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.
How is Washington State L&I calculated? ›
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 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.
Who is responsible for determining if an injury is work-related? ›
If there is a question or doubt about the injury or illness being job-related, the supervisor shall attach a memorandum to SCIF e3067 (STATE) outlining the facts as they are known and request further investigation by State Compensation Insurance Fund.
Do I have to pay taxes on L&I Washington State? ›
No taxes will be withheld.
The IRS considers time-loss compensation to be a disability benefit, not earned income, so income tax laws do not apply.
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.
Can I sue L&I Washington State? ›
Can You Sue L&I? You cannot sue L&I, even if you are unhappy with how they handle your claim. Washington State workers injured on the job cannot sue their employer for negligence, instead, they must file a workers' compensation claim with L&I.
What is the statute of limitations on L&I in Washington state? ›
Washington State L&I Statutes. of Limitations Explained
In the land of Labor and Industries, occupational disease claims have a two-year filing time limit, while you only get one year to file industrial injury claims.
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).
How long do you have to report an injury at work in Washington State? ›
Don't delay. Claims for injuries must be filed within 1 year of the accident. Claims for occupational diseases must be filed within 2 years after receiving written notice from a health-care provider that the condition exists and may be work-related.
What does Washington L&I cover? ›
L&I is a government agency in Washington State that handles workers' compensation claims and provides medical benefits and limited wage-replacement coverage to workers who are injured or develop certain occupational illnesses at work.
What is the compensation to be paid to the workers? ›
Compensation describes the cash rewards paid to employees in exchange for the services they provide. It may include base salary, wages, incentives and/or commission. Total compensation includes cash rewards as well as any other company benefits.
How does employee compensation work? ›
Employee compensation isn't just about the base salary. It includes a wide range of benefits and perks such as health insurance, life insurance, 401k matching, stock options, paid time off, and more. These elements collectively form the total compensation package.
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.
What to do when injured at work in Washington State? ›
Claim-specific questions:
- Report your injury or exposure to your employer as soon as possible.
- File a claim for benefits by submitting a completed Self-insurer Accident Report (SIF-2). ...
- Have your medical provider submit a Provider Initial Report (PIR) with your employer or their third-party administrator.
Washington State L&I Statutes. of Limitations Explained
In the land of Labor and Industries, occupational disease claims have a two-year filing time limit, while you only get one year to file industrial injury claims.
