If you returned to the workplace after your L&I claim closed and your work-related medical condition has now worsened months or years later, you may be wondering whether your claim can be reopened. You might also be unclear about what evidence is actually required. Critically, reopening a closed L&I claim is a normal, built-in part of the Washington Workers’ Compensation system, not a rare exception or long shot. In situations such as this, you may be entitled to seek restoration of your benefits.

What It Means to Reopen a Closed L&I Claim in Washington

Reopening a closed L&I claim doesn’t mean you are filing a new claim. Under RCW 51.32.160, reopening a claim restores benefits under the existing claim for the same accepted work-related condition, based on aggravation. However, to reopen a claim, the worsening of the condition must not simply be a subjective increase in pain. There must be an objective worsening of the condition as demonstrated by a measurable, medically documented decline. When determining whether to reopen a claim, L&I would consider evidence such as new imaging findings, reduced range of motion, and documentation of a lower functional capacity.

There are two specific points in time used to evaluate a claim reopening, referred to as the “terminal dates.” The first terminal date is either the date the claim was most recently closed or L&I denied an application to reopen it. The second terminal date is the date the current application was filed to reopen the claim. Specifically, the period the condition worsened must have occurred between those two dates to reopen a claim.

The 7-Year Rule for Reopening a Closed L&I Claim in Washington

Under RCW 51.32.160, a worker generally has seven years from the date the first closing order became final in order to apply to reopen a claim. For claims involving the eyes, a worker typically has ten years to reopen a claim. If a worker files within this time window, an approved reopening can result in restoration of a full range of benefits under the Industrial Insurance Act. A worker would not only be entitled to medical treatment, but time-loss benefits and loss of earning power benefits as well.

After seven years, medical benefits would still remain available under the same worsening standard, but wage-replacement and disability benefits shift to the L&I Director’s discretion. Unfortunately, that discretion is only rarely exercised in favor of a worker.

The Medical Evidence Needed to Reopen an L&I Claim

Strong medical evidence is key to reopening a closed L&I claim in Washington. To reopen an L&I claim, a worker must be able to show:

• A causal connection between the medical condition accepted by L&I at closure and the current condition.
• A medical opinion stating that the condition has worsened since the claim closed.
• Objective medical findings that support the doctor’s opinion, such as imaging, exam findings, or functional testing.

Under the L&I rules, there is an exception regarding the evidence necessary to support reopening a claim for a mental health condition. In such cases, objective findings are not required. However, a medical opinion that connects the worsening to the accepted condition is still needed.

How to File to Reopen a Closed L&I Claim in Washington

Filing to reopen a closed L&I claim is not inherently difficult in and of itself, but it can be challenging to get the claim approved. Importantly, there is a specific administrative process that must be followed when it comes to reopening a closed L&I claim in Washington:

• Obtain a medical evaluation: The first step when it comes to reopening a closed L&I claim in Washington is the worker obtaining an evaluation from a physician. A worker must ensure their medical chart clearly documents how the condition has changed since the claim closed.
• File an application to reopen the claim: An application must be filed with L&I to reopen a claim. L&I has a specific form that can be used (F242-079-000). However, a clear written request that describes the worsening of the condition is sufficient.
• L&I issues a written order: L&I generally has 90 days to decide whether it is appropriate to reopen a claim. This time period can be extended up to 150 days for good cause under WAC 296-14-400 and RCW 51.32.160. Regardless of whether it decides to reopen the claim or denies the request, L&I will issue a written order and notice.

If L&I has approved the claim to be reopened, the reopening can go into effect retroactively, up to 60 days before the application was filed. This is meant to cover medical care that was already received. In the event the claim has been denied, the worker has the right to protest and appeal L&I’s decision, just as they would any other L&I decision.

Contact an Experienced Washington L&I Attorney

If your work-related medical condition has worsened after your L&I claim has been closed, you may be entitled to have it reopened. It’s crucial to have a skilled Workers’ Compensation attorney by your side who can assist you with building the strongest possible medical record and present the evidence needed to reopen your claim. At Reck Law, PLLC, we are committed to helping injured workers navigate all aspects of their L&I claims and achieve positive results. To learn more about our legal services in Washington State, contact us today to schedule a free consultation.