If you are injured at work, there are two very important things you can do right away, even before a claim is filed:
Your first visit to a doctor for a specific workplace injury is covered, even if your claim is not approved.
If you need 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 choose a new one with our Find a Doctor lookup tool.
If your workers’ compensation claim is approved, L&I or your self-insured employer will cover medical bills directly related to your injury until your doctor certifies your injury has stabilized and reached a point where further recovery isn't expected.
Many injuries are treated and healed before the paperwork reaches L&I. In these cases, we may issue a single Notice of Decision both authorizing medical expenses and closing the claim. This saves time and paperwork for everyone.
If you return to work and your claim is still open, you will continue to receive medical benefits while you are working.
What’s not covered by workers’ compensation
- Medical conditions not related to your workplace injury or illness.
- Treatment that cannot be measured objectively by a doctor.
- Treatment that continues after the worker is medically stable.
- Treatment not covered by workers compensation.
- Treatment from providers who are not enrolled in L&I’s network.
- Note: Your first office or emergency room visit when the claim is filed is covered, even if they are not in our network
If your claim is closed but you need more medical care for the same injury
- Within 60 days of closure: you and your doctor can protest the closure of your claim.
- More than 60 days after closure: you and your doctor may apply to have your claim reopened.
Primary care/attending provider
Like many insurance companies, L&I requires a primary care doctor, also called an attending provider, who is responsible for:
- Managing the workers treatment.
- Reporting progress to the L&I claim manager.
- Helping the worker return to work as soon as safely possible.
Your attending provider may refer you to a specialist (such as a surgeon or an orthopedic specialist) and still continue to manage your treatment.
Changing doctors
You may change doctors, subject to approval by your claim manager, as long as the new doctor is qualified to treat your accepted injury or illness and has joined L&I's network.
What is covered under workers’ compensation
Visit our Drugs and Prescriptions page to find out if your prescription is covered for a work-related injury or occupational disease.
What is not covered
Prescription medications for the treatment of unrelated conditions and/or conditions not allowed on a claim must be paid for by the worker, or billed to their private health insurance.
Billing and Payment
If you have paid for a prescription medication out-of-pocket, and they meet the coverage guidelines above, you may submit the Statement for Pharmacy Services (F245-100-000) form to request reimbursement. For self-insured claims, send your receipts directly to your employer or their claims representative.