People that suffer a work injury while working their job have certain rights and benefits under the Industrial Insurance Act. After they file a workers’ compensation claim or L&I claim, they also have some responsibilities under their claims. This fact holds true for an industrial injury workers’ comp claim as well as an occupational disease L&I claim. If you fail to meet these responsibilities, then L&I can consider it as noncooperative behavior.
The risks of non-cooperation in a workers’ compensation claim
If L&I thinks that you are not cooperating, you will likely receive a non-cooperation or non-coop letter. As a result, they might reduce some of your workers’ compensation claim benefits, or even suspend or deny other benefits. In my experience, I feel that some claims managers are unreasonable when they accuse injured workers of noncooperative behavior. And, this issue of unjust accusations of non-coop behavior in the workers’ compensation claim process concerns me. I believe it is contrary to the intent and purpose of the Industrial Insurance Act. Furthermore, it’s something I strongly advocate and fight against.
However, candidly speaking, I have also seen my fair share of legitimately noncooperative behavior. It’s very important for work injury claimants to understand that non-cooperative behavior can significantly harm the outcome of their workers’ compensation claim. More explicitly, WAC 296-14-410 outlines that the Department of Labor and Industries (L&I) or Self-Insured Employer administrators have the authority to reduce, suspend, or deny benefits when a work injury claimant is indeed noncooperative.
What is non-cooperation in L&I claims?
Noncooperative behavior is when an injured worker (or their representative) obstructs or delays L&I’s ability to resolve a claim or claim-related issues in a timely manner. The administrative code WAC 296-14-410 provides some good examples, which include:
(1) Failing to attend an Independent Medical Examination (IME);
(2) Not attending vocational appointments;
(3) Not making or scheduling appointments or evaluations with an attending provider;
(4) Unsanitary or harmful behaviors that slow recovery; and
(5) Refusing essential treatment for recovery.
Non-cooperation in L&I claims: Theory versus reality
In my experience, there are often very good reasons an injured worker may miss an appointment or elect not to undergo an invasive treatment (like surgery). If an injured worker has a “good cause” reason for their actions, then they are not noncooperative under the law. Before L&I or a Self-Insured Employer can reduce, suspend or deny benefits, they must give the injured worker an opportunity to provide a “good cause” explanation.
Practically speaking, L&I or the Self-Insured Employer must send a letter to the injured worker warning them that their benefits may be suspended for lack of cooperation. Then, the work injury claimant has 30 days to provide a written explanation about the allegations of noncooperative behavior. If the injured worker fails to respond within 30 days, or if the explanation is unsatisfactory, only then can L&I or the Self-Insured Employer reduce, deny, or suspend benefits.
Non-cooperation in workers’ comp cases is very subjective
From my perspective, as a workers’ compensation law firm and attorney, the problem is that the process if highly subjective. Who is to decide if certain behavior counts as “good cause” or not? Accordingly, there are many inconsistencies in L&I decisions with respect to non-cooperative behavior in L&I claims. Some people with work injury claims repeat their non-cooperative behavior without penalty. Others seem to receive penalties at the drop of a hat. This is infuriating. Personally, I believe that all injured workers should be treated in the same, fair manner without prejudice.
How can we fix non-cooperation decisions in workers’ compensation claims?
I believe the following practices can help injured workers avoid noncooperation accusations:
(1) See your attending provider roughly every 30 days and avoid missing or cancelling appointments;
(2) If you must miss or cancel a doctor’s appointment, then you must reschedule it as soon as possible and let your L&I claim manager know;
(3) You must attend all your vocational meetings even if they seem unproductive;
(4) If you are participating in a retraining program, then you should keep good communications with your vocational counselor;
(5) If you are struggling during your retraining program, then ask for help or tutoring right away;
(6) Meet all the deadlines you are given by your claim managers or vocational counselor;
(7) Attend all IME appointments unless you speak to the workers’ comp claim manager in advance and they agree to cancel or reschedule; and
(8) If you have a good reason for engaging in behavior that might be considered noncooperative, then share your reason with your claim manager before they have an opportunity to send you a warning letter.
As always, if you receive a warning letter saying that you are noncooperative under your L&I claim or workers’ compensation claim, then you should probably consult with an experienced attorney. To summarize – learn your options, make sure you know your rights, and be sure to adhere to the rules.