If you are a Washington State employee and have been hurt at work, a denial of your L&I claim doesn’t have to be the end of the road. You may have been affected by one of many mistakes employers make with L&I claims that result in an improper denial of benefits. If so, appealing an L&I denial could get you the financial support you need to pay for your recovery and get back to work.

What Happens When an L&I Claim is Denied?

After an L&I claim manager has reviewed your claim, he or she will decide whether your claim qualifies for benefits, and the amount to be paid to you or your medical providers for lost time and treatment costs. When that happens, the claim manager will issue a written decision called:

• Order and Notice (a written decision stating whether you claim has been allowed or rejected)

The L&I claim manager could deny your claim outright because:

• You failed to prove the accident occurred
• The injury was not work-related
• You missed the deadline to file your claim
• Your paperwork was incorrect
• Documentation is missing or incomplete
• Your employer contended that your claim should not be allowed

However, claims managers also make mistakes and the reason for rejecting your claim may be incorrect under the law or facts. It may not be clear to your claims manager how your occupational disease or injury was connected to your work.

How Long Do You Have to Appeal an L&I Denial?

If your L&I claim is denied, you have the right to send a protest letter to the Claim and Account Center or file a formal appeal. A protest letter triggers a readjudication of your L&I claim denial. A protest is less formal than an appeal. This can extend the time it takes to resolve your claim, especially if your employer is self-insured. However, if the insurer reverses or modifies its earlier decision, it can avoid the need for appealing an L&I denial.

If you have received an Order and Notice, you have 60 days to submit a written protest or file an appeal. This is an absolute and non-negotiable deadline. If you miss it, there is nothing that can be done. Therefore, it is imperative to reach out to an attorney or submit the protest yourself without any delay. You can protest any unfavorable Orders or Decisions, even if you would receive some but not all of the benefits you sought.

A protest must be in writing and contain sufficient details to put L&I on notice that you disagree with their decision. You can mail, fax or send your protest to L&I through secure messaging in Claims and Account Center. In a protest, it is a good idea to provide L&I with all the rational and medical or employment evidence you can to show that their decision is incorrect.

Appeals should be filed using the Board of Industrial Insurance Appeals’ appeal filing portal found on their website: https://biia.wa.gov/Filing.html. Following the Board's online form will ensure you submit all the correct information which generally includes:

• Your name and claim number (on every page)
• Your mailing address and telephone number
• The date of your L&I claim
• The date of the Order and Notice you are appealing
• The reason or reasons you believe the Order is unjust or unlawful
• The city where you want the proceedings to be held

There are a variety of legal strategies that can apply to any claim rejection appeal. Therefore, if your decision is to appeal it is best to speak with an L&I attorney as soon as you can, to identify any errors in the L&I denial, weigh your options in submitting a protest letter or appeal, and timely file your protest or appeal.

Possible Outcome of Protesting or Appealing Your L&I Claim Denial

If you protest the decision, then L&I will take a second look and make another decision whether to allow your claim or affirm rejecting it. If you file an appeal, the Board will review the documentation provided to determine if it has jurisdiction over the claim. If the Board does have jurisdiction, it will then review the substance of your case. There is no deadline for this to occur, so it may take several months before you receive a decision on your L&I denial appeal. Regardless, as the appealing party you have the burden of proving that the L&I decision to reject your decision was wrong. Some possible outcomes of appeal include:

• Settlement or Resolution: You and L&I (or the self-insured employer, as the case may be) may reach an agreement through mediation or negotiation to resolve the case before the appeal is complete.
• Hearing: Essentially litigation. You may need to go before an industrial appeals judge to present your case for reversing or changing the L&I denial order. This usually requires testimony from both you and other lay witnesses and testimony from a medical professional supporting that your claim should be allowed. Then, based on the evidence the Board may either affirm L&I’s decision to reject your claim or reverse the decision and direct L&I to accept your claim.

Summary

If you have received an L&I denial Notice and Order rejecting your claim, your first call should be to an experienced L&I attorney to determine if an error has been made. You only have 60 days to protest or appeal an L&I denial, and there are a variety of legal strategies that could be employed when protesting or appealing such a decision.

At Reck Law, PLLC, we know it can be frustrating to get the help you need. We are here to help you review your L&I denial, weigh your options for protesting or appealing the denial. To learn more about our individualized approach to workers’ compensation claims in Washington State, contact Reck Law to schedule a free consultation.