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Injured? What you need to know

Closed claim.

Claims are closed when:

  1. Your health-care provider or another physician certifies that further treatment won't improve your condition
  2. L&I has no information showing you need further treatment
  3. Your injury was minor and treatment was successful. (In these cases, we accept and close your claim at the same time, in a single Notice of Decision.)

Protest or appeal.

Right to protest

If you, your doctor or your employer disagree with any decision L&I makes about your claim, all of you have the right to protest the decision or appeal directly to the Board of Industrial Insurance Appeals (BIIA).

Questions workers have

How do I protest to L&I about a decision made about my claim?

L&I must receive your written protest within 60 calendar days of the date you received the decision. (You may not phone in your protest.) If we do not receive a protest by this time, our decision is final and you lose your right to be heard. (RCW 51.52.060) Read protest instructions.

May I appeal if L&I rejects my protest?

You have the right to appeal L&I's decision to the Board of Industrial Insurance Appeals (BIIA). Read appeal instructions.

May my doctor or employer protest or appeal an L&I decision about my claim?

Yes. They receive copies of our decisions and have the same protest/appeal rights and instructions that you have.

What if I get a benefit check after my claim is rejected?

Do not cash it. You are required to send it back to L&I.

May I phone in my protest?

No. Your protest must be in writing. It must clearly state what you are protesting and why.

Do I need to hire an attorney in order to protest the closing of my claim?

No. You have the right to be represented by an attorney, but you are not required to have one.

Can I get help understanding the appeal process?

Yes - 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 individual claims assistance on your behalf.

Project HELP staff can assist you with both self-insured and state fund claims, but they are not attorneys and do not give legal advice.

Did you know?

You can get more information from the BIIA Web site (www.biia.wa.gov) about protesting and filing an appeal or, you may call L&I.

Apply to reopen your claim if your injury worsens.

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You and your doctor may apply to reopen your claim. However, there must be objective medical evidence that the condition caused by the same workplace injury has worsened and needs more medical attention.

Questions workers have about reopening a claim

How long do I have to reopen my claim?

You may apply to reopen your claim (for medical treatment only) at any time.

What benefits am I eligible for if my claim is reopened?

You are eligible to receive both time-loss and medical benefits. However, if your claim has been closed for more than 7 years, you need special permission from the director of L&I to receive time-loss benefits.

Can I see the same doctor as before?

Starting January 2013, if you need to reopen your claim, you will need to see a health-care provider in our network. If your regular doctor is not in our network, encourage them to join, or find one that is in our network.

Can I get independent advice on how to reopen my claim?

Yes - 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 individual claims assistance on your behalf.

Project HELP staff can assist you with both self-insured and state fund claims, but they are not attorneys and do not give legal advice.

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.

Did you know?

If your reopening application seeks time-loss as well as medical benefits, you must apply within 7 years of the date your claim was first closed (10 years for eye injuries).

You may be rated for a permanent partial disability before L&I closes the claim.

patience

When you have completed treatment but have suffered a permanent disability, you may qualify for a Permanent Partial Disability (PPD) award. PPD must be rated by a qualified doctor.

Questions workers have

What's a permanent partial disability?

This means you can still work, but your physical ability has been impaired.

Will I lose my eligibility for a disability award if I go back to work?

No. Permanent partial disabilities are based on the degree of your impairment, not on whether you can work.

Do medical benefits and any time-loss compensation continue after I receive a disability award?

No. After the claim is closed, these benefits end (unless the claim is reopened).

Can I get independent advice on disability awards?

Yes - 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 individual claims assistance on your behalf.

Project HELP staff can assist you with both self-insured and state fund claims, but they are not attorneys and do not give legal advice.

What if I live or move out of state?
  • You may have to return to Washington for an independent medical examination. If needed, L&I or your self-insured employer will pay for your transportation, lodging, meals, and wage replacement for lost wages to attend the exam.
  • Be certified permanently and totally disabled before L&I closes the claim

    Person in a wheelchair

    There are two types of pension:

    1. If you lose (or lose the use of) both legs, both arms, an arm and a leg, or your vision, you are eligible for a monthly pension by law, even if you can return to work.
    2. If, after medical and vocational evaluations, L&I finds that your injury prevents you from ever becoming gainfully employed, you may receive a pension. Contact Us About Pension Benefits for more information.

    Questions workers have

    Cooperate with any requests for an independent medical exam

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    Sometimes, a claim manager will authorize an independent medical exam for an injured worker. This means another doctor will be evaluating your medical condition.

    Questions workers have

    What is the purpose of Independent Medical Examinations?

    These exams (called "IMEs") are performed when:

    • L&I needs to know the extent of any impairment you may have.
    • L&I has a question about your treatment, or its duration.
    • You are asking to have your claim allowed, reopened or closed.
    • You want a reconsideration of an L&I decision or are appealing — and we need more information.
    • Your doctor, employer or claim manager has asked for an evaluation of your condition.
    Who conducts Independent Medical Examinations?

    Doctors or panels of doctors who regularly give impartial medical opinions about a worker's condition or medical treatment. A claim manager will request it for you, if needed.

    Who pays for Independent Medical Examinations?

    L&I pays for the cost of the exam, as well as any expenses you may have traveling to the exam or missing work.

    How can I make comments about my IME?

    An IME Comments Form (F245‑053‑000) is available online or you may call 1‑888‑784‑8059 to request a comment form. You can specify your preferred language.

    What if I live or move out of state?
    • You may have to return to Washington for an independent medical examination. If needed, L&I or your self-insured employer will pay for your transportation, lodging, meals, and wage replacement for lost wages to attend the exam.

    Did you know?

    If you do not attend your scheduled Independent Medical Exam, you may be charged a no-show fee. Also, you may jeopardize any benefits you are receiving.

    Learn about getting back to work.

    Employer

    There are many resources available to help you return to work or receive training for a new job once your claim is closed:

    Your employer should:

    • Find out if your doctor has ordered any permanent work restrictions, if you are still an employee.
    • Keep legal notices and correspondance related to the claim on file.(NOTE: This is not a legal requirement.)

    Did you know?

    L&I cannot close your claim if there is an outstanding protest from you, your employer or your provider.

    Your doctor should:

    • Send the claim manager a final report on the worker's condition. All medical reports go directly to:
      (Claim manager)
      Department of Labor & Industries

      P.O. Box 44291
      Olympia, WA 98504-4291
    • Send bills separately from medical reports. Billings go directly to:
      Department of Labor & Industries
      P.O. Box 44269
      Olympia, WA 98504-4269
      (Please attach a copy of the report for which you are billing L&I)
    • Call the Provider hotline if there are questions: 800-547-8367.
     More about workers' comp claims
     Claim information online in Claim & Account Center

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