Apply for reimbursement

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What you'll need

For wage reimbursement:

• Payroll information (pay stubs, records & daily timesheets)
• Provider's description of the physical restrictions
• Provider-signed Employer's Job Description (F252-040-000).

For expense reimbursement:

• Dated, itemized receipts
• Provider's description of the physical restrictions.
• Provider-signed Employer's Job Description (F252-040-000).

Apply online with My L&I

Login using your existing My L&I account
(Powered by SecureAccess Washington):

New user? Sign up with My L&I
(Powered by SecureAccess Washington):

To sign up for My L&I, you'll need your:

• UBI number.
• Federal tax ID.
• L&I account number.
• PAC code from your account’s quarterly report.

Need help signing up?

Email WebSupport@Lni.wa.gov or call 360-902-5999
(Weekdays 8 a.m. to 5 p.m. Pacific Time)