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:
- Report your accident to your supervisor.
- Seek immediate medical attention. All injuries should be evaluated by a medical provider.
- 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:
- Your medical treatment is finished, and you are, hopefully, able to return to the workforce, but you have a permanent impairment; and
- 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.
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Do I Have the Right to Choose My Own Physician?
Yes. Under workers’ compensation laws, injured workers are permitted to choose their own physician. You need a doctor who you can trust to provide reliable care. However, that provider must be on L&I’s approved provider list. Labor & Industries has put together a searchable network of medical providers. If you are not sure where to find a doctor, this database is helpful. For treatment outside of Washington State, providers must have an L&I provider number in order to treat injured workers. If you need help finding a doctor, an experienced workers’ compensation attorney may be able to assist you in finding a qualified and trustworthy provider near you.
L&I is Requesting an Independent Medical Evaluation (IME). What Does that Mean?
The term Independent Medical Evaluation is a bit of a misnomer. It is a medical evaluation requested by L&I or a self-insured employer. Claims managers typically want a second doctor to assess your medical condition: usually to determine entitlement to time loss benefits or need for medical treatment. These medical evaluations are requested and paid for by L&I or the self-insured employer, and they choose the doctors who will conduct the examination.
If L&I or an employer schedules an IME, you should cooperate even though it could be a sign that the claims manager is seeking to deny or stop benefits on your claim. Failure to attend the examination, except for “good cause,” could result in the suspension of your claim and termination of monetary benefits. You may want to consult with a workers’ compensation lawyer before your independent medical evaluation.
Is there a Difference Between an Injury Claim and an Occupational Disease Claim?
Yes, there are some notable differences. In Washington State, an injury is defined as a “sudden and tangible happening of a traumatic nature.” The term industrial injury refers to something that happened at a specific point in time. In contrast, an occupational disease is defined as a “condition that develops gradually because of the work performed.” An occupational disease could be anything from a repetitive stress injury such as carpal tunnel syndrome to a lung disease caused by breathing in toxins in the workplace.
For a number of different reasons, occupational disease claims are complex. There are often questions about how the condition can be linked to the workplace. To qualify for L&I benefits for an occupational disease, a worker must prove that the condition arose “naturally and proximately” out of employment. For more information on occupational diseases and L&I benefits, contact a Washington workers’ compensation lawyer.
I Disagree With an L&I Decision. What Can I Do?
The L&I claims managers are not perfect. The agency sometimes makes mistakes and comes to incorrect decisions. If you believe that L&I got something wrong in your case, you have the right to protest or appeal the adverse order or determinative letter, such as a vocational determination. However, you only have a limited amount of time to do so. If you fail to take action, an adverse workers’ compensation decision will become final. L&I orders give workers 60 days to file a written protest or appeal.
To challenge an L&I decision, an injured worker must file a protest. You must submit an L&I protest in writing, and you must do so before the deadline expires. You can submit supplemental documents, records, and information to support your protest. The Department will issue a subsequent order, which if unfavorable, can be appealed to the Board of Industrial Insurance Appeals. Again, you have 60 days to file your appeal with the Board of Industrial Insurance Appeals.
An experienced workers’ compensation lawyer will help you build a compelling and strong protest or appeal.
My L&I Claim Was Already Closed. Can I Reopen It?
Yes. Under Washington State law, claimants can reopen an L&I claim within seven years of the date of first closure to receive monetary benefits such as time loss, PPD, or pension. You can apply to reopen a claim at any time, but after seven years, it is at L&I’s Director’s discretion whether or not benefits other than medical will be paid.
Additionally, you cannot reopen your L&I claim simply because you disagreed with the initial closure. To successfully reopen a workers’ compensation claim in Washington State, a doctor must say that your condition has objectively worsened since the date of closure.
If you have any questions or concerns about reopening an L&I claim, contact an experienced Washington workers’ compensation lawyer for help. An attorney will explain your options for getting additional financial support.
How Does My L&I Claim Affect My Right to File a Third-Party Liability Lawsuit?
As a general rule, an L&I claim is an injured worker’s exclusive legal remedy. It is a no-fault insurance, which means if your accident was caused by your own fault, your coworker’s, or your employer’s negligence, you would be entitled to receive benefits. It also means you cannot sue your coworker or employer. However, you retain the right to file a personal injury claim against any other party that caused your accident through recklessness or carelessness. For example, if you were injured on the job because of the negligence of a property owner, you can hold them accountable through a personal injury lawsuit. These types of claims are called third-party liability claims.
To clarify, your L&I claim and your third-party liability claim are two separate legal cases. If you were injured on the job in Washington, you should file a workers’ compensation claim. If your injuries were caused by a negligent third party, then you should also file a claim against the negligent third party. Through a third-party claim, you may be eligible for additional financial support, including compensation for your pain and suffering.
Should I Hire a Workers’ Compensation Attorney for My L&I Claim?
All workers in Washington have a right to hire an attorney to assist with their L&I claim. In some cases, injured workers can effectively handle their own claim. However, if you run into any problems or have any questions, you should speak to a professional. Here are three signs that indicate that you need to consult with a workers’ compensation attorney:
- You or your loved one suffered a severe injury;
- You have run into problems with your employer or L&I; and
- Your workers’ compensation claim was rejected, or your benefits denied.
If you are unsure whether or not you need to hire a workers’ compensation attorney, we encourage you to reach out to our law firm for a free and confidential initial consultation. During a consultation, our workers’ compensation attorneys can review your case, answer your questions, and help you take action to maximize your L&I benefits.
Call Our Washington State Workers’ Compensation Lawyers for Help
At The Walthew Law Firm, our Washington workers’ compensation attorneys have the skills and legal experience to assist you with all types of L&I claims. With more than nine decades handling work injury claims, we are more than ready to protect your rights. To set up a no-cost, no-commitment review of your case, please contact us today. From our legal offices in Seattle and Everett, we represent injured workers throughout the entire region, including in Bellevue, Redmond, Tacoma, Olympia, Kent, Puyallup, Federal Way, Issaquah, and Lakewood.
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