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Frequently Asked Questions (FAQ) About L&I Injuries with Answers and Helpful Links

What is L&I

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 L&I injury coverage. When you get hurt insist on getting the L&I benefits you have paid for.

Who is covered by L&I?

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.

  • Most workers are covered by L&I in Washington State. You may have L&I insurance even if your employer says you do not, and even if your employer has not paid for this coverage.
    Most employers don’t like L&I claims. Some will tell you that you do not have L&I coverage to discourage you from filing a claim. Don’t believe an employer who is not telling the truth. Some employers may not have paid L&I for your worker compensation coverage. That doesn’t matter.  If you are a worker you are covered, even if your boss cheated L&I.
  • You’re covered even if you work “under the table.”
    Common sense seems to say that if you work under the table, you have no L&I coverage. Common sense is wrong. If you’re a worker in Washington State, you are covered, even if you work “under the table.”
  • You’re covered, even if you are undocumented and not a citizen.
  • If you are a worker, you are covered, with some exceptions.
  • The exceptions to mandatory L&I insurance coverage are listed in RCW 51.12.020.

What benefits does Labor & Industries provide to injured workers?

Labor and Industries can provide benefits such as:

To find out more see L&I Benefit Information.

How do I file a Labor and Industries claim?

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.

Is there a deadline to file 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.

Can I choose any doctor I want?

You may choose your own physician, from a limited pool of doctors (network providers), and have the medical bills for treatment and diagnostic testing paid for. The treatment you receive needs to be related to your job injury or occupational disease. To continue with L&I medical care, your medical treatment needs to be curative. For more information, see Medical Care.

Does workers’ compensation pay for my lost wages? What is time loss?

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 How do I get a fair time loss rate?

What is a permanent partial disability (PPD) settlement?

Yes as an injured worker, you have a right to receive a money award if you have an impairment which is an objectively measurable impairment that 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.     See also: Claims Resolution Structured Settlement Agreements.

Should I disagree with an L&I decision? 

L&I decisions are important. Pay attention to them and take appropriate action if you receive an order or letter. See How to Disagree with an L&I Decision, and learn how to protest, appeal, and protect your rights.

What is an overpayment? 

An overpayment is a determination by L&I that benefits have been inappropriately paid. The difference between what was pad 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 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. Challenge a wrong decision. How to Disagree with an L&I Decision.

Can I have an attorney represent me for a workers’ compensation claim?

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 Lawyers.

Do I want to hire an attorney to represent me for my workers compensation claim?

It depends on many things. Mostly it’s about your facts and L&I law. If you know what to do, you can DIY. If you are unsure, ask for a free consultation and strategy session. This will help you figure it out.

What is a third party claim?

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 can demand payment for the losses that they have caused you and, if necessary, sue them. For more information, see Third Party Claims.

Can I get job retraining if my injury does not allow me to return to my old job?

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 .

What is the difference between an injury and an occupational disease?

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 Injury or Occupational Disease.

What is an order? 

An 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

What is an IME?

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.

What is an L&I Pension?

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

What is an L&I Settlement

Can I reopen my Labor & Industries claim after it is closed?

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

Do I have to pay taxes on my L&I payments?

Mostly good news here. Federal Tax Regulation 1-104-1(b) states that workers’ compensation benefits for personal injuries or sickness incurred in the course of employment are excluded from gross income (not taxable).

There is however 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.

What is a Social Security offset?

Offsets are bad news. They are easy to hate. Offsets are L&I and Social Securities way of making sure you don’t get full benefits under both systems. Offsets are bogus, but they are the law and one or the other of these agencies will deduct this 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.

Is there more than one type of L&I?  What is Self Insurance?

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.

  • State Fund Claims:
    • State fund cases are handled by claims managers who work for L&I. These L&I claims managers are there to move your claim along. They may or may not be helpful.
  • Self Insured Claims:
    • Self insurers, often large employers, manage their own L&I claims. These claims are handled by employees or agents of the employer. Self insured claims managers are not there to help you. They will only help if they have no other choice. See also Self Insured Employers

Penalties

Penalties are assessed against employers for certain prescribed conduct. Some penalties are payable to the injured worker, others to L&I.

Are there other workers compensation systems other than L&I?

Yes.

How to Get Legal Help with My L&I Claim

Most L&I lawyers are happy to give you an initial free consultation. Here at the Sharpe Law Firm we offer a free consultation togehter with  a free strategy session. We might get a copy of your L&I file  and talk with you about the important things we see in your L&I file and what they mean. 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.

What’s Next?

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