Important L&I People

The “Players” control the progress and direction of your L&I claim.

They are:

1. Attending Provider (AP) – This doctor is the one whose opinion counts the most because you see this provider several times and they they are familiar with your condition. They should be a health care provider that you choose and they should want to help you with your L&I claim. You have a right to choose your Attending Provider. In L&I’s mind the Attending Provider is the health service provider who they have typed into the attending provider slot in your L&I file. Make sure the doctor you want as Attending Provider is the one they have written down in their file. The Attending Provider can prescribe medications, order tests, certify time loss, and report to L&I about your treatment plan and progress.
2. An “attending provider” means a person who is:
   • a member of the health care provider network:
   • treating injured workers within the person’s scope of practice; and
   • licensed under state law in one of the following professions:
     •  physician:
     • osteopathy:
     • chiropractic:
     • naturopathy:
     • podiatric medicine and surgery:
     • dentistry:
     • optometry:
     • psychology, in claims solely for mental health conditions:
     • physician assistant;
     • licensed advanced registered nurse practitioner.
3. Independent Medical Exam (IME) – The independent medical exam generally takes the form of a report produced by a doctor who sees you one time for the purpose of assessing a claim and answering questions. Independent medical examiners range from truly independent to totally biased and willing to say whatever they think the people paying them want them to say. Be careful of of independent medical exams. They are generally set up by people whose interests are different than yours. These examiners are asked questions designed to get opinions that either deny surgery or close your case. Most independent medical examiners are not there to help you. When somebody orders an independent medical exam in your case, watch out. See IME
4. Claims Managers – Claims Managers are paid employees of the organization that manages your claim. In state fund cases, they are paid by Labor & Industries. In self insured cases, they are either in house employees of your employer or they are agents of your employer who work for a service company. These people have a lot of power over your claim. They adjudicate whether or not you get medical care, time loss payments, vocational training, and a settlement or a pension. Many of them, especially state fund claims managers, are good people who are trying hard to help. Others of them, including some state fund and most self insured, are not there to help you. They are there to help your employer save money. The only way the employer saves money is to not pay it to you.
5. Vocational Rehab Counselor (VRC) – VRC’s come in all varieties. Some are very talented – others are nitwits. Some want to help you – some don’t. Most of them are hired by a claims manager, and they know it. The important concept to understand is that your L&I claim can’t close until you are found employable. The VRC is the expert who decides whether you’re employable or trainable. They have alot of power.
6. Nurse Case Managers – Nurse case managers are rarely hired by Labor & Industries. When L&I does this it is generally to assist with complicated and severe medical situations. Most of these nurse case managers are good people trying to help. Nurse case managers hired by self insured companies are generally there to spy on you, come between you and your doctor, report back to the employer, and help close your claim early. If you think the nurse case manager is not working in your best interest, you’re probably right. Nurse case managers have no right to attend your medical exams or tell you what to do. If you let them do it, then they will. Your doctor does not have to talk to a nurse case manager. If you let him do it, he probably will. If there is a nurse case manager on your case, watch out.
7. Injured Worker – That’s you, whether you have an injury or an occupational disease claim. You interact with all the other players. You either help move your claim in the right direction or you don’t. You tell your doctor what your symptoms are and whether or not you can work, or he guesses. You tell and show the claims manager what benefits you think you deserve or they give you what they want to give you. You help the vocational counselor pick a program for yourself or they decide what your future career is going to be. You have some power in these claims and you either use it or lose it. Speak up and help yourself out.
8. L&I Lawyer – There is much detail in the L&I laws. A good L&I lawyer concentrates his law practice in this area so he can recognize problems before they happen, and help you make smart decisions. See L&I Lawyer and Attorney
9. The Laws – Revised Code of Washington (RCW ) Title 51, and  Administrative Code (WAC) Title 296, are the section of the law that applies to workers compensation claims and claim management.  They are complex, having been written by politicians and insurance people and intended to be understood by doctors, lawyers, and judges.