If you experience a workplace injury or industrial disease, it is crucial that you seek medical assistance as soon as possible. Some injuries require minimal care, while others require extensive treatment. L&I — workers’ compensation medical benefits will cover all medical costs associated with your claim. This can include doctor appointments, treatments, surgeries, occupational therapy, and prescription medications.
What Is Not Covered by L&I — Workers’ Compensation Medical Benefits?
It is important to understand that only certain medical conditions and treatments are covered by the Washington State Department of Labor and Industries (L&I). To qualify for medical benefits, your injury or illness must be work-related. Some of the reasons that you may not be entitled to workers’ compensation medical benefits include the following:
- Medical conditions not related to your workplace injury or industrial disease
- Treatment that continues after the worker is medically stable
- Treatment from providers who are not enrolled in L&I’s network
L&I — Workers’ Compensation Medical Benefits
In order to receive workers’ compensation medical benefits from L&I, there are two very important things that you must do right away, even before a Washington state L&I claim is filed:
- Get medical help.
- Tell your employer.
L&I, or your self-insured employer (SIE), can approve your Washington state L&I claim if your doctor certifies that you were the victim of a workplace injury, or if you have an industrial disease. If your claim is approved, you may be eligible for medical benefits.
L&I Medical Provider Network
Workers’ compensation medical benefits will be available to you for as long as your Washington State L&I claim is open, even if you have returned to work. Your first visit to a doctor for a workplace injury is covered by L&I, even if your claim is not approved. If you need medical care after the first visit, you will need to see an approved provider in the L&I network.
Protest or Appeal Denial of Medical Treatment
Sometimes, workers who feel they have fully recovered will later find that they still need additional medical care for the same ongoing injury. If your claim was closed prematurely and you need further treatment, our Seattle Workers’ Compensation and L&I Attorneys can work to reopen your claim to ensure that any additional medical bills will be covered, including L&I disability benefits.
Who Pays the Medical Bills if You Are Injured at Work?
If your claim is open and allowed, L&I or your self-insured employer (SIE) will pay for all medical bills that are directly related to the on-the-job injury until your doctor certifies your injury has stabilized and reached maximum medical improvement. L&I or the SIE will only pay for medical care that is related to your accepted workplace injury or industrial disease. Proper and necessary services may be either curative or rehabilitative.
- Curative treatment: Treatment provided to a patient with the goal of curing a workplace injury or industrial disease.
- Rehabilitative treatment: Treatment intended to allow an injured or ill worker to regain or improve the abilities needed to get back to work.
These benefits typically end when a workers’ compensation claimant reaches maximum medical improvement (MMI) or when the Washington state L&I claim closes.
How to Choose a Workers’ Compensation-Friendly Doctor
Medical benefits will be available to you for as long as your claim is open, even if you have returned to work. Your first visit to a doctor for a workplace injury is covered by L&I, even if your claim is not approved.
If you need medical care after the first visit, you will need to see an approved provider in the L&I network. Your attending provider is responsible for:
- Managing the worker’s treatment.
- Reporting progress to the L&I Claims Manager.
- Helping the worker return to work as soon as safely possible.
Your attending provider may refer you to a specialist as long as they are in the L&I-approved network. Some of these providers may include:
- Psychiatrists,
- Chiropractors,
- Dentists,
- Optometrists,
- Advanced registered nurse practitioners,
- Naturopathic physicians,
- Podiatry physicians and surgeons,
- Physician assistants,
- Surgeons, and
- Orthopedic specialists.
You may also change doctors if:
- The new doctor is qualified to treat your accepted injury or illness.
- The new doctor has joined L&I’s approved provider network.
Common Questions About L&I—Workers’ Compensation Medical Benefits
If your Washington state 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 medical treatment costs and replace lost wages during the recovery period.
An Independent Medical Exam (IME) is a medical evaluation requested by the Washington State Department of Labor and Industries (L&I) or a self-insured employer (SIE) to review your medical history and accident details, to establish finding, opinions, and conclusions about your physical condition. Independent Medical Examinations (IMEs) are conducted by approved L&I providers and IMEs are intended to be objective, so no patient-provider relationship is established. However, IMEs can be problematic. Call Emery | Reddy, PLLC today to speak with an experienced Intake Specialist and to learn more about how we may be able to help. No fee unless we recover for you.
Travel reimbursement is for expenses incurred in connection with medical treatment and must be pre-authorized. Workers’ comp travel reimbursement will be provided if:
- Your medical treatment is with an L&I-approved provider.
- The provider is further than 15 miles one way from your home (30 miles round trip).
- The Travel Reimbursement Request form is complete, including a copy of all expense receipts.
- You needed to pay for parking over $10, tolls, and some other travel expenses.
To receive travel reimbursement, you must make your request within one year of the trip. You must include the date, destination, and your reason for travel. You must also save and submit all of your receipts on the L&I Travel Reimbursement Form.
After you file your Washington state L&I claim, you will follow several steps in order to reach claim closure and, with the help of an experienced Seattle workers’ compensation and L&I attorney, receive the benefits to which you are entitled.
- You will complete an Independent Medical Exam (IME) from an approved L&I provider stating that you have reached maximum medical improvement (MMI) and that your medical care is complete.
- Your Vocational Counselor will release you to work.
Your Washington state L&I claim can also be closed when your doctor has released you to work. This may be released to full-duty, released to full-duty but with reduced hours, released to light-duty, or released to light-duty with reduced hours.
- L&I will release a written closing order.
If your workplace injury or industrial disease worsens after claim closure, 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 Washington state L&I claim depends on the benefits you are seeking.
- For medical treatment only, you may apply at any time.
- For both time-loss benefits and medical benefits, 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.
If your Washington state L&I claim is denied, you, your employer, and your doctor all have the right to protest or appeal 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
How Employment Law and L&I Claims Work Together
Your Washington State L&I Claim Is Worth More If You Also Have an Employment Claim
A significant number of Washington state L&I claims often involve additional legal claims such as employment or third-party claims. Many people file their claims without seeking representation from an experienced Seattle workers’ compensation and L&I attorney and thus never discover that, in addition to their Washington state 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 Seattle workers’ compensation and L&I attorney has the potential to significantly increase a claim’s overall compensation. At Emery | Reddy, our experienced Attorneys practice both Employment and Labor Law as well as 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.
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, 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 Washington state L&I claim while simultaneously filing a federal or state law claim for the violation of workers’ rights by your employer.
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 Washington state 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 Washington State L&I Claim?
If you have a Washington state L&I claim or wonder if you should contact an experienced Seattle L&I worker’s compensation attorney, ask yourself the following:
- Have I been denied the medical 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 Washington state L&I claim process?
If any of the above apply to you, Emery | Reddy may be able to help.
Navigating a Washington state L&I 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 Seattle workers’ compensation and L&I 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 Workers’ Compensation and L&I Attorneys are here for you every step of the way.
Emery | Reddy Can Help You with Your Washington State 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 Workers’ Compensation and 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. No fee unless we recover for you.
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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.
The Labor and Industries claim process is anything but straightforward. Find out the answers to your L&I — workers’ compensation questions today.
Understand time-loss compensation for L&I claims: partial wage replacement paid every two weeks during inability to work due to injury or illness.
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Meet the Team
The Seattle Workers’ Compensation and 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 Workers’ Compensation and L&I 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 a Washington state L&I claim, 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. No fee unless we recover for you.
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