L&I claim in Washington State – reality versus perspective

L-and-I claim claim manager perspective

Workers compensation claims are challenging for a variety of reasons. However, I think one of the biggest reasons that L&I claims are so challenging for work injury claimants, is because there is a disconnect between reality and the claim narrative. What I mean is, I can review claim file materials like letters, forms, decisions and orders, vocational reports, and medical records. Based on that review, I can generally see the claim narrative.

 

L&I claim narrative

Here’s an example of a standard narrative for an open L&I claim with accepted condition of low back sprain/strain. The injured worker is treating with a chiropractor and a surgeon. An MRI done of the low back showed severe degenerative disc disease impacting the nerves and producing radiating symptoms into the legs. The surgeon recommends a series of epidural steroid injections. These were not authorized. An IME was done and concluded the injured worker has reached maximum medical improvement for the accepted low back strain. Any more serious conditions are attributed to the natural aging process, not the industrial injury. Based on the IME, no further treatment with the surgeon is being authorized.

 

The assigned vocational counselor has concluded based upon the accepted sprain or strain that the injured worker can return to work as a drywall installer without limitation. Although, all the medical providers agree that this occupation is likely not appropriate when considering the more severe degenerative disc disease seen on MRI. Nonetheless, an order has been issued terminating time-loss compensation benefits and the claim is headed for closure.

 

L&I claim in reality

In my experience, a closer look at the injured worker’s life reveals an entirely different reality. Prior to the injury, the worker had no low back problems. No symptoms, no complaints, no need for treatment. After the work injury, the worker has been plagued by debilitating low back pain. It took months to secure authorization for the MRI. Finally, the MRI provided some clues as to the source of the symptoms and a potential treatment plan. However, that treatment plan cannot be carried out because the Department of Labor and Industries (L&I) will not authorize it. L&I will not take responsibility for the degenerative disc disease despite the injured worker having no symptoms prior to the injury. The employer aggressively fought claim allowance.

 

After the workers compensation claim is allowed and the injured worker was off work for some time, the employer laid the injured worker off. As a result, the injured worker has no private insurance, has lost their source of income, has taken a serious hit to their retirement plan, and lives each day in chronic and debilitating pain. Relationships with family and friends are strained, at best. Now, the worker’s benefits are being terminated and their claim is being closed leaving them in the worst possible way. L&I is going to make its decision. That decision probably isn’t going to be favorable to the injured worker. The injured worker will have the burden of proving that L&I is wrong. That burden is not just a legal burden of proof, it is a financial burden. One that the injured worker likely cannot afford.

 

Bridging the disconnect in L&I claims

This disparity between the claim narrative and actual reality makes workers’ compensation claims challenging. That challenge is exactly why I do what I do. A big part of my job is using my knowledge, experience, and expertise to make the claim narrative and reality match.

 

I’ll be the first to admit, it isn’t always easy to do. In fact, it isn’t something I can do alone. I rely on medical and vocational evidence, facts and data to argue for a realignment of the L&I claim narrative with reality. Until and unless there is a dramatic change in how claims are administered, claims are going to continue to present challenges. Meanwhile, I am going to be here to help injured workers face those challenges head on.

8 thoughts on “L&I claim in Washington State – reality versus perspective

  1. L&I attorneys cannot ask for money from you until settlement. Its the law.
    If you find yourself in this or similar situation, get a good L&I attorney.

  2. My L&I was just closed for a right shoulder injury at work. Had two surgeries, shoulder did not heal, have very little movement, or use of the shoulder and the stupid dr where I moved to didn’t do sh** about it just wanted the money. He didn’t care what I said about pain, movement, numbness, etc. He closed my case and released me to work without restrictions. Knowing I have no use of my shoulder all the way to my fingertips. This has been very hard for me and my children since it’s hard to get a job where I can’t lift nothing but a pencil, write or cutting.

  3. Washington state Department of Labor & Industries does not care about the injured worker. Instead these claim managers seem to have one goal — that is find a way to deny the claim or delay any time loss payments to the point of starving the claimant back to work before he or she is medically ready just to put food on the table. My so called claims manager in setting my wage to establish my time loss comp takes my 3 months of wages (I was off work for 6 months during Covid) and averaging them over a 12 month period and in the same decision letter she makes a point to say my work is neither full time or year round. I was averaging just over $10,000 a month while I was working before my accident so time loss payments should be around 6K per month but instead I get $560 every 14 days. This is just one example of the bush league, underhanded and heartless plays performed by one of the worthless claim managers at the Department of L&I in Washington state.

  4. You got that right. Been on L&I for 2 years from an injury at work. Have not received a penny from them. Its bulls****. All they want me to do is go back to work. But my Doctor won’t release me to go back to work because I am still not ready. What am I supposed to do?

  5. Lni has been a joke. It is broken and nobody wants to fix it. Lni just want to deny deny deny and my lawyer, yes i had to lawyer up, just want to prolong everything. I’m at the point i’m back to work and i just want it all to go away.

  6. I am going through a rough time right now. I would ask Lni or any employer to put themself in mind if one of there family members were involved in a bad situation like mine would you care. Would you analyze would you treat would you. I’m asking. would you? IF IT WAS YOUR KID YOUR HUSBAND. WOULD YOUR DECISIONS BE THE SAME.DOCTORS SIT YOU DOWN IN A ROOM SO YOU CAN FOLLOW PROTOCOL. AND TELL YOU ONE THING AND WHEN YOUR WALKING OUT. WHY WOULD YOU PUT A REPORT SAYING DIFFERENT FOR ONE TO TURN IN THERE OF LIFE ON PAPERWORK. WHILE SITTING IN THE ROOM YOU CAN HERE THEM WHISPERING OF MY LIFE. ISN’T IT ENOUGH TRY TO GET OVER THIS COVID. AND DOCTORS AND LNI CARRY THEMSELVES LIKE THE DISEASE THAT IS KILLING ALL OUR FAMILIES.The most safest and mental damage is having your family and kids lose faith In the only person they trust no longer carry a title. how can lni not contradict and put doctors on check and stop railroading. IN GOD I TRUST ALL MY LIFE I THOUGHT I WAS WRONG SOMETIMES BUT I PASS ON THAT AND LEAVE THE TITLE TO WHOEVER DESERVES IT.
    .

  7. 1 – Injured 07/19/2018
    2 – Laid off 01/25/2019
    3 – Began getting payments after IME and acceptance to make time loss payments 05/??/2019 1st payment was 1/2 of the time that I was off and unable to work approx. 15k+/- sent May maybe June and my monthly pay before unable to perform at work productively and efficiently enough to stay on as Electrical Superintendent of public works projects primarily schools making approximately 12k+/- a month but time loss was then
    3A – $2850.00 every 14 days to
    3B – $3252.00 every 14 days
    3C – $232 X 30 days = $6970.00
    4 – $14575.00+/- back pay check from
    January 25th 2019 to
    June ?? 2019
    L&I and vocational Are aware of my Disabilties like
    1 – gender dysphoria,
    2 – ADHD,
    3 – (2) brain trauma attacks
    4 – Arson fire while sleeping in car & I Almost died
    5 – fight or flight
    6 – false allegations of being abusive
    7 – no contact or anything with my son for 19+ months
    8 – best friend died 08 2018
    9 – another best friend no contact 2+ years 01 – 2018
    10 – 2 best friends no contact 19+ months 07 01 2019
    11 – dad diagnosed Terminal illnesses 03 02 2019
    12 – mom diagnosed Terminal illness 09 10 2018

    Temporary and Permanent
    ADA approved assistance for Permanent Disabilities and approved for assistance

    Temporary Disabilities I am waiting to see what L&I or ADA says about the recent request for ADA assistance in scheduling and being sure to navigate the process to Surgery so far have lost 2 surgeons due to the effects of everything effectively caused by L&I and the slow life altering process to treat and rehabilitate from being hit by a tractor on the job and I was making $97.00 pr hour with benefit package typically 20% to 30% above wage at time of injury.
    INJURY AND Divorce causing MY WIFE after keeping my secret for 15 years ousted me as transgender with gender dysphoria then lost job/career then Son started hating me then marriage over then son and wife tell cops all lies when I was attacked and it costs me over 20k in medical bills then 5 weeks later almost beaten &

Leave a Reply

Your email address will not be published. Required fields are marked *