L&I claim benefits and workers’ compensation claim rules vary from state to state. L&I claim in Washington State follows the requirements of the Industrial Insurance Act. Here, in Washington State, the goal is to provide benefits to people with a work injury claim and their dependents.
Labor and Industries (L&I)
The Department of Labor and Industries (L&I) is the Washington State agency that administers these benefits. Consequently, it’s L&I’s job to determine the benefits to provide in every workers’ compensation claim. Generally, employers and employees statewide pay workers’ compensation insurance premiums out of every paycheck. For state-funded work injury claims, L&I pays benefits out of the premiums they collect throughout the year. Overall, when I think about all available L&I claim benefits, I group them into categories: treatment, wage replacement, vocational, and closing.
L&I claim medical treatment
L&I must authorize treatment that is “necessary and proper” for any condition that relates to the work injury claim. In essence, “necessary and proper” typically refers to diagnostic, curative, or rehabilitative treatment. Moreover, L&I does not consider purely palliative treatment as necessary and proper under the law. L&I uses a third party called Comagine to help determine whether treatment fits the definition. Usually, treatment continues until the work injury claimant gets to maximum medical improvement. That’s when medical providers say the person with the work injury is as good as they are going to get.
Wage replacement in workers’ compensation claims
Employers can opt to keep the work injury victim on salary while they recover. However, in many cases employers don’t do this. Then, if the work injury claimant can’t work or has reduced earning capacity, they may be entitled to wage replacement benefits. Explicitly, these include time loss compensation or loss of earning power. Realistically, L&I pays time loss compensation if the work injury claimant is temporarily incapable of working while recovering. This is referred to as being “temporarily totally disabled”.
L&I pays time loss compensation benefits at base rate of 60% of the work injury claimant’s wages at the time of injury. Loss of earning power benefits are paid when the work injury victim can work to some extent while recovering but has at least 5% reduction in earnings.
L&I claim vocational benefits
Surprisingly, many people don’t realize that vocational services are part of their L&I claim benefits package. Personally, I think that vocational benefits are particularly important for work injury claimants. Many workers need retraining to get back to work. In particular, this is often the case for people that work physical jobs after they suffer a work injury. Often, their work injury results in permanent physical limitations. When this happens, L&I can authorize and cover the costs of retraining for up to two years. Finally, L&I assigns a vocational counselor to oversee the entire process.
Closing L&I claim
Are there L&I claim benefits during claim closure? Yes! Many people are surprised to learn that L&I pays certain benefits when their workers’ compensation claim closes. In fact, L&I provides benefits at claim closure whenever the injured person has permanent measurable residuals. Many times, the person having the work injury is capable of working (despite the residuals). For compensation, they should get a permanent partial disability award (PPD award). The PPD is a monetary award. L&I bases the PPD award amount on the permanent disability that they can measure. More correctly, a competent medical provider is responsible for measuring the level of disability.
Sometimes, the person that suffered an injury at work is no longer capable of working. In such instances, we refer to them as “permanently totally disabled”. L&I places such injured people on an when their claim closes. The value of L&I pension benefits is comparable to time loss compensation benefits. However, L&I pays pension benefits monthly for the remainder of the work injury victim’s life. That’s true as long as they remain permanently and totally disabled.
The role of a workers’ compensation attorney in Washington State
An L&I attorney or workers’ compensation attorney like me has several roles. For one, L&I attorneys ensure that L&I and insurance companies provide work injury claimants the benefits they deserve under the law. Furthermore, L&I issues orders or notice of decision letters regularly. These decisions are very important. They often contain entitlement to benefits. In many cases, people with L&I claim disagree with L&I’s decision. Therefore, they can protest or appeal the decision. Many times, the likelihood of success can be much higher with the help of an .
FAQs
L&I pays time loss compensation benefits at base rate of 60% of the work injury claimant's wages at the time of injury. Loss of earning power benefits are paid when the work injury victim can work to some extent while recovering but has at least 5% reduction in earnings.
How does L&I claim work in Washington state? ›
L&I or your self-insured employer can approve your claim if your doctor certifies that you were injured at a specific time and place at work, or have an occupational disease. If your claim is approved, you may be eligible for a variety of benefits, including medical care, if it's directly related to your injury.
How much does L&I pay in Washington state? ›
A worker receives a percentage of wages based upon family status and number of dependents at the time of injury. A worker is entitled to 60% of their gross monthly wage. An additional 5% is added for a spouse and 2% for each dependent child, up to five children.
What is the employer's responsibility when a worker is injured? ›
The employer shall: Assure that first aid is administered for minor injuries or arrange medical treatment by an employer selected physician or the employee's pre-designated physician when necessary. For extreme emergency get the injured to any available doctor, hospital, or public medical service.
How does Washington State pay for workers compensation? ›
The Department of Labor & Industries, Insurance Services Division, manages the Washington State Fund. This fund derives its income solely from premiums paid by you and your employees. The fund receives no money from general tax revenues.
What is the waiting period for L&I in Washington State? ›
If your worker misses time from work and their doctor certifies they are unable to work, L&I may pay for a portion of their lost wages, which is called "time‑loss compensation." However, the first 3 days immediately following the worker's injury are considered a waiting period.
Who is responsible for determining if an injury is work-related? ›
In the preamble to the 2001 final rule, OSHA explained that recording a case on the OSHA recordkeeping forms indicates only three things: (1) that an injury or illness has occurred; (2) that the employer has determined that the case is work-related (using OSHA's definition of that term); and (3) that the case is non- ...
What is the first thing that must be done when a worker is injured? ›
One of the most important things to do is to report the injury to your Workers' Compensation provider. Keep in mind that all injuries must be reported. Reporting also involves notifying a supervisor, HR department, or designated safety officer.
Are employers liable for injuries to employees even if the employees are at fault? ›
In cases where a worker's own behavior resulted in an accident, employers are still responsible for ensuring the workers' safety if the accident occurred on company property or on company time. They are also responsible for making sure that the employee receives medical treatment.
What is the first action when someone at work has become badly injured from an offenders aggressive actions? ›
Call 911 and other appropriate emergency contacts (such as Federal Protective Service) for that particular facility, particularly if the situation requires immediate medical and/or law enforcement personnel. Remain Calm and Contact supervisor. Secure your personal safety first.
Each year, L&I actuaries calculate base rates for each risk classification based on 5 years of claim costs by claim type and hours worked (Risk classifications with insufficient data are combined with larger classes to calculate combined base rates.)
Is WA L&I the same as Workers Comp? ›
Is L&I Insurance The Same As Workers' Compensation? While L&I is the primary form of workers' compensation in Washington state, it is not the only option. Employers can pay for their own self-insurance if they meet certain requirements. Regardless of your coverage, your worker's rights to benefits will not change.
How does workers' compensation work in WA? ›
The workers' compensation scheme operates on mutual obligations. The employer and insurer have obligations to pay you a salary and cover the cost of your treatment. In return for accepting that salary, you must attend work and undertake duties that are medically appropriate, as indicated on your certificates.
How is L&I calculated in Washington State? ›
Here's how L&I calculates the premium rate for each of the business's risk classifications: Multiplying the business's experience factor by the sum of the Accident Fund, Medical Aid Fund, and Stay at Work base rates, and then. Adding the base rate for the Supplemental Pension Fund.
How does workers compensation work in WA? ›
The workers' compensation scheme operates on mutual obligations. The employer and insurer have obligations to pay you a salary and cover the cost of your treatment. In return for accepting that salary, you must attend work and undertake duties that are medically appropriate, as indicated on your certificates.
How long do you have to reopen an L&I claim in Washington State? ›
The amount of time that you have to reopen your L&I claim depends on the benefits you are seeking: For medical treatment only, you may apply at any time. For both wage replacement benefits and medical treatment, apply within 7 years of the date your claim was first closed (10 years for eye injuries).
What to do when injured and can't work? ›
Seek medical attention for your injuries right away, even if you think your injuries aren't severe. Notify your employer of your injury and need to recover. File a Workers' Compensation claim. Contact a personal injury and Workers' Compensation lawyer.
