How SIMP Programs Work in Washington L&I Claims

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l&i lawyer chris sharpe Christopher Sharpe
Home L&I How SIMP Programs Work in Washington L&I Claims

A SIMP is a structured, intensive, multidisciplinary program to treat chronic pain. It is typically performed at a multidisciplinary rehabilitation center that evaluates and treats injured workers. It has many different programs to help L&I with difficult and complex cases. It helps L&I more than it helps the injured workers.

Do I Have to Go? Recommendation vs. Referral

A SIMP can be recommended by an occupational nurse consultant, Office of the Medical Director, independent medical examiner (IME), claims manager or vocational rehabilitation counselor.

The attending physician must be the one to make the referral. L&I will suggest and sometimes pressure your attending physician to make the referral. If your attending physician does not think a SIMP program would benefit you and your claim, they need to write to L&I. Your doctor will then need to propose a curative treatment plan.

The Harsh Reality of a Serious Injury

Not everybody gets better after a severe injury. Significant problems sometimes last forever. This is the real tragedy of an L&I claim.

L&I will not keep a case open forever. When they think your time is up, they will use a SIMP or an IME to help them close your claim.

Claim Closure Rules to Think About

  • The legal system has some interesting rules about what it takes to close an L&I claim. 
  • Rule #1 – L&I can’t close your claim until you either return to work or some doctor says you can work.
    • Consider this: SIMP has doctors and specialists ready to see you today and say you can work tomorrow.
  • Rule #2 –  You are not an expert in your own ability to work.   Doctors are the experts in the courtroom. It is their opinion about your ability to work that counts.  The opinions of medical experts win or lose cases. Doctors who are willing and able to write reports and testify will help decide how an L&I claim turns out. 
    • Consider this: If the SIMP doctor has become an expert in your case, claim closure is easy. L&I will close your case based on the opinions of SIMP doctors. Depending on who the SIMP doctor is and what they say, that may or may not be good. If you disagree with the opinion of the SIMP doctor, you may need your attending physician to help. Your doctor is going to be asked if you can work. This is where your doctor, the attending physician, needs to step up and write a helpful report. If your doctor doesn’t help you, the SIMP doctor or the IME will lead in helping L&I close your case.
  • Rule #3—Ability to work is an opinion. There is no bright line between can work and can’t work. It is a vast grey area. Many seriously injured workers end up in this vast grey area. Their ability to work is uncertain. The facts are not obvious. Therefore, the ability to work will probably be decided by doctors’ opinions. Often, it becomes a fight between L&I’s doctors and the injured worker’s attending physician.
    • Think about this: SIMP exists to help L&I. SIMP offers many programs. In the end, if you go through any of these programs, the SIMP doctors and therapists become the experts who will likely say you can work.

What is Offered in a SIMP Program?

Pain Management Program

The Pain Management Program is a rehabilitation program for injured workers and others with disabling conditions and pain. The functional restoration program includes medical treatment, cutting off or reducing drugs, physical conditioning, treatment of mental health concerns, and vocational counseling.

Work Hardening

This program anticipates a return to a specific job. It consists of simulated work tasks related to that job to increase conditioning and work capacity to tolerate a safe return to full-time work.

Work Conditioning

Work conditioning treatment is meant to improve strength and endurance so that workers can safely progress to work hardening or return to work.

Physical Capacity Evaluations

A Physical Capacity Evaluation (PCE) is a controlled physical assessment over a sustained period. It is a test, often not so obvious, of an injured worker’s ability to work. The PCE is used to consider returning to work in the job of injury, returning to prior employment performed by the injured worker, or considering a retraining goal. The PCE may be used to determine the need for specific work restrictions. It may also be used to close the L&I claim.

SIMP Doctors, SIMP Therapy, and SIMP Rehabilitation programs help some injured workers, and they hurt others.

  • Workers who respond well to a program are helped. They get back to work, and for the most part, everybody wins.
  • This process may hurt workers who do not improve. Their insignificant gains seem to be enough for their SIMP doctors to OK a job analysis and put an end to additional services, including vocational training. This often results in a quick claim closure.

Meet Our L&I Attorneys

The Walthew Law Firm

The Walthew Law Firm specializes in workers’ compensation. With over 90 years of combined experience, our dedicated attorneys help individuals navigate injury claims and secure the compensation they deserve quickly. We prioritize our clients over businesses and insurers, fiercely advocating for injured workers’ rights and best interests.

Read More About The Walthew Law Firm

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