I believe my law ﬁrm is one of the best social security disability and workers’ compensation law offices in the State of Washington. For the past 15 years I have exclusively represented employees in their ﬁght against the Department of Labor and Industries (LNI) and Self-Insured Employers, i.e. Boeing, Nalley's, Weyerhaeuser, etc. Moreover, many of my social security disability clients often have become unable to work as a result of on-the-job injuries. I know how to navigate both systems-utilizing all of the information to bring a winning result.
The following is overview of a LNI claim and the typical problems seen in my office. This overview is not complete. There are many more "Phases" to a claim. I believe this is the easiest way to communicate the major steps of the claim process and the errors often made. It is not a legal opinion. Want a legal opinion, obtain an attorney. I believe if you have a claim you should have counsel. It is your choice. This overview highlights the errors I commonly see done by injured workers. Unfortunately it is often too late for me to help the injured worker once they have come to me. It is a horrible feeling. Mistakes put a knot in my stomach when I tell them, "I cannot help. It is too late." We all make choices that we have to live with. The system is complex and has many areas that can trip up an injured worker. These are some errors I have seen over the last 15 years based on workers’ choices.
PHASE 1- INJURED AT WORK
If you are injured at work and your claim is accepted, workers‘ compensation (LNI) pays for medical care directly related to your accident. If you are unable to work following your injury, you may be eligible for a portion of your lost wages. Problems arise when injured workers don't: 1. Tell their employer; 2. Get ﬁrst aid; 3. See a doctor and 4. File a claim.
PHASE 2 - FILE A CLAIM
If you are injured at work, you and the doctor who treats you will ﬁll out an accident report form. Your claim is ﬁled when your doctor sends this report to LNI for processing. Problems arise when injured workers don't: 1. Complete the application accurately; 2. Complete the application completely; 3. File the application timely; 4. Cooperate with independent medical exam requests; and 5) Follow Phase 1.
PHASE 3 - APPROVED CLAIM OR REJECTED CLAIM
LNI can approve your claim if your doctor certiﬁes that you were injured at a speciﬁc time and place during the course of employment, or that you have an occupational disease. Beneﬁts may include payment of medical bills, wage replacement or earning capacity replacement. Other beneﬁts may include potential payment for permanent impairment, return-to-work help, or even lifelong payments for the severely injured. Problems arise when injured workers don't: 1. Seek recommended medical treatment; 2. Follow through with recommended medical treatment; 3. Take action when they disagree with a LNI decision; and 4. Take action when they disagree within the required time period.
LNI can also reject your claim. Claims are often rejected if the injured worker's doctor cannot certify that the worker's medical condition is related to an injury or an occupational disease while in the course of employment. This process frequently requires the LNI claims manager to collect background information about the worker's application and the worker's medical and or job history. The claims manager will likely send the injured worker to an independent medical examination. Problems arise when injured workers don't: 1. Participate with LNI to provide this historical information; 2. Communicate properly with their doctor about the onset of symptoms; 3. Give consistent accounts of the injury or occupational disease throughout the treatment process; 4. Take immediate action when the IME report is against the injured worker's interest; 5. Exercise their right to protest or appeal any decision made about your claim; and 6. Exercise their protest or appeal rights timely.
PHASE 4 - CLOSED CLAIM
LNI normally closes claims when the injured workers have reached their maximum medical improvement. Often this is based on their doctor or another physician certifying that further treatment will not improve their condition. When LNI has no information showing that the injured worker needs further treatment they often send the worker to an IME. The purpose behind treatment is to return the injured worker to pre-injury status. Problems arise when injured workers don't: 1. Return to pre-injury status; 2. Obtain proper rating for permanent partial disability; 3. Obtain proper rating for permanent total disability; 4. Act when they disagree with LNI decision; and 5. Act timely when they disagree with LNI decision.
PHASE 5 - REOPENING CLAIM