The Washington Department of Labor and Industries handles around 70% of workers’ compensation claims in the state (L&I). L&I is essentially a state-run insurance organization that offers benefits to employees who are injured on the job or acquire a work-related disease or illness. The remaining workers’ compensation claims are handled directly by self-insured employers.
What Exactly Is L&I?
L&I is an abbreviation for the Washington State Department of Labor & Industries, which is responsible for processing workers’ compensation claims for employees who are injured or acquire certain illnesses on the job.
How Does Legal & Industrial Relations Work?
When a person in Washington is injured, becomes ill, or catches certain types of illness on the job, the claimant is eligible to workers’ compensation benefits. They can initiate the L&I claims procedure by submitting a claim online, by phoning the L&I office at (877) 561-3453, or by visiting their doctor’s office. If all goes according to plan, L&I will accept the injured worker’s claim and the worker will receive numerous compensation. However, as a result of the claims process’s bureaucratic structure, many cases become bogged down in red tape, paperwork, and technicalities. An L&I claim can be denied by the WDLI for practically any reason, and once denied, reversing an initial denial requires experience and determination.
What Is Considered To Be A Worker’s Compensation Claim?
In most circumstances, if it is established that the worker’s injury or sickness was caused by his or her job, career, or work-related responsibilities or activities, the L&I claim is granted and the worker is entitled to various benefits. Claimants may, however, be denied for a variety of grounds, including the following:
- Preexisting conditions are referred to as “preexisting workplace injuries.”
- It is found that the injury occurred outside of work.
- An opinion that the harm is not as severe as described, or that it does not exist at all.
- Because the accident occurred in a parking lot, it is not covered.
- If the injury is a result of a mental health problem, it is frequently dismissed due to a lack of medical proof.
- A physician believes that the injury as stated does not correspond to the actual injury identified.
Who Is Covered By Liability & Insurance?
Workers’ compensation insurance covers virtually all employees in Washington state. Around 70% of Washington employees are eligible for workers’ compensation benefits under L&I. The remaining 30% make direct claims against their self-insured companies.
Am I Insured Through L&I Or Through My Employer?
Determine the type of workers’ compensation coverage you have by contacting your human resources department.
Benefits from Workers’ Compensation
If you are injured on the job and have an accepted L&I workers’ compensation claim, you are entitled to benefits to assist with treatment costs and to replace lost wages throughout your recovering period.
What Is Covered by Workers Compensation?
L&I offers a variety of benefits aimed at assisting employees with their return to work. However, L&I does not pay for healthcare for any other medical conditions unrelated to the occupational accident, for medical care that is not covered by workers’ compensation, or for treatment provided by doctors who are not part of L&I’s provider network (other than the initial emergency room visits).
Medical expenses incurred as a direct result of the injury or sickness will be covered as long as the healthcare providers are members of the L&I provider network. Additionally, certain prescription drugs are covered.
Alternatively referred to as “time loss compensation,” salary replacement normally provides between 60% and 75% of the worker’s earnings prior to the injury or illness, subject to a cap. To maintain consistent time loss compensation payments, which are typically provided twice a month, your doctor must certify your health status on a regular basis.
Compensation for Disabilities
Individuals who become disabled as a result of an injury or occupational sickness can normally get one of two types of monetary compensation: lump-sum settlements for people who are able to return to work and pensions for workers who are unable to.
These are monetary awards made when your claim is resolved and you are able to return to work. To be eligible for PPD compensation, your accident or illness must be evaluated by a physician who determines that you are permanently partly disabled.
Pensions are available to workers over the age of 50 who are unable to find job due to a work-related accident or sickness. As with time loss compensation, a structured settlement pension pays between 60% and 75% of the worker’s pre-injury salary, with twice-monthly pension payments continuing for the length of the worker’s life.
Displacement And Retraining Of Workers
Another benefit that is occasionally provided in lieu of a pension is job retraining (also known as Vocational Rehabilitation). Essentially, with the support of a Vocational Rehabilitation Counselor, L&I tries to certify you in a new line of work (VRC). However, unless you are capable of performing the task required in a new field, retraining may place you in a worse position.
Benefits Upon Death
Relatives of deceased workers are also eligible to workers’ compensation. Survivor pensions, funeral reimbursements, or a lump-sum payout to the deceased worker’s spouse or domestic partner are all available benefits.
What Is The Definition Of A Third-Party Claim?
Workers in Washington State cannot sue their employer for compensation if they are hurt by a third party. However, if your accident is caused by defective items or machinery, or by someone who is not a coworker, you may be eligible to file a third-party injury claim to get compensation for your injuries.
How To Submit A Claim For L&I
If you are injured on the job, you have three choices for filing an L&I claim in Washington state:
- To file a complaint, call (877) 561-3453.
- Submit your application online.
- Maintain a file at your physician’s office.
- To make an L&I claim, you will want assistance from your physician. Each of the following tasks will be performed by your physician:
- Ascertain that your injury was indeed work-related.
- Ascertain your abilities to re-enter the workforce.
- Complete the form for the Accident Report.
Should You Hire An Attorney To Represent You In A Workers Compensation Claim?
Simply being eligible for workers’ compensation does not guarantee you will receive aid. The claims procedure can be lengthy and complicated, replete with red tape, paperwork, and legal terminology. Without the appropriate tools and resources, navigating the complexity that is an L&I claim can significantly exacerbate an already stressful situation. Carol, Colven, Robison & Shafton possesses extensive expertise litigating L&I claims. We take the time to thoroughly research your case to ensure that all potential claims are found.