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Injured? What you need to know

Approved claim

L&I or your self-insured employer can approve your claim if your doctor certifies that you were injured at a specific time and place at work, or have an occupational disease. Benefits cover medical bills. They also may include wage replacement, return-to-work help and disability or pensions for the severely injured.

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.

Time-loss / wage replacement

If you miss work because of your injury and your doctor certifies you are unable to work, L&I or your self-insured employer may pay for a portion of your lost wages, called "time‑loss compensation."

However, the 3 days in a row of work immediately following your injury are considered a waiting period. L&I or your self-insured employer won't pay for these days, if they are the only ones you miss.

Questions workers have

Does time-loss compensation pay me the same amount I earned as a worker?

No. Time-loss compensation benefits can replace some — but not all — of the wages you were earning. The benefit amount is 60 to 75% of the wage you were earning (up to a limit), depending on how many dependents you have.

Find more information in the:

Because of legislation (331 KB PDF) (www.leg.wa.gov) passed in 2009, time-loss compensation benefits for new claims filed for industrial injuries or illnesses that occur on or after the effective date (December 3, 2009) by individuals in State Registered Domestic Partnerships (www.sos.wa.gov) will be calculated at the same rate as for married persons and will include benefits for any eligible dependent children. This change doesn't apply to existing claims or to new claims for industrial injuries or illnesses that pre-date the effective date.

Persons in common law marriages or in unregistered domestic partnerships aren't considered married under the workers' compensation laws. Compensation for these individuals will be calculated based on a family status of single and will include any eligible dependent children.

The child's portion of time-loss compensation benefits must be paid to the person who has legal custody of your child or children. Notify your claim manager of any change in the custody of your child or children so the benefits can be paid to the appropriate individual.

When do I begin receiving my time-loss checks? How long will they continue?

If you are eligible, and no further information is needed, your first check is mailed within 14 days from the date L&I or your self-insured employer receives notice from your doctor that you are off work.

Checks are mailed about every 2 weeks or bimonthly, as long as:

  • Your doctor certifies that you cannot work (supported by objective medical findings).
  • Your claim manager receives your signed Worker Verification Form (F242‑052‑000). Your self-insured employer may require you complete a similar form.
What happens if I don't cash my benefit check?

Uncashed benefit checks expire after 180 days. You can ask L&I to reissue an expired check, but only if it has been less than 2 years since the issue date. After that, you'll need to contact the Department of Revenue to file a claim for unclaimed property.

Is time-loss compensation taxable?

No. The IRS considers time-loss compensation to be a disability benefit, not earned income.

Did you know?

Time-loss compensation benefits won't cover all of your lost wages, only a fraction. Plus, it requires your medical provider's ongoing certification. Ask your employer if there are other jobs you can do to earn your wage or salary while you recover.

Prescription medications

L&I or your self-insured employer only pays for prescription medications necessary for treatment of accepted conditions resulting from industrial injuries and occupational diseases on open and allowed workers' compensation claims.

Limitations on reimbursement for prescription medications

Prescription medications are covered only for conditions accepted under open claims or, in rare instances, in claims with treatment orders that authorize payment for specific medications for life-threatening conditions.

Prescription medications for treatment of unrelated conditions and/or conditions not accepted under a claim must be paid for by the worker or billed to their private health insurance.

Medications prescribed for workers who are outpatient (not confined in a hospital) are listed on the L&I's Outpatient Drug Formulary (150 KB PDF). Drugs and/or therapeutic classes listed on the formulary do not guarantee coverage and are subject to L&I's policy and decisions regarding appropriateness for the accepted conditions.

Drug coverage

Review a list of drugs that may or may not be covered by L&I.

Billing and payment

Submit the Statement for Pharmacy Services (F245‑100‑000) form to request reimbursement for out-of-pocket costs for prescriptions that are accepted under your claim. For self-insured claims, send your receipts directly to your employer or their claims representative.

If you must travel further than 15 miles to see a health-care provider, you can get reimbursed for some of your travel expenses.

To be reimbursed, your trip must fulfill all these requirements:

  • The provider must be further than 15 miles one-way from your home (30 miles round-trip).
  • There aren't any providers closer to you that could treat your condition.
  • You get the travel reimbursement pre-authorized by your claim manager.

These requirements are only for travel reimbursement. You can still see any health-care provider listed in our online directory, but your travel expenses won't be covered if you don't meet these requirements.

You can't get reimbursed for travel if:

  • There is an adequate provider within 15 miles of your home, but you just prefer to go to a provider further away.
  • You see a provider, but you didn't get pre-authorization from your claim manager for the travel reimbursement.
  • You are just visiting a pharmacy to fill or pick up prescriptions.

What you can get reimbursed for:

  • The mileage you have to go to reach the provider, minus the first and last 15 miles (30 miles round trip).
  • Parking, tolls, and some other expenses. See the form for details.

Questions workers have

How do I apply for reimbursement?
How to apply for reimbursement
If your claim is managed by... You must...
L&I
a self-insured employer Request reimbursement directly from your employer or their claims representative.
How much is the travel reimbursement?

The current rate is $0.56 per mile.

Check the state reimbursement rates for other expenses: Reimbursement Rates for Lodging, Meals, and Privately Owned Vehicle Mileage (25 KB PDF) (www.ofm.wa.gov).
How do I find out the distance to a provider?

Search for providers near you at www.FindaDoc.Lni.wa.gov. Depending on how far from your home you search, the search results will show estimated distance a little differently:

How to apply for reimbursement
If you search for providers... Then we'll show you an estimate of...
within 15 miles the distance to each provider as you would drive.
further than 15 miles away the distance to each provider “as the crow flies”.
Independent medical exam (IME) - can I get travel costs reimbursed?

If your claim manager requests that you go to an IME, and the IME is further than 15 miles from your home, you will be reimbursed travel costs, including the first and last 15 miles of a round trip.

If you now live out-of-state, you may have to return to Washington State for an IME. 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.

Vocational services and retraining - can I get travel costs reimbursed?

Yes, mileage for meetings requested by your vocational rehabilitation counselor (VRC) may be reimbursed, if the meeting is further than 15 miles from your home. In addition, some travel costs that are approved in your vocational plan may be reimbursed.

Orthotic/prosthetic repairs after claim closure - can I get travel costs reimbursed?

Yes, reasonable travel expenses may be reimbursed if you need to get your orthotic/prosthetic appliance repaired after your claim is closed. Hearing aids are not included. The appliance must be originally purchased by L&I or your self-insured employer.

What if I live or move out of state?

You may have to travel a greater distance to receive care for your claim. If so, payment for some travel costs may be considered if the travel is pre-approved by your claim manager. You won't be paid if your claim manager doesn't pre approve your travel.

If you're thinking of moving out of Washington, learn what you can do to communicate with L&I and find new care.

 

Property reimbursement

You may be reimbursed for personal property lost or damaged during a workplace accident.

Coverage is limited to:

  • Prescription eye glasses or contacts.
  • Clothing.
  • Shoes or boots.
  • Personal protective equipment.

To apply for reimbursement, complete and submit the form "Statement for Miscellaneous Services".

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

    Structured settlement agreement

    One alternative to monthly time-loss benefits is a structured settlement.

    This is when you and L&I agree to a sum of money that you would receive in a series of fixed, cash payments, over a relatively short period of time.

    Medical benefits may continue for your injury.

    Who's eligible?

    Injured workers who:

    • Are age 55+ and
    • Have an accepted L&I claim that's at least 6 months old.

    Who might want a structured settlement?

    You might be interested if you:

    • Have a source of income other than L&I benefits.
    • Want to return to part-time work.
    • Aren't interested in retraining for another occupation.
    • Are eligible (or soon will be) for any retirement benefits you've earned, such as Social Security or a union pension.

    Your employer should

    • Look for light-duty jobs you can do. Your employer can get reimbursed for 50% of the base wages they pay, plus expenses such as tools, training or clothing needed. Employers can read more about this incentive at www.StayAtWork.Lni.wa.gov.
    • Strictly observe any work restrictions the doctor may order.
    • Promptly reply to all L&I inquiries for more details about the worker or the accident.

    Your doctor should

    • 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.)
    • Know that pre-authorization is still needed for outpatient surgery.
    • Fill out and sign a Time-Loss Notification form at least once a month if the patient is unable to work.
    • Seek a consultation from a medical doctor of his/her choice in a similar field of medicine, if the worker has missed more than 120 days of work.
     More about workers' comp claims
     Claim information online in Claim & Account Center

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