You’ve Got Questions About L&I Claims – We Have Your Answers
L&I is the Washington State Department of Labor & Industries. It is a quasi insurance system covering workers hurt on the job. Benefits include medical care, time loss compensation, permanent partial disability, vocational rehabilitation, pensions, and other payments. Workers in Washington pay an insurance premium for this no fault L&I injury coverage. When you get hurt on the job insist on getting L&I benefits. You have paid for them, you deserve them.
A claim progresses like this:
However all this can be complicated and may not turn out well. For example L&I does not pay for pain and suffering, but if you have diagnosed as depression, you can get paid. Get help if you need it. See Things you need to know.
Most workers are covered by L&I Insurance. You may have L&I insurance even if you think you don’t. Coverage is mandatory, and your employer is required to pay for it, either before or after you are injured.
Labor and Industries can provide benefits such as:
To find out more see L&I Benefit Information.
To file a claim, you must see a doctor and complete a Labor & Industries accident report form. For state fund cases, most doctors have this form in their office. For self-insured employers, your employer should have the form you need. Complete your part of the form, then give it to the doctor’s office to complete their part of the form, and send it to Labor & Industries. It is also smart to report your injury to your employer as soon as possible. For additional information see L&I Claims – Detailed Guide to Starting an L&I Claim.
Yes, for sure there is a deadline to file a claim. It is called the Statute of Limitations (SOL). There are two such SOL’s, one for injury and another for an occupational disease. For an injury you have one year from your injury date to file an L&I claim. For an occupational disease you have two years or longer, from the manifestation of your occupational disease, to file an L&I claim. These are important deadlines. Get more information at L&I Claims are Either an Injury or an Occupational Disease
You may choose your own doctor, however there is a limited pool of doctors you can choose from. L&I keeps a list of these doctors. They are called network providers in Washington State. Finding a good doctor who is on the list is often a big problem. See: L&I Medical Treatment for more information.
L&I does pay for your medical if the treatment you receive is related to your job injury or occupational disease.
L&I will continue to pay for medical care so long as your medical treatment continues to be curative. For more information, see Medical Care.
Workers’ Compensation coverage will pay time loss for 60 to 75 percent of what your wages were on the day of your injury. This amount is limited and cannot exceed the state maximum rate. You should receive a check every two weeks, as long as you are properly certified as unable to work by your attending physician. For more information, see: Frequently Asked Questions (FAQ) About L&I Time Loss and How do I get a fair time loss rate.
Permanent Partial Disability is an award of money (if any) at L&I claim closure. Persons who are awarded PPD money are employable and can or have returned to work. As an injured worker, you have a right to receive a money award if you have an objectively measurable impairment from your job injury which exists at the time of your claim closure. The amount of the award is dependent upon the extent of the impairment and the date of injury. Claim closure will usually occur shortly after the doctor has completed treatment and L&I says you can work. For more information, see How to Get a Fair Permanent Partial Disability (PPD) Settlement.
Claim closure and permanent partial disability awards take time
Before L&I will order payment of PPD settlement money
Time loss payments should be quick
Vocational training does not come easy
An overpayment is a determination by L&I that benefits have been inappropriately paid. The difference between what was paid and what should have been paid is the overpayment amount. When an overpayment is specified in an Order this is serious business. Protest or L&I will either be taking that money back, or they will deduct it from your future benefits.
Keep in mind that just because L&I says it is so – doesn’t make it true. The facts and the law decide what is right. If L&I’s decision is wrong then challenge it. How to Disagree with an L&I Decision.
L&I decisions are important. Pay attention to them and take appropriate action if you receive an incorrect order or letter. See How to Disagree withan L&I Decision and learn how to protest, appeal and protect your rights.
Yes in workers’ compensation, you have a right but not an obligation to have legal counsel. If you have any questions regarding workers’ compensation law, or your rights, you may want to consult an attorney. You may choose any attorney you wish, and you have a right to have the fees that your attorney charges reviewed to ensure that they are reasonable. For more information see L&I Lawyer and Attorney or Contact Us.
It depends on many things. Mostly it’s about your facts and L&I law. If your situation clearly entitles you to L&I benefits and if you know what to do, you can DIY. If you are unsure how to proceed if you want some help to figure it out ask for a free consultation and strategy session. Contact Us
Temporary workers do get L&I benefits after a job injury. Get details at Temporary Agency Employee Lawsuits and L&I Job Injuries.
A third party claim exists if, while on the job, you are injured intentionally by anyone, or if you are injured negligently by someone who is not your employer or co-worker. When this occurs you have two claims. You can file an L&I claim and you can file a third party claim for the losses that the negligent party has caused you. For more information, see Third Party Claims in Washington State.
Limited vocational assistance is sometimes available to injured workers whose injury continues to totally restrict their ability to work. For more information, see L&I Vocational Training .
A job injury is basically defined as a sudden and traumatic outside event producing an immediate result to the worker. An occupational disease is a medical condition or disease that has developed slowly, over time, resulting from exposure or a continuous condition on the job. An example of a job injury is falling off a ladder and breaking an arm. An example of an occupational disease is loss of hearing due to working around noisy equipment. For more information and a more formal definition see L&I Claims are Either Injuries or Occupational Diseases
An L&I order is a written determination by L&I or the self-insured employer that affects your legal rights. Orders are issued for many purposes, to include opening or closing claims, setting wage rate, accepting or denying benefits, etc. The time period between the date the order is communicated to you and the time you must act is often 60 days. 60 days is the amount of time you have to protest or appeal in writing, that order. If you do not timely protest or appeal, then the order becomes final – and cannot be changed. See “Res Judicata”. See also : How To Disagree With An L&I Decision
An IME is short for independent medical examination. An IME is requested by the state or self-insured employer for the stated purpose of obtaining an expert opinion regarding medical conditions. In reality, IME’s are performed by hack doctors and often used to cut off benefits and close claims. Labor & Industries or the self-insured employer has the power to schedule and insist on your attendance at a reasonable number of IME’s. If an IME is scheduled for you, you might want to consider consulting an attorney and preparing yourself for the IME. See: Eleven Things That Can Ruin Your Claim. See also: IME.
An L&I pension is the rough equivalent of your time loss for the rest of your life. A pension is also known as Permanent Total Disability. To qualify for a pension you must be unable to return to work. Pensions can be worth a lot of money. They are not easy to get. You can get permanent partial disability or a pension, not both. To learn more see L&I Pension
At L&I, voluntary retirement amounts to L&I saying you do not get time loss or pension payments. Don’t let them do this. More info at Voluntary Retirement and L&I Benefits.
Yes, Labor & Industries claims (except CRSSA’s) can be reopened for full benefits any time within seven years of the date of first final closure. L&I claims can be reopened for medical benefits anytime. To reopen you must show an objective worsening of your accepted condition. See Reopening an L&I claim
Mostly good news here. The IRS statute 26 USC 104(a)(1) and Federal Tax Regulation 1-104-1(b) state that money received under workers’ compensation acts, benefits for personal injuries or sickness incurred in the course of employment are excluded from gross income. This means they are not taxable.
There are two exceptions to the not taxable rule. Sidebar payments may not so qualify. Also, there is a tax injustice in the reverse offset years (age 62-65), for some persons getting both social security disability and either L&I time loss or L&I pension payments. The L&I benefits which offset the taxable Social Security benefits are treated as though they are a taxable Social Security benefit. Social Security will send a statement to the injured worker and to the IRS. Depending on the remainder of household income, income taxes may be due on these Social Security Benefits even though they are never received. 28 U.S.C. § 86(d)(3). US Tax Court Flores v. Commissioner. This is an unfair tax. Talk to your tax advisor if this taxation of the reverse offset applies to you.
Offsets are bad news. They are easy to hate. Offsets are L&I and Social Security’s way of making sure you don’t get full benefits under both systems. Offsets are bogus. However they are the law, and one of these agencies will deduct this offset money from your benefits. L&I and Social Security often get the offset amount wrong. Check their math. Protest or Appeal wrong decisions. Get help if you need it. See Social Security Offset for more info.
There are two types of Washington State L&I insurance. The Department of Labor & Industries (L&I) is in charge of worker’s compensation in Washington State.
Penalties are assessed against employers for certain prescribed conduct. Some penalties are payable to the injured worker, others to L&I.
Yes, here is a list with brief descriptons:
Most L&I lawyers are happy to give you an initial free consultation. Here at the Sharpe Law Firm we offer that free consultation together with a free strategy session. With your permission we can view a copy of your L&I file and talk with you about the important things we see in your L&I file and how they might impact your L&I claim. Call us and we’ll answer your questions. Don’t think twice, it’s free. Give us a call or complete our do I have a case questionnaire.
Telephone – Call for information or a free strategy session – 206-343-1988