Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

Coverage decision - Not Covered

L&I does not generally recognize fibromyalgia as an industrial injury, an occupational disease, or an aggravation to a pre-existing condition due to a lack of scientific evidence.

In response to a Court of Appeals decision, the department and self-insurers do not accept fibromyalgia as an industrial injury or occupational disease.

Related information on coverage and treatment

In Grant v. Boccia, 133 Wn. App 176 (2006), the Court of Appeals held that expert testimony was inadmissible under the Frye test to establish a causal relationship between alleged trauma from an automobile accident and the onset of fibromyalgia.

The Court of Appeals, presented with competing “expert opinion” and having performed research on its own, determined that it is not generally accepted in the relevant scientific community that physical trauma causes fibromyalgia. On the topic of trauma-induced or physical-injury fibromyalgia, the law of the State of Washington has succinctly stated in the decision: “such evidence is inadmissible under the Frye test as adhered by this state”.