WORKER’S COMPENSATION (“L&I”) CLAIMS.
A Worker’s Compensation claim is based on an on-the-job injury or occupational disease. A worker’s compensation claim is also known as an L&I claim. It is handled through the state of Washington’s Department of Labor and Industries (“L&I”). With few exceptions, this is the only way to recover damages for a job injury; directly suing an employer is not allowed by statute.
Unless the employer is self-insured for worker’s compensation claims, such a claim is handled entirely through L&I. If the employer is self-insured, then its representative handles the claim with L&I’s supervision.
An On-the-Job Injury is one that is a traumatic, sudden, and tangible happening (e.g., slip and fall, carrying a very heavy item, etc.) that causes a resulting physical condition (broken bone, back injury, etc.).
An Occupational Disease is a disease or infection that arises naturally and proximately from job activities. This can result from cumulative exposure over time to some job condition that results in, for example, a skin condition, deafness, blindness, etc., to the worker.
A Psych Claim can also be made for job injuries upon diagnosis and prognosis by a mental care provider.
On-the-job injuries, occupational diseases, and psych claims individually or in combination can be bases for the same L&I claim.
Typically, if the treating doctor says that the injured worker cannot work at least temporarily, then the worker may be paid Time Loss Compensation (“TLC”) until maximum medical improvement is reached.
An L&I claim is a very involved process. The injured worker will need to have an L&I-approved doctor treating him or her (at no expense to him or her) while the claim is open. That doctor will create a file on the worker that can be used to help determine the type of L&I award (if any) to which he or she may be entitled. A psychiatrist may be used for treatment too.
The worker will be examined also by L&I or the employer’s doctors. These doctors evaluate rather than treat the worker. They are hired by L&I or the employer for its purposes. These purposes are to (a) challenge the credibility of the worker’s claim, (b) minimize any restrictions, and (c) get him or her back to work even though he or she may not be able to do so even with restrictions.
The work will be evaluated by L&I or the employer’s vocational rehabilitation counselors also. Their aim is to get the worker back to work without restrictions or with as few restrictions as possible. This means that the worker would return to work even though he or she is unable to do so or has significant restrictions.
When the worker is at maximum medical improvement, it will be determined whether he or she is (a) able to return to work without restrictions, (b) entitled to a permanent partial disability award and is able to return to work with restrictions; or (c) unable to work at all and so entitled to a permanent partial disability and a life-time pension. If the worker, the employer, and L&I are unable to agree on an outcome, then a Court hearing may be required to determine it.
The worker’s compensation claim process is long, hard, and frustrating. It is not straightforward by any means. It is designed to make you want to give up your claim and all of your rights. If that happens, then you could be out of not only your job but also any work injury financial compensation.
For these reasons, you do not want to try to handle your worker’s compensation claim by yourself. You do not know the process nor all of your rights. You may be talked into unwittingly waiving very important rights that you have. Therefore, an attorney is essential to handling your claim.
I have handled this kind of matter for over fifteen years and have gotten both permanent partial and total permanent disability awards for clients based on both work-related physical injuries and psych problems related to the physical injuries.
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