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Medical Benefits

Medical benefits

If you are injured at work and need treatment, go to the emergency room or doctor of your choice and say you were injured at work. The doctor will assist you in filing the workers' compensation claim.

If your claim is approved, L&I or your self-insured employer will cover medical bills directly related to your injury. Your coverage may continue until your doctor certifies your injury has stabilized and reached a point where further recovery isn't expected.

New in 2013: If you need further medical care after the first visit, you will need to see a provider in our network. If your regular doctor is not in our network, encourage them to join, or find a provider that is in our network.

Questions workers have

Will my medical benefits continue if I go back to work?

Yes. If your claim is still open, you receive medical benefits even if you are working.

What medical care isn't covered by workers' compensation?

Workers compensation cannot pay for:

  • Medical conditions not related to your workplace injury or illness.
  • Treatments with benefits that cannot be measured objectively by a doctor or that continue after the worker is medically stable.
  • Treatments not covered by workers comp, such as acupuncture.
  • Treatment from providers who are required to join but are not enrolled in L&I’s network, other than an initial office or emergency room visit when the claim is filed.
Why does my Notice of Decision say that my claim is both allowed and closed?

Many injuries are treated and healed before the paperwork reaches L&I. In these cases, we may issue a single decision both authorizing medical expenses and legally closing the claim. This saves time and paperwork for everyone.

How do I reopen my claim for more medical care?

If you need treatment within 60 days after your claim was closed, you or your doctor may protest the closure of your claim.

After more than 60 days from claim closure, you and your doctor may apply to have your claim reopened so that your medical bills can be paid, as long it is for the same workplace injury.

What if I thought I was okay, but now I need reopen my claim for more medical care?

If your claim was closed, you and your doctor may protest with in 60 days. Later than that, you and your doctor may apply to have it reopened so that your medical bills can be paid, as long it is for the same workplace injury.

Also, your doctor may refer you to a specialist (such as a surgeon or an orthopedic specialist).

What if I need to change doctors?

You may change doctors as long as the new doctor is qualified to treat your accepted injury or illness, and has joined L&I's network if practicing within Washington State. Your request to transfer to a new doctor is subject to approval by your claim manager.

If you prefer to do this in writing, fill out the Case Transfer Card (F245‑037‑000) from your doctor or local L&I office.
What is vocational (return‑to‑work) assistance?

Depending on your injury, you may have difficulty returning to work right away. Your claim manager may assign you to a vocational counselor to help develop a solution involving you, your employer and your doctor. Read more about Vocational Services.

What if I live or move out of state?
  • Your rights, benefits, and responsibilities for your claim will remain the same. Washington laws will always apply to your claim regardless of where you live.
  • Many doctors and health-care providers in other states don't accept workers' compensation cases. Find a Doctor in your area.
  • If you're thinking of moving out of Washington, learn what you can do to communicate with L&I and find new care.
What if I need help finding a new doctor out of state?
  • Use the L&I search at Find A Doctor.
  • If you are unable to find a provider, talk to your claim manager. The claim manager may assign a Nurse Case Manager to help you find a doctor. Nurse Case Managers are privately employed individuals in your geographic area who receive referrals from L&I. They don't direct you to specific providers but will help you find needed health care resources. Nurse Case Managers can also help your health care provider understand what is needed by L&I.
What if I'm still confused about my medical benefits?

If you are still confused by the claim process, you can call Project HELP at 1-800-255-9752. They are a cooperative effort between L&I and the Washington State Labor Council (AFL-CIO), and can provide you with one-on-one counseling to help you navigate the claims process.

Project HELP can assist you with both self-insured and state fund claims.

Did you know?

You may change your doctor once your claim is accepted. Just make sure your new doctor is in our network, and submit a request to us online at www.TransferCare.Lni.wa.gov, or fill out the Case Transfer Card (F245‑037‑000) from your doctor or local L&I office.

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