1. L&I Wants Me to Submit to an Independent Medical Examination (IME)
An Independent Medical Examination (IME) is a medical appointment scheduled by the claims manager during which a doctor or doctors evaluate a worker’s medical condition. During the evaluation, the “independent” doctor weighs in on the nature and severity of a worker’s injuries and medical conditions and the necessity for additional treatment.
Under Washington law (WAC 296-23-302), L&I or a self-insurer has the right to request an IME to evaluate the claimant’s injuries or occupational illness. Notably, the term “independent” can be misleading. An IME is conducted by a doctor who is paid by L&I or the self-insured employer. The Independent Medical Examination is the claims manager’s or the employer’s evaluation.
Assuming that it was properly requested, you are required to go through an IME to get your workers’ compensation claim approved. Although it can be frustrating and even intimidating to deal with an IME, failure to attend such an examination can jeopardize your medical treatment and time loss compensation.
Claims managers often schedule IMEs when they are considering ending treatment, closing a claim, or otherwise denying benefits. You must be properly prepared for the examination. There are proactive steps that you can take to get yourself ready for a so-called Independent Medical Examination.
2. L&I Says Medical Treatment is Not Related to My Work Injury
Under Washington State law, L&I and self-insured employers are required to pay for treatment related to an employee’s work injury or occupational disease. If L&I denies your medical treatment or rehabilitative care as not related to your injury, you need to take immediate action to protect your rights.
Sometimes a new condition arises from an accepted condition and your doctor says the new condition is related to the original injury or occupational disease. Your claims manager denies the new condition and any treatment related to that new condition. At that point, it is a good idea to consult with your doctor and with a workers’ compensation attorney. Whether a medical condition and treatment are connected to the workplace injury or disease can be a complicated matter. You may need to hire an attorney and file a protest or appeal challenging the improper denial of your workers’ compensation benefits.
3. I Do Not Have a Doctor—And I Am Not Sure How to Find One
Injured workers can always benefit from finding a reliable doctor. Not only will a great doctor ensure that you get the proper care, but they can also document your entitlement to benefits through your workers’ compensation claim. Unfortunately, it is not always easy to find the right doctor.
In fact, in Washington, not every physician is willing to accept L&I patients. There are many different reasons for this—from the heightened paperwork requirements to lower billing rates for procedures to the fact that the agency sometimes makes it challenging for a doctor to provide care without disruption.
The Department of Labor & Industries has a database that you can use to search for doctors and medical providers who accept workers’ compensation patients. In addition, a local workers’ compensation claims attorney may be able to recommend some physicians in your area.
4. I Need to Reopen My Claim for More Treatment.
Sometimes, a worker’s medical condition worsens after claim closure. If your claim closed by order and more than 60 days elapsed from when you received the closing order, you can apply to reopen your claim for “aggravation” or worsening of your medical condition. You and your doctor must submit the reopening application to L&I, and L&I must act on that application within 90 days (or 150 days if an extension is granted by order). You can reopen a claim at any time and receive medical treatment, but payment of monetary benefits can only be paid if a claim is reopened within seven years of first claim closure. After seven years, it is discretionary on the part of the Director of L&I whether such monetary benefits will be paid.
Claims managers frequently obtain IMEs to determine worsening. If your application to reopen is denied, you must take action to protect your rights as reopening a claim can be complicated.
5. I Feel Overwhelmed Navigating the Claims Process
The workers’ compensation claims process is notoriously confusing—particularly if you run into any resistance from L&I or the self-insured employer. You are certainly not alone. You may have questions like, how do I initiate the L&I claims process or what is my L&I claim worth? Alternatively, you may have a specific and technical matter that you need guidance with.
You should never hesitate to seek professional guidance. During a free, completely confidential initial consultation, our workers’ compensation lawyers will review your case, answer your questions, and explain the next steps you need to take to obtain coverage for medical care and the full monetary benefits you are owed. If your L&I benefits have been denied, we are ready to get started right away on your case.