L&I Claim Closure – There are Two Parts
- Medical treatment is at maximum medical improvement or a doctor says your medical treatment is at maximum medical improvement and
- When employablity is established and you have returned to work or L&I says you are employable
How L&I Closes Claims
- Most commonly they get an IME which says medical care is complete.
- Next, they get your doctor or a vocational counselor to say you can work.
- After that they issue a closing order.
- Then they wait to see what you are going to do about it.
What Happens After Claim Closure?
- If you do nothing, after 60 days the closing order becomes final.
- If you protest, request reconsideration or appeal, then the closing order is held in abeyance, and they will deal with your objections and concerns.
- L&I might then deal with you fairly. Or they might just get another IME and close your claim again.
The Rules and Reality of Claim Closure
L&I knows how to close claims. Here are the rules and reality of claim closure.
The medical care treatment rule
You are entitled to medical treatment until your job related medical condition reaches maximum medical improvement (MMI). Maximum medical improvement means additional treatment is not likely to improve the condition.
The medical care reality
L&I or the self insured employer wants to close your claim. So they send you to an independent medical exam (IME). In reality the so called independent medical exam is neither independent, nor is it a medical exam. It is a sham records review by a bought and paid for doctor who planned to say you were no longer in need of treatment before he “examined” you. This doctor is paid by L&I. He reports in the IME that you are at maximum medical improvement. L&I takes that IME report and uses it to close your claim.
What to do about a bad IME.
The law give more weight to the opinion of your attending physician than to the IME doctor. If your physician disagrees with the IME, in writing, to L&I then you have some evidence to keep your claim open for additional medical care. If your attending physician agrees with the IME then you have a problem.
If you need more medical treatment for your job related condition, then get your doctor to say so in writing to L&I, and don’t wait too long.
Disagreeing with a faulty IME requires good timing and may eventually require legal action such as a protest, appeal or reopening. Get legal advice or help if you need it, and don’t wait to long.
The Vocational Rule
L&I cannot close your claim until you are employable. L&I makes employability decisions through their vocational rehabilitation section and IME doctors. Sometimes they use vocational counselors to assist in their decisions. The legal threshold in employability determinations can be very low. The result is harsh for the worker.
L&I and the Self Insured Want to Close Your Claim
So they come up with a vocational decision that allows them to do this. Vocational decisions are sometimes fair and sometimes unfair. Your facts bear on which it is in your case. The vocational rules make it easy for L&I to find you employable. In general, if you ever have had job experience or training at any job that pays at least minimum wage and you can perform that job, then you are employable. This means for example, if you were injured as a laborer making $35 an hour plus overtime and can’t do that type of work now, and if you worked as a cashier ever in your life, and if you could work as a cashier now for minimum wage, then you are employable. Harsh but true.
What to do about a bad employability determination
If there is still time you can dispute a wrong determination. Pay attention to the time deadlines L&I puts on their decisions. If you think you can prove you are not employable then protest or appeal the claim closure and prove your case. How to Dispute a Vocational Decision
What To Do About L&I Claim Closure
You have choices about how to handle a claim closure.
Here are the most common choices:
- Do nothing
- Disagree with L&I’s decision
- Ask for a better decision with a dispute. You must dispute See: How to Disagree with an L&I Decision
- Request more settlement money
- Ask for what you want
- Request a pension
- Apply to reopen if the claim is closed more than 60 days
Ask for a better decision
Claim closure is a legal determination. To change that legal determination you will need to take legal action. Here are your legal choices:
- Protest and request reconsideration to L&I asking for a more favorable determination
- Appeal to the Board of Industrial Insurance Appeals asking for a more favorable determination
- Appeal to Superior Court or further
- The important thing about protest and appeal is that you do so in writting before the 60 days pass. After you file the protest and apeal you will have additional time to prove your case.
This is complex. It involves evidence, good timing, and an understanding of legal procedure. It involves getting evidence that can win and knowing when you have a winner.
Get legal advice. If your case can be won and it has value, a lawyer may be willing to take your case. Good luck, and don’t give up at least until you have talked to a lawyer about your case.
Reopening Your Claim
This is a different type of legal remedy. You can only request reopening if your claim is finally closed, meaning more than 60 days have passed since the initial closure. It is more difficult to reopen a claim than to keep it open. For more information see Reopening an L&I Claim.
