L&I Pension Cases

When you hear the term “pension,” you probably think of retirement benefits. A Washington workers’ comp pension is different. RCW 51.08.060 defines permanent total disability (pension) as: “loss of both legs, or arms, or one leg and one arm, total loss of eyesight, paralysis or other condition permanently incapacitating the worker from performing any work at any gainful occupation.” If you cannot return to work after an on-the-job accident or disability occupational disease, an L&I pension may be your best option.

At The Walthew Law Firm, our top-rated Washington workers’ compensation attorneys have extensive experience handling L&I pension cases. We want to make sure that you have the tools and knowledge you need to protect your interests. Here, you will find a guide to L&I pension benefits in Washington. If you have specific questions about L&I pensions, your legal rights, or options, please contact our law firm for immediate help.

An Overview of Washington State L&I Pensions

Washington workers’ compensation pension benefits are paid directly by Labor & Industries. You may be eligible for L&I pension benefits whether or not your date-of-injury employer offers its own pension plan. These benefits are designed to support workers who cannot return to work because of many factors – their age, education, work history, pre-existing disabling conditions, and the effects of the industrial injury or occupational disease. Here are three key things to know about L&I pensions in Washington State:

1. L&I Pensions are for Workers Who Will Never Return to Work: The single most important thing to know about L&I pensions is that these benefits are for injured workers who cannot return to gainful employment. Under Washington law (WAC 296-14-150), gainful employment is defined as a regular occupation for income or salary. Put another way, if your doctor or vocational counselor says that you cannot ever work again because of a job-related injury or illness, you should pursue L&I pension benefits.
2. Pension Benefit Payments are based on Your Time Loss Rate: Pension benefit payments are paid for your lifetime and, if you elect, for your spouse or child’s lifetimes. You may be wondering: how is my pension calculated? The short answer is that your monthly wages at the time of your accident, receipt of Social Security benefits, and whether you select an Option to provide benefits to a spouse, child, or domestic partner determine your pension rate. Notably, Washington State L&I pension benefits are not counted as taxable income for Federal income tax purposes.
3. Qualifying for an L&I Pension Can Be Challenging: Unfortunately, it is not always easy for injured workers to receive an L&I pension. You need to present a strong case that proves that you cannot work again at gainful employment. Many factors will be considered in assessing eligibility, including your age, education, and work experience. Most importantly, injured workers need comprehensive, compelling medical and vocational documentation that prove permanent total disability. A workers’ compensation lawyer can help you put together the medical and vocational information and opinions that you need to support your claim.

Only a small percentage of workers’ compensation claims in Washington end in an L&I pension. The claims process and path to a total disability pension is difficult to navigate. You do not have to go through it alone. If you or your loved one cannot return to the workforce after suffering a job-related injury or developing an occupational disease, contact an experienced Seattle L&I pension attorney for immediate help.

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 80 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.

Labor & Industries: Frequently Asked Questions (FAQs)

Unfortunately, many hardworking people get hurt on the job. The National Safety Council (NSC) estimates that 4.6 million Americans are injured at work every year. While some of these injuries are relatively minor, many others are serious—even completely debilitating. An accident can cause significant disruption to your life and could keep you off the job for weeks, months, or even permanently. Injured workers are entitled to the maximum available compensation to support themselves and their loved ones.

At The Walthew Law Firm, our Washington workers’ compensation attorneys have extensive experience advocating for the best interests and legal rights of injured workers. We want to make sure that people understand their rights and responsibilities under state law. Here, our legal team has put together answers to some common questions people have about L&I claims. If you have any specific questions about your legal options, please do not hesitate to contact our L&I lawyers for a free and strictly confidential initial consultation.

What is L&I?

The Washington State Department of Labor & Industries (L&I) is a state governmental agency that regulates and enforces industrial insurance benefits to workers who are injured on the job, crime victims’ compensation, work-place safety, wage and hour issues, and leave benefits. Primarily, L&I is responsible for administering the Washington State workers’ compensation insurance program. The agency is headquartered in Tumwater, and it has satellite offices in nearly twenty cities and towns across the state.

Am I Covered By L&I Insurance?

The vast majority of workers in Washington State are covered by the state’s mandatory no-fault workers’ compensation insurance system. Employers are required to provide L&I coverage to most employees—including part-time workers and temporary workers.

Under Washington State law (RCW 51.08.180), the term ‘worker’ is defined broadly. Almost everyone who is engaged in employment is a worker for the purposes of state law. For example, you should be covered by L&I insurance even if you are an undocumented immigrant or paid in cash wages; however, there can be challenges in proving coverage in such cases.

There are some limited exceptions to coverage. You can find some of these exceptions outlined in RCW 51.12.020. Maritime workers such as dock workers or ship builders, federal employees, and railroad workers are some examples of workers not covered under Washington State L&I. If you have any specific questions about your coverage, contact an experienced Washington State L&I lawyer for assistance.

What Do I Need to Do to File an L&I Claim?

Following an on-the-job injury, injured workers need to take immediate action to protect themselves and their legal rights. If the injury occurred while working for a large self-insured employer, report the injury to your supervisor and ask for form SIF-2, which is the Report of Accident. File that document with your employer and see your doctor who will complete the Providers Initial Report. For all other on-the-job injuries, see your medical provider as soon as possible and fill out the Report of Accident at the provider’s office or online. While filing an initial L&I claim is relatively straightforward, there are many common mistakes that you need to avoid. Here is a brief overview of the process of filing a Washington workers’ compensation claim:

1. Report your accident to your supervisor.
2. Seek immediate medical attention. All injuries should be evaluated by a medical provider.
3. Complete the Report of Accident (ROA) form. As indicated above, you can get this form from your doctor and/or your employer.

Are There Any Deadlines for Filing an L&I Report of Accident?

Yes. There are strict deadlines for filing an L&I claim. First, you should report your injury or occupational disease to your supervisor as soon as possible. Second, get medical attention right away. Failure to seek medical care can also undermine your ability to recover full and fair L&I benefits. Here are the deadlines for filing an L&I claim:

• Industrial Injury Claims: You must file your industrial injury claim with L&I or your self-insured employer within one year of the date of the accident.
• Occupational Disease Claims: You must file your occupational disease claim within two years from when your doctor tells you, in writing, that you have a work-related condition.

With most industrial injury claims, there is rarely a dispute over the date of the accident. With occupational disease claims, the onset or manifestation of the illness or condition is not always so clear. It is best to file an occupational disease claim as soon as you have symptoms of your work-related condition and have seen your doctor. If your doctor informs you in writing that your condition is probably linked to your employment, the two-year clock has started to run.

What Workers’ Compensation Benefits Can I Get in Washington?

If you were hurt on the job and your L&I claim is approved, you are entitled to benefits. These benefits provide a much-needed financial lifeline to injured workers and their families. Here is an overview of the benefits that may be available:

• Medical Coverage: In Washington, L&I coverage pays for all medical care that is deemed “proper and necessary.” Among other things, this may include emergency medical treatment, hospital bills, diagnostic studies, health care provider visits, costs of medications, and occupational and physical therapy. Medical care should be covered until your condition has stabilized, and, based on the opinion of a medical provider, no further physical or mental health recovery is expected. Unfortunately, L&I may deny certain types of treatment.
• Time Loss Compensation: If you miss time from work as a result of your disabling condition, time loss compensation is paid as compensation for lost wages. Time loss is calculated as a portion of your average weekly wages. The benefit is typically between 60 percent and 75 percent of a worker’s wages from all employment and is based on marital status and number of children. State law sets the minimum and maximum time loss rates.
• Loss of Earning Power (LEP) Benefits: One of the most underutilized types of workers’ compensation benefits, Loss of Earning Power (LEP) benefits compensate workers who can only return to part-time work or are forced to take a lower-paying position upon their return to the workplace. If you have questions about LEP benefits, contact an experienced Washington loss of earning power attorney for help.
• Vocational Services and Travel Reimbursement: Injured workers may be entitled to vocational retraining services and travel reimbursement. These are important benefits, and they should be accounted for in any claim. L&I also provides coverage for some of the incidental costs related to items damaged during an injury, limited to prescription eyeglasses, boots, clothing, and personal protective equipment.
• Permanent Partial Disability (PPD) Benefits: PPD benefits are paid to claimants who have a permanent impairment related to their work injury. If you reached maximum medical improvement and the disability or impairment remains, then PPD benefits should be paid by L&I. PPD benefits are paid based on a predetermined schedule set forth by Washington law and must be rated by a doctor.
• Structured Settlements: If you have an accepted workers’ compensation claim and are over the age of 50, you can resolve your claim with a structured settlement. The settlement resolves all issues on a claim with structured payments agreed to by all parties—the worker, the employer, and L&I or the self-insured employer. It is best to work with a qualified workers’ compensation attorney before entering into such a settlement as there are risks involved.
• Pension Benefits: In Washington, total disability pension benefits may be available for injured workers who can never reasonably return to the workforce. L&I considers your age, education, work history, prior injuries or disabling conditions, and the effects of an industrial injury to determine if a worker can return to gainful employment. If you cannot work at any job because of your injuries, an experienced workers’ compensation lawyer can help you make a claim for lifetime pension benefits. These benefits supplement other forms of financial support, such as Social Security Disability and Retirement benefits.
• Work-Related Death Benefits: The loss of a family member is heartbreaking and devastating. While nothing can make things right, L&I provides death benefits to help support spouses, children, and others who are financially dependent on the deceased worker. Death benefits may include immediate burial and funeral coverage, immediate payments, and widow or dependent pension benefits. An attorney can help your family navigate this system and obtain the maximum L&I death benefits.

How are PPD Benefits Determined in Washington?

Many serious injuries qualify for a final benefit payment at the closure of a workers’ compensation claim. These payments are called Permanent Partial Disability awards or PPD awards. As explained by the Department of Labor & Industries, you may be paid PPD if:

1. Your medical treatment is finished, and you are, hopefully, able to return to the workforce, but you have a permanent impairment; and
2. You have been given a PPD rating by a doctor.

The key thing to know is that your disability rating will control your award. In other words, there is a pre-set PPD “schedule” that will determine how much an injured worker is entitled to receive. That schedule of payments is based on your date of injury or manifestation and not the date the PPD rating is done. It is crucial that your PPD rating accurately represents the severity of your injury. If your PPD rating is improperly low, then you will be denied the full and fair workers’ compensation payment you deserve.

Navigating The L&I Claims Process

In Washington, employers are required to obtain no-fault workers’ compensation coverage for their employees. If you were hurt on the job or you developed an occupational disease, workers’ comp insurance offers medical coverage, time loss compensation, and disability benefits.

As L&I claims are complicated, it is easy to get overwhelmed—especially after suffering a serious work injury. At The Walthew Law Firm, our Washington workers’ compensation attorneys want to make sure that you have all of the information that you need to navigate the L&I claims process.

Your Five-Step Guide to the L&I Claims Process

1. Seek Medical Attention

Injured workers need immediate medical attention. If you were hurt on the job or if you developed an occupational illness, you need to see a qualified medical provider as soon as possible.  Your claim process will go more smoothly with the support of a qualified doctor.  You deserve reliable, high-quality medical care from a trusted doctor.

Your L&I claim will not be allowed unless you seek medical care. It is a required part of the claims process. At your initial appointment, inform your medical provider that you suffered a work-related injury or developed a condition related to your work. You and your doctor will complete certain necessary claim forms that you need to file your claim.

2. Notify Your Supervisor/Employer

As emphasized by the Washington State Department of Labor & Industries (L&I), injured workers have a legal responsibility to notify their employer of an injury or occupational disease. You may inform your first-level boss, another supervisor, or a representative of your company’s HR department. Your employer likewise has a duty to report your injury to L&I.   With full information, your company or organization, particularly large, self-insured employers, can help you with the L&I paperwork. It is illegal for your employer to discourage you from reporting your accident.

3. File a Workers’ Compensation Claim

You need to make sure that your workers’ comp claim is filed properly.  With the exception of a written report to a self-insured employer, reporting your work injury to your employer is not the same thing as filing an L&I claim. While your employer should help facilitate your claim, not all companies or organizations know how to do so.

File your worker’s compensation injury or occupational disease claim as soon as possible. Your workers’ comp claim cannot be processed by a claims manager until your doctor has submitted the relevant paperwork to L&I or your self-insured employer.

4. Await Approval of Your Workers’ Comp Benefits

Once your L&I claim is approved, you will get access to workers’ comp benefits to cover all claim-related, proper and necessary medical expenses. Of course, an L&I claim can cover more than just medical care. If your medical provider certifies your inability to work because of your injury or medical condition, you should receive time loss compensation. You may also be entitled to other benefits, including job-retraining services, permanent partial disability benefits, and pension benefits, depending on medical provider support. If L&I or a self-insured employer deny any of these benefits, you should consult with an attorney. Serious injury claims benefit from professional legal guidance and support.

5. Take Immediate Action to Protest or Appeal an Adverse Decision

Getting benefits paid in an L&I claim can be challenging. Even workers who are qualified for benefits sometimes run into problems in the claims process. If your L&I claim was rejected or if you received any other type of unfavorable decision, you must take immediate action to protect your rights. Call an experienced Seattle L&I claims attorney for help.

As confirmed by Washington’s Board of Industrial Insurance Appeals, you have 60 days to file a protest or an appeal after receiving a decision from Labor & Industries or your self-insured employer. Do not wait to get started with the appeals process. Our workers’ compensation attorneys will review your case, explain your options, gather all necessary supplemental evidence, and take action to get you the full and fair L&I benefits that you deserve.

Benefits through an L&I Claim

If you were injured on the job, you may be eligible to receive benefits through an L&I claim. This raises an important question: How much will my Labor & Industries claim be worth? There is no easy answer to this question. Every work injury claim has its own unique set of facts and circumstances.

The Department of Labor & Industries reported that monetary benefits paid in the average payment of time loss compensation in a claim in the fiscal year 2019 was $38,084.  Your L&I claim could be worth significantly more or less depending on how long you receive time loss benefits. Here, our Seattle workers’ compensation lawyers explain what you need to know about how L&I claims are valued.

Know How to Value Your L&I Claim

L&I claims are always valued on a case-by-case basis. How much a claim is worth varies based on the specific circumstances of the case. In Washington, workers’ compensation insurance provides benefits for medical treatment, time loss compensation, loss-of-earning power benefits, vocational benefits, permanent disabilities or impairments, and lifetime pensions. Depending on the nature and severity of your injury or disease, your L&I claim may include benefits for any of the following:

• Medical Treatment: First and foremost, workers’ compensation covers the cost of all medical care that is proper and necessary. An L&I claim should include coverage for emergency medical treatment, surgeries, office visits, and rehabilitative services.
• Time Loss Compensation: If you are unable to work on a full-time basis because of your injury/illness, wage replacement benefits should be available through L&I or your self-insured employer. Time Loss compensation pays between 60 percent and 75 percent of your date-of-injury wages from all employment, up to a current maximum rate of $6,970 per month. Your time loss compensation is not taxable.
• Loss of Earning Power: In some cases, injured workers are entitled to Loss-of-Earning-Power (LEP) benefits. If you are only able to return to work on a part-time basis or were forced to take a lower-paying, light duty position, your L&I claim may include LEP benefits. The basic formula for LEP benefits is payment of 80% of the difference between date-of-injury wages and current wages not to exceed a worker’s full-time loss rate.  To better understand how much compensation may be available, L&I put together a Loss of Earning Power (LEP) worksheet detailing the calculations involved in determining LEP payments.
• Vocational Retraining Services: A severe injury or occupational disease may make it impossible for you to return to your previous position. If you do not have prior job experience, qualifications, or education to return to any other employment, you may qualify for vocational retraining services. If L&I approves a retraining plan, you can choose to participate now and receive time loss compensation during retraining (Option 1) or delay the start of your retraining plan and receive funds to pay for school but receive no time loss compensation (Option 2).
• Permanent Partial Disability: Permanent partial disability (PPD) benefits are paid to workers who have reached maximum medical improvement but have still not made a full recovery. This rating is made independent of someone’s ability to work.  PPD will be rated by a medical provider based on lost bodily function. The higher your PPD rating, the higher your monetary benefits. Do not accept an unfairly low PPD rating.
• Total Permanent Disability: If your injury/illness is so severe that you cannot reasonably return to any type of gainful employment, your L&I claim should include compensation for total disability pension benefits. These lifetime monthly total disability payments vary based on a claimant’s date-of-injury wages and marital status and whether or not the injured worker receives Social Security benefits. As total disability cases are highly complex, injured workers should be represented by an experienced workers’ comp attorney.

The Washington State Department of Labor & Industries (L&I) is a government agency that regulates and enforces workplace safety standards and handles workers’ comp claims.

Through an L&I claim, an injured worker may be entitled to payment of medical treatment, wage replacement, permanent partial disability (PPD), and other benefits.

At The Walthew Law Firm, our Seattle workers’ comp lawyers provide proactive, effective legal representation to people who need it the most. If you have concerns about your right to receive L&I benefits, we are here to get you reliable answers. To learn more about what we can do for you, please contact our Washington workers’ compensation attorneys today.

Know Your Legal Rights: An Overview of L&I Benefits

All Proper and Necessary Medical Care

L&I benefits cover all medical care that is proper and necessary and related to the underlying workplace injury or occupational disease. Your medical bills should be paid for as part of your L&I benefits as long as your treatment is through an L&I approved provider. Notably, L&I benefits include coverage for rehabilitative treatments and therapies such as chiropractic, physical therapy, and limited massage therapy. Nothing should come before your health and your recovery.

You are entitled to get medical care from a physician who you trust. In Washington, injured workers have the right to choose their own doctor. Unfortunately, there are sometimes disputes over whether or not medical care is needed. If you are struggling to get your medical treatment covered as part of your L&I claim, an experienced workers’ comp lawyer can help.

Time Loss Compensation (Wage Replacement)

One of the most challenging things about being hurt on the job is that you might be required to miss time from work (and paychecks) in order to recover from your injuries. Your L&I benefits should provide financial coverage for wage replacement. Known as “time loss compensation,” those benefits are paid between 60 percent to 75 percent of your pre-injury wages—up to Washington’s maximum weekly benefit.  Time loss is based on your date-of-injury wages from all jobs, your marital status, number of children, and other factors.

Vocational Retraining and Other Educational Services

In some cases, an injured worker may be able to return to the workplace, but not in their previous position. L&I benefits can provide coverage for vocational retraining and other similar educational services if you are medically unable to return to your job of injury, and you have no other transferrable skills. Vocational services are designed to help get an injured worker back to work as quickly as possible.

Permanent Partial Disability (PPD) Benefits

Unfortunately, a work injury or an occupational illness may cause a permanent impairment. In Washington, an injured worker may be eligible to receive permanent partial disability (PPD) benefits if they have completed treatment, but they suffered a permanent impairment as a result of the injury or occupational disease.

In other words, PPD benefits are an award for a physical or mental impairment that remains even though a claim is being closed. The value of a PPD award is based on the worker’s disability as rated by a doctor. The PPD award can be protested once the closing order is received if you believe the rating of impairment is low.

Loss of Earning Power (LEP) Benefits

Depending on the specific circumstances of your case, you may be entitled to loss of earning power (LEP) benefits. LEP benefits, as explained here, are designed to protect workers who have lost wages because they are only able to work part time or at a lower-paying, light-duty position while they recover. LEP benefits are notoriously underutilized. If you have concerns about LEP benefits, our workers’ comp lawyers can help.

Permanent Total Disability Pension Payments

Lifetime pensions are available for workers who are not able to return to gainful employment due to their on-the-job injury or occupational condition. If, because of your work injuries or conditions, your age, education, work history, and pre-existing conditions, you are unable to return to work,  you may be entitled to pension benefits through an L&I claim. Our attorneys have extensive experience in this area of workers’ comp law.

Widow and Dependent Benefits

There is nothing more painful than losing a loved one as a result of a work accident. If the worker’s death is directly attributable to the injury or occupational disease, then L&I provides burial benefits.  If the deceased worker left a widow, children under 18 (age 23 if in an accredited school full-time), or other dependent, pension benefits can be paid.  There are limitations to those benefits, however.  Our Washington workers’ comp lawyers understand the challenges faced by family members and will work to protect your rights and help you recover the maximum available financial support.