Saturday Oct 23, 2021

L&I Claims for Medical Only and Workers’ Compensation Claims in Washington State

What is a “medical only” workers’ compensation claim?

As the name suggests, when an L&I claim is medical only, then L&I or the self-insured employer only pays for medical expenses. Therefore, you do not receive other benefits such as compensation for lost time, loss of purchasing power, or permanent partial disability. You also cannot get permanent total disability or death benefits. When a workers’ compensation claim pays these other benefits, it is called “compensable claims.”

From my perspective, “medical only” claims are appropriate when doctors can quickly treat an occupational injury or illness in the workplace. In practice, this type of L&I claim works when there is no interruption in your employment or ability to earn wages. For example, a work accident claimant who is injured at work may need urgent medical attention. The person is rushed to the hospital to clean and bandage or suture the wound. If all goes well, the injured worker may miss less than one day of work. The injury will heal and will not have a limiting impact on the worker’s ability to do their job. Under these circumstances, a “medical only” workers’ compensation claim is appropriate. The insurance covers medical expenses for the work injury. From here on, there is no need for other benefits under the claim.

Employer Tactics Under a Workers’ Compensation Claim

People who are injured on the job should know that L&I offers incentives to employers with no claims (or with “medical only” claims). Businesses that prevent workplace injuries get a “no-claims discount” from L&I. Here, the condition is not to have a “compensable claim” for a period of 3 years. Job discounts range from 10% to 40% of the base rate for your business. Consequently, some companies and employers go to great lengths to ensure that no compensable claims are filed.

Some employers reduce the volumes of compensable workers’ compensation claims by increasing workplace safety. Others provide employees with accommodations and flexibility so as not to interrupt the worker’s employment. I applaud those employers because it is a victory for both the worker and the employer.

Unfortunately, some employers unfairly attempt to limit compensable claims, to the detriment of the worker. In these cases, employers can argue that the injuries are less important than they are. Another strategy is when the employer creates a job to keep the work injury claimant going, regardless of their medical condition. For example, some people have been paid their regular salary to watch safety videos while recovering from injuries. This is not necessarily a bad thing, unless the employer has ulterior motives. For example, when employees have a workers’ compensation claim, some employers work hard to find a basis for firing the work injury claimant for cause. When an employer terminates a person with a workers’ compensation claim for good cause, they are not eligible to receive benefits such as time loss compensation benefits.

Summary and conclusion

In short, a medical-only workers’ compensation claim is appropriate after a simple injury on the job. Remember, such a workplace injury should not have a long-term impact on your physical abilities or future employment. However, if you suffered a more serious illness or injury, the Industrial Insurance Act (RCW 51) provides other claim benefits. Additionally, these other benefits are important when your work injury has a real impact on your functioning and employability.

This article first appeared at https://tarareck.com/l-and-I-claim-medical-treatment/

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