Washington State L&I Medical Care

Washington State is only as strong as its workforce. Every employee deserves safe working conditions. Unfortunately, job-related accidents and illnesses remain a significant public health problem. According to the latest data published by the Department of Labor (DOL), there were 2.8 million nonfatal workplace injuries and illnesses reported in the United States in 2019 alone. Approximately one-third of those accidents (888,220 in total) required an employee to miss at least one day of work. If you were hurt at work in Washington State, you are entitled to high-quality medical treatment for your injury or illness.

Through an L&I claim, you have the right to seek treatment for your injuries, although the claims process can be somewhat difficult to navigate. At The Walthew Law Firm, we have represented injured workers in Washington for more than 90 years. In this article, our Seattle workers’ compensation lawyers provide an in-depth guide to L&I and medical care. If you have any specific questions about medical treatment or workers’ compensation claims in general, we encourage you to call our office to schedule a free initial consultation.

Know Your Rights: An Overview of L&I Medical Care

You Have the Right to Proper and Necessary Medical Care

In Washington, employers must provide no-fault workers’ compensation insurance to their employees with few exceptions. If you are injured on the job, and your claim is allowed, your workers’ compensation benefits should include medical treatment that is deemed “proper and necessary.” Under Washington law, Labor & Industries (L&I) or a self-insured employer should pay for all medical/health services related to the accepted diagnoses and conditions resulting from your injury or illness. The term proper and necessary is defined to include any medical treatment that is both:

1. Reflective of accepted standards of good practice; and
2. Curative or rehabilitative and related to the accepted injury/illness.

Of course, it is not always clear as to what constitutes “proper and necessary” medical care or rehabilitative treatment. If you believe that you were denied proper and necessary medical treatment through L&I or a self-insured employer, our Seattle, Washington workers’ compensation lawyers can help.

You Have the Right to Choose Your Own Physician

The doctor-patient relationship is an important one. If you were injured on the job or you developed a debilitating occupational disease, you need a physician you can rely on to provide high-quality care.

Neither your employer nor the claims manager has the legal authority to make you go to one specific doctor. In Washington, injured workers have the right to choose their own doctor so long as they are part of L&I’s provider network. Your selection matters. A supportive doctor can help you throughout your L&I claim by certifying your time loss benefits and advocating for medical treatment.

If you need to change your doctor, your claims manager must approve that transfer (WAC 296-20-065), although no reasonable request should be denied. You should immediately notify your claims manager of the selection of your new doctor and make sure the transfer is approved.  Before changing doctors, you may want to consult with a Washington workers’ compensation lawyer for guidance.

You Have the Right to Protest or Appeal Denial of Treatment

Ideally, the Department of Labor & Industries will allow your claim, approve your medical care, and allow you to recover without much trouble. Unfortunately, the claims process is not always so straightforward. L&I or a self-insurer may deny coverage for some or all of the medical treatment your doctor recommends. Under Washington law, you have the right to protest or appeal the denial of your benefits once L&I issues a denial order.

There are strict deadlines for protesting or appealing the denial of workers’ compensation medical coverage. If you believe that your treatment was improperly denied, contact an experienced Washington workers’ compensation attorney for immediate assistance. A workers’ compensation lawyer can review L&I’s denial and put together the documents, records, and evidence to file a timely appeal.

L&I Covers Treatment Until Maximum Medical Improvement (MMI) or Closure of the Claim

As noted above, injured workers have the right to medical treatment that is proper and necessary. This raises an important question: When does medical treatment end in a workers’ compensation claim? In Washington, per WAC 296-20-01002 (3), L&I or a self-insurer will cover the cost of treatment:

…once a worker reaches a state of maximum medical improvement. Maximum medical improvement occurs when no fundamental or marked change in an accepted condition can be expected, with or without treatment. Maximum medical improvement may be present though there may be fluctuations in levels of pain and function. A worker’s condition may have reached maximum medical improvement though it might be expected to improve or deteriorate with the passage of time. Once a worker’s condition has reached maximum medical improvement, treatment that results only in temporary or transient changes is not proper and necessary. “Maximum medical improvement” is equivalent to “fixed and stable.”

Maximum medical improvement is defined as the point when the injured employee cannot reasonably be expected to get any better with further treatment. To be clear, MMI does not necessarily mean a complete recovery. This means that your claim could be closed and your medical coverage ended even if you are not fully recovered from your injuries.

Maximum Medical Improvement is a Medical Opinion

It is not always clear whether an injured worker can benefit from additional treatment. Indeed, one doctor may believe that your condition could dramatically improve with additional physical therapy, while a second doctor may state that MMI has already been reached.

It is crucial that injured workers present a strong and compelling case for continued medical benefits if their doctor states that more treatment is needed. Even if the claims manager thinks that an individual has reached maximum medical improvement, that may not be the case.