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:
- Reflective of accepted standards of good practice; and
- 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.
Workers’ Compensation Video
Five Common L&I Medical Care Challenges (And How to Protect Your Rights)
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.
Contact Our Washington L&I Attorneys for a Free Consultation
At The Walthew Law Firm, our Washington workers’ compensation lawyers are experienced, effective advocates for injured workers. Our practice is devoted to protecting the rights of injured workers and their families. You deserve high-quality medical care and full and fair workers’ compensation benefits.
If you have any questions or concerns about L&I medical care and your rights, we are ready to get you answers. Contact our firm today to schedule your free case evaluation. From our office locations in Seattle and Everett, we proudly represent people throughout Western Washington, including in Tacoma, Bellevue, Olympia, Kent, Puyallup, Issaquah, SeaTac, Kirkland, and Lynnwood.
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