L&I Claims in Washington State: Injured Workers Are No Longer a Priority (2024)

Has L&I lost its way? As an agency, I think that L&I might have forgotten its purpose.

What is L&I and what are its duties?

The Department of Labor and Industries (L&I) is the agency responsible for administering the Industrial Insurance Act in Washington State. This Act, also known as RCW 51, was created to ensure that injured workers receive sure and certain relief for workplace illnesses and injuries (see RCW 51.04.010).

To that end, L&I has the following powers and duties (among others):
1. Establishing and adopting rules to govern its administration of the Industrial Insurance Act;
2. Ascertaining and establishing the amounts needed to be paid into and out of the accident fund, which in turn pays for benefits for injured workers;
3. Regulating the proof of accident and extent thereof;
4. Supervising medical, surgical and hospital treatment efficiently, making sure they are on par with the standards of modern surgery;
5. Issuing payments or certificates for benefits;
6. Investigating the cause of serious injuries and reporting violations to the governor;
7. Compiling reliable statistics regarding division operations;
8. Making an annual report to the governor regarding L&I's work;
9. Entering agreements with appropriate agencies of other states to address conflicts of jurisdiction insofar as permitted by the US Constitution and agreements with the provinces of Canada; and
10. Designating an appropriately licensed medical Director.

Protecting stakeholders or injured workers?

Not one of these duties includes looking out for the best interest of "stakeholders" at the expense of work injury victims. There isn't a single power or principle in this list for reducing employer workers’ compensation insurance costs at the expense of injured workers. Yet, at this time, and from the looks of the new L&I website, it seems that L&I is primarily focused on this goal.

Over the course of my legal career representing injured workers in Washington State, I’ve seen a steady and alarming trend towards protecting and reducing rates for employers and other stakeholders, at the expense of injured workers. I believe this is evident in programs like the retrospective rating program, employer incentives for early return to work, experience ratings, pursuit of fraud allegations, the medical provider network, the Department’s medical treatment guidelines, and numerous other programs and initiatives across L&I.

L&I is not making injured workers a priority

I feel that this is a dangerous an inappropriate trend in Workers’ Compensation. L&I IS NOT MAKING INJURED WORKERS THE PRIORITY. I mean, take a look at new L&I website. The new site has 6 menu options. These are Safety & Health, Claims, Patient Care, Insurance, Workers’ Rights, and Licensing & Permits. Selecting the Claims option, you can see six new options: All About Claims, For Workers, For Employers, For Medical Providers, For Vocational Providers, and Crime Victim Claims. Below, is what you will see if you choose the All About Claims.

Of the 6 options, only three are intended to be used by injured workers. Two of them contain information for employers including financial incentive programs. The final option is labeled "Identify and Report Worker Fraud". This is a blatant example of how L&I is not making injured workers a priority. Why isn’t "Identify and Report Claim Suppression" a tab, which is what happens when employers prevent workers from filing an L&I claim after an accident? Why isn’t "Identify and Report Retaliation for Filing a Claim" another option here?

Fraud versus willful misrepresentation in L&I claims

I would be remiss if I didn’t point out that there is no such thing as fraud in workers’ compensation. That was abolished years ago. Today, it is called willful misrepresentation and it is different. Clicking on the "Identify and Report Worker Frau"d option is even more disheartening. According to L&I, claim fraud is when a person is not injured at work or isn’t injured at all. Willful misrepresentation is obtaining benefits you aren’t entitled too. On its webpage, L&I lists behaviors it says are indicative of fraud. These include an injury reported in the absence of witnesses, conflicting accident descriptions, significant lapses in time between injury and first medical attention, and moving out of state or country shortly after injury.

Real life example and personal notes

In my experience, these behaviors occur in most if not all of the legitimate and valid claims I see. For example, Robert is one of my paralegals. He came to work with me after sustaining a low back injury during his employment with Waste Management. When his injury occurred, he was alone collecting garbage. There were no witnesses to his injury, which required surgical treatment and ended his career in that industry. The fact that he was alone when he got injured isn’t unique to Rob and L&I knows it. Suggesting that having no witnesses to an injury is a red flag for fraudulent behavior is L&I at its worst.

In summary, this is just one example in the ongoing trend where L&I is not making injured workers a priority. Rather than focusing on how to quickly and efficiently protect and provide benefits for injured workers, L&I uses its resources to advocate questioning injured workers’ entitlement to benefits under the Industrial Insurance Act.

Zale says:

January 19, 2021 3:12 am

L&I was not helpful to me. All I wanted is to go back to work . My MRI stated that I had 3 herniated disks from recent injury 3 compressed disk. From old injury. Absolutely no signs of any kind of shoulder injury. Yet they gave a needless shoulder surgery and only allowed treatment for my shoulder and carpool tunnel. They made up their own dates for my injuries. Changed case numbers 3 times. I have worked my whole life. I become homeless and lost everything . It was almost 2 years before they even payed any benefits. They changed the dates of my last work days. Maybe if they allowed the doctors to treat my injuries instead of their made up bu**sh**. I would be working today.

Robin Kerschner says:

January 23, 2021 7:44 pm

I had an injury to my back in 2002 that resulted in 2 discectomies, and 2 fusions within a 14 year span. I was able to see the same dr for those instances. I now only have Va medical benefits, and my back has gone out again “which is what my previous surgeon said would happen roughly about 5 years after the last fusion”. I’ve been out of work since Jan 4th & I have been unsuccessful with returning to my main provider or any other provider because my claim was closed for more than 6 months. LNI keeps telling me to use the preferred provider list of dr’s. The only dr that is willing to see me is my surgeon but he can’t reopen my claim. At this point I don’t know what to do? LNI isn’t being helpful. They’re telling me that they don’t understand why I’m not being seen. I have requested my medical records so I could have to give another dr to go over, to possibly take my case. But I haven’t even been able to find a dr to give me a chance. Any advise would be greatly appreciated. Thank you,

Joseph Criss says:

March 3, 2022 8:13 pm

I prevailed in front of the board in 2018 but my attorney reclused her decision because she was hired by the board, I don’t understand why my attorneys decision that mattered I thought it was the IAJ decision? I passed my burden of proof and was disabled as of 2018?

Dominick Carson says:

March 9, 2022 7:08 pm

I was working for a furniture company tasked with loading finished furniture like bathroom vanities and kitchen cabinets onto trucks for shipping. I was working alone, as my manager refused to assist me, and as I was lifting one of the vanities, wrapped in shrink wrap, up onto the third tier of the truck it bumped a counter below and slipped from my grasp landing on top of my foot. It began to swell instantly and I hobbled to the office and explained what happened. I was sent home for the rest of the day. I was never asked or told to fill out an incident report. I put my foot up for the weekend and iced it hoping it wasn’t serious and intended to return to work. I attempted to step up into my kitchen from the garage and fell to the floor in pain. I tried to make an appointment to be seen and due to covid couldn’t get one for a week. Tuesday morning I couldn’t put any pressure on my foot without lightning shooting up to my hip and I was taken to the ER.
I was a new hire at the company and while I was down over the weekend I read through the company manual. When I was done reading it I found I had a very uneasy feeling about reporting what had happened to my foot especially after I was rushed off the job site when it happened. When I called HR to get the insurance information they gave me information for the SAIF self insured claims so the Dr initially reported it under that. I told the ER I dropped a brick on my foot but when I got home and spoke with my mother and told her what happened she said I need to get in touch with my manager verify that he made a report and HR to verify that they had the report from my manager. Then I called the hospital and explained what happened and an L&I claim was filed. My Dr took me off work for a month after I tried to do light duty. L&I denied my claim a week after seeing the Dr and now I am stuck because the Dr won’t take my state insurance on an L&I initiated case. I can’t work, I’ve asked for reconsideration from l&I and was laughed at and now I don’t know what to do. I can’t go to work I was terminated from the company when I was denied by L&I and I have a family to support. Please Help!!

Summer says:

April 27, 2022 2:07 am

My husband was working as a CNC machinist and was required to hand carry 150 pound boards of 4×8 (approximately) often if not continuously during his 8.5 hour shift. There is an OSHA requirement on heavy lifting that is not and was not adhered to here.
My husband could barely walk the day he went to the hospital due to a bulging disc. He was allowed to go back to light duty (office work). Then return to JOI for five days but no more than 40 #… They put him back in the office. Finally, back on the floor they put him in a reasonable position for a few days but then back to the 140# job again. He told them he can’t do it after the first day due to back pain but they put him back there again. Today he was terminated due to flu for a day and a half. No verbals, written, or nothing prior… He’s been back to work almost two weeks. We feel it’s due to his demands for a lighter load and OSHA guidelines. What do you think?

Isaily says:

June 26, 2022 12:47 am

I was injured while working as an apprentice at a contruction jobsite with Garco Construction(Through the Union)Treatment was fine but I was released to light duty a little soon. My back pain wasn’t allowing me to sit down for 8 hours a day. I received a letter saying that I have voluntarily forfeited my benefits for not showing up and basically sending a text I was in pain. I’m not healed yet, is there anything I can do?

Michael bass says:

August 2, 2022 1:34 am

I am just curious about my situation as it seems that L and I possibly took advantage of me and my inability to completely understand all the legal mumbo jumbo and hoops to jump through just to start a business in Washington state. So, I am now in my second year as a specialty contractor doing residential tile. I did everything I thought I was supposed to do to be legal. S.o.s., d.o.r., bonded, ect. A d I obtained personal general liability insurance and it is filed with l and I as them being the certificate holder. As I read it, that if I am not going to hire employees, which I don’t plan on, then I don’t need a workers comp account, just personal liability with l and I as the certificate holder, did all that. Well, they hit me with a 1000 fine saying I wasn’t registered with them. But they had all my insurance paperwork. Can they do this or is this the big government taking advantage of the small business owner who just wants to work and provide for his family? Any input is greatly appreciated.

Appollonia Perez says:

August 15, 2022 9:01 am

I need help . My benefits got cut due to a activity prescription not turned in when in fact my time loss benefits sheet was indeed turned in by my doctors with date and time. It’s not the doctors or my fault of lni failure to look
Also my ime was missed when I was in hospital

stephen satterwhite says:

October 3, 2022 3:34 pm

Good morning, I was hurt on the Job At Tote on the Port of Tacoma This Year. Hurt my Knee and am getting L and I comp. I had MRI was told the risk of surgery was too great to fix my Knee was told to let it heal Naturally. I am done with Physical therapy, was not having any progress in it. My Dr put me on permanent Lifetime restrictions and now I can’t do my job of 35yrs. My employer Terminated me in May but am still receiving L and I benefits. Now I am being asked to retrain not sure what yet. My company never had Light Duty work for me I am A Truck Driver since 1986. It’s all I have done my whole life. I can’t climb into a truck I need knee replacement. I feel that the Vocational Counselor doesn’t have my best interest at heart.

Dan D'Onofrio says:

March 7, 2023 4:29 pm

I have come by just to wish all of you the best luck and hope in the world. Labor and Industries is like any other job, where employees are paid to do what the warlords demand. It is not any fun for the employees to deal with hurt and sad clients. The entire situation is a mess and constantly regulated by political heads. (Inslee needs to go!) As we know, there are truthful people on both sides as well as those who are full of feces. I have a claim which is now open (original claim opened in 1999) for the third or fourth time. You’d think they’d settle with me already but something tells me they will and are arbitrarily making me wait. It was a year ago last November when they reopened my claim. The designation was, ‘torn right meniscus’. Problem is (one of several) I do not have a ‘right meniscus’. I had a full knee replacement (due to the injury/L&I) in 2010. I also had another ‘full replacement’ of the right knee in 2017 due to a SEVERE nickel allergy that I was forced to live with (which nearly killed me) for nearly seven years. In other words Labor and Industries knew full well that I did not have a right meniscus nor have I since 2010. And yet they use that to satiate me and reopen my claim. It is nearly impossible to get an appointment with someone when your insurance company is saying something totally different. They have been working on changing the designation for two plus months now. Tick tock tick tock. They cut off my time loss in December 2010 about two and a half months after being implanted with over a pound of a substance my body is severely allergic to and tried desperately to break down for six and a half years. I won’t tell you how sick I became over the years (while implanted w/nickel) waiting and hoping for L&I to open my claim. Just this…I went from 140pds all the down to 107pds and lost 6 teeth even though I was brushing daily. I was a helpless and hopeless wreck and it took my wife’s begging and pleading to keep me going. I was dying. No doubt about it. And since it took almost seven years for L&I to reopen my claim (I was actively daily weekly and monthly with L&I, to the point I was crying over the phone/your pain is subjective and we will not reopen your claim) my body had plenty of time to beat me up. To the point of neuropathy. The replacement surgery took about 150% of the normal time which played a part in acquiring ‘peripheral neuropathy’…which should be the designation when they get around to changing it. I will apologize here at the end as this is a longer post and I did prattle a bit longer than intended.
Be patient. Be diligent. Also know there are others just like you that are working towards fairness for all that DO care and want you better. I am working on my own case although I am carrying the burden of all of you. Hopefully at least some. God bless and hopefully you can find a reason to smile. Regards…

Daniel says:

June 14, 2023 7:43 am

I was involved in a working Injury Did many months of physical Therapy as a byproduct of the injury I also needed to get Shoulder put on the claim 2 weeks after the initial injury Experiencing a lot of shoulder pain neck pain And leg Pain it took them 7 months to get my shoulder on to the Claim. After initially saying that I had a bone spur in my shoulder and that I might need Surgery on it. The surgeon said he would not do it. They then sent me to a another physical therapist She within no time told me that she believed the injury was in my neck. They Then did MRI of my neck. They found that I had a “” Slight Contusion Between C5 & c6. They told me it was not bad enough To do surgery. They then told me that I had the option to go down to a Chronic pain clinic. Again they said this was optional. I declined because they wanted me to go an hour and a 1/2 away from my family And stay there For up to 4 weeks. They Then shut my L and I off Without even telling me. I called my case manager she said there was nothing she could do the doctor had released me to go back to work and They ended up paying me a settlement. I told them I didn’t want a settlement I wanted my shoulder and neck Fixed. I am now having to Sue L and I I have been off work for going on 2 and a 1/2 years I am in constant pain. Most times I can’t even hold up a Cup of coffee with my left arm. I also have throbbing pain in my leg my left one. I literally most the time can not even walk through a store for more than maybe 20 minutes Before my leg starts going completely numb and my shoulder and neck start to hurt really bad. My attorney that is helping me Sue L and I Told me that L and I Wanted me to go do an independent medical exam At that exam I literally could not hold a pen to fill out my paperwork I had to ask They’re assistant to do it for me. I was in tears due to the things they made me do in their office. 2 weeks later my attorney calls and tells me that the independent medical exam ino released me for full duty. I couldn’t believe it. Here I am 37 years old only done hard Physical labor my whole life very Active very strong and now There are times that I can’t grip a dollar bill to give it to the guy in the drive through it’s Embarrassing. Just trying to hand him money my arm will start shaking and at times I have dropped it I then have to pull forward get out of my car Go back and get the money and then give it to him. I have now been without any income for For I think 7 months I have 4 kids And a wife. I realized that I have an attorney already working with me But I’m worried. Worried about the financial stability of my family we are completely broke And I’m also worried that after all this they’ll do nothing. If there’s any advice you could give me I’d really appreciate it. I just want to get through this trial. But it is seeming to be very difficult to do that and drives me nuts not being able to work. It’s embarrassing in front of my wife I can’t You can hardly have sex anymore cause I can’t hold my body up Sorry if that’s to personal But at this point I just need somebody to help me I’m tired of being in pain.

J. Dempsey says:

August 21, 2023 9:23 pm

I had torn my rotator cuff at work and required surgery. However I’m worried that the surgery was unsuccessful. What happens to me and my claim if that is in fact the case?

Scott Wilson says:

October 13, 2023 9:34 pm

I have an accepted claim almost 10 years old! Under that claim I’ve had a hip replaced, many treatments and dr appts. 100s, and am scheduled for a knee replacement and back surgery possibly after that. I’m still trying to work. The company I was working for shut down. They never reported my wages and my former lawyer okayed locking me in at $15 an hour which now is less than minimum wage. With 39 years experience and having owned my own company for 18 years I’m a $100k plus guy! How do I fight this when I’m being told it’s not possible?

Todd Melton says:

April 18, 2024 7:11 pm

Hi, my name is Todd. I was attacked while at work in Seattle The cops never showed up. Somebody finally called an ambulance, I got to the hospital and all they saw was the dent to my head and the stitches that I needed even though I complained of my shoulder injury, it had been stomped on. Was to go home and was rushed to the ER and had to spend three days in the hospital I finally got rotator cuff surgery and my bicep fixed and now I’m to the point where L N I is saying they’re going to cut off my monthly checks because I am working with rehab. I have a disability rating that won’t allow me to go back to the kind of work that I had worked before and all of the jobs that are hiring at 17 bucks an hour and my wife and I cannot survive on that. If I don’t get back to soon, my wife and I are going to lose our house and I’ve been implying for all the jobs that they’ve been sending me for three months with no success and very few callbacks What do I do the money that they’re gonna give me should be able to be invested in my future and at this rate I may have to use that just to keep our house I wish there was a way to sue Washington state they never even went after the guys that left me for dead on the streets

Leave a Reply