action against them for additional compensation under third party claims.
HOW IT WORKS
Watch This Video to Learn More about How Employment Law and L&I Claims Work Together
Your L&I Claim Is Worth More If You Also Have an Employment Claim
A significant number of L&I — workers’ compensation claims often involve additional legal claims such as employment or third-party claims. Many people file their claims without seeking representation from an L&I attorney and thus never discover that, in addition to their L&I claim, they may be missing out on the ability to file an employment claim or a third-party claim. Pursuing additional legal action with the help of an experienced workers’ compensation attorney has the potential to significantly increase a claim’s overall compensation. At Emery | Reddy, our experienced Attorneys practice both Employment and Workers’ Compensation Law, which means we will investigate all aspects of your claim to make sure you aren’t missing out on any potential benefits.
What Is an Employment Claim?
Many injured workers find that their employer has taken, or plans to take, adverse action against them because they filed an L&I claim or they are out of work. You can file a lawsuit against your employer for several reasons, including retaliation, wrongful termination, disability discrimination, or unpaid wages. An L&I attorney who is experienced in both L&I — Workers’ Compensation Law and Employment and Labor Law can help you with your L&I claim while simultaneously filing a federal or state law claim for the violation of workers’ rights by your employer.
What Is a Third-Party Claim?
A third-party claim is one in which someone other than your employer or co-worker is responsible for your injury. If you have been injured on the job due to someone else’s actions or negligence, you may be entitled to additional compensation through a third-party claim, which combines your L&I claim with a personal injury claim using the same facts.
Unlike workers’ compensation payments, there is no limit to the amount of compensation an injured worker may seek in third-party damages. Third-party claims are private matters and are typically litigated directly with the Washington State Superior Court.
How Do I Know If I Have a Strong L&I Claim?
If you have an L&I claim or wonder if you need the assistance of an experienced L&I — workers’ compensation attorney, ask yourself the following:
- Have I been denied the medical care benefits to which I am legally entitled?
- Has L&I asked me to undergo an Independent Medical Exam (IME)?
- Do I have questions about the L&I claim process?
If any of the above apply to you, Emery | Reddy may be able to help.
Navigating a workers’ compensation claim can be difficult and very time-consuming, especially when you’re ill or injured. You want to focus on healing and make sure your bills are paid, but if you don’t file things properly or on time, your health, home, and job could be in jeopardy. Many individuals miss out on much-needed L&I benefits because they don’t understand what to do or how to get the most compensation for their injuries. If you are experiencing any challenges in your case, a workers’ compensation attorney can assist you. By contacting Emery | Reddy as soon as possible after you’ve been injured, we can help you avoid the common pitfalls of filing and navigating an L&I claim. Our Seattle L&I Attorneys are here for you every step of the way.
Emery | Reddy Can Help You with Your L&I Claim
Emery | Reddy is the only law firm in Washington state that is equipped to provide comprehensive representation on your case from every angle. Our Seattle L&I Attorneys thoroughly assess every case to determine if our clients have additional claims, and at times this can extend far beyond the underlying workers’ compensation claim.
If you have been injured in the workplace, call Emery | Reddy today for a Free Case Review with an experienced Intake Specialist to learn more about how we may be able help you. No fee unless we recover for you.
Want More Information?
Learn more about the workers' compensation process and how you can receive the treatment and benefits to which you are legally entitled.
The Labor and Industries claim process is anything but straightforward. Find out the answers to your L&I — workers’ comp questions today.
To determine the value of your L&I claim, you first need to understand the different types of L&I awards offered in Washington state.
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Meet the Team
The L&I Attorneys at Emery | Reddy, PLLC are passionate about helping workers with L&I claims and Employment and Labor Law issues. We Help Workers®. It’s our motto and what drives us every day.
We know how L&I and big companies think, and we understand the tactics they use. Our Seattle L&I and Workers’ Compensation Attorneys use that knowledge coupled with over eight decades of experience to help our clients get access to the L&I benefits to which they are legally entitled and hold employers accountable when they break the law.
If you’re struggling with an L&I claim, injury, or legal issue at work, call us for a Free Case Review with an experienced Intake Specialist to learn more about how Emery | Reddy may be able to help you today. No fee unless we recover for you.
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