A L&I claim may be reopened within 7 years from the date the first closing order becomes final, for full benefits. That means, time loss, medical benefits, vocational services, disability awards, all benefits that are available under the law. If it has been more than 7 years since the claim was first closed, the claim may be reopened for medical benefits only. The Director of the Department has discretion to provide full benefits in certain circumstances in these ‘over 7’ reopenings.
Keep in mind, the time limit is 7 years from first claim closure, not the date of injury, not the date you returned to work, not the date the final installment of any PPD was paid. If a closing order was protested or appealed, and ultimately set aside, that is NOT the first claim closure. You are looking for the first final claim closing order. That is the start of the 7 year clock.
In a nutshell, a claim will be reopened only where there is medical evidence, based on objective medical findings, that the industrially related condition has worsened, or become aggravated, since the claim was closed. Your own subjective descriptions of increased pain, loss of function, or inability to work are not enough. A claim can not be reopened solely for vocational services. The Department is looking for increases in objectively measurable findings. Worsening in measures of atrophy, nerve damage, degenerative changes, muscle wasting, range of motion, sensation. Worsening which is evident on MRI, CT scan, EMG. I tell clients, we are looking for concrete, objectively measurable changes in their work related condition.
Reopening requests, or aggravation applications as they are sometimes called, should be forwarded directly to the Department, even if your employer was self-insured. There is an actual form, which you can get here:
http://www.lni.wa.gov/FormPub/Detail.asp?DocID=1591
However, an informal written requests, with or without supporting medical information, will start the ball rolling. If there is such an informal request, the Department will forward you the reopening application to complete. There is a portion of the form for you and a section for your medical provider to complete.
You can go to any medical provider to complete a reopening application. If you had a good relationship with the physician who treated you while your claim was open, that is a great place to start. Your primary care provider is ok, an appropriate specialist may be even better. If you have a copy of the closing medical report, take it with you. This will help the physician in comparing your current findings on exam to those at the time your claim was closed. The medical provider will be paid by the Department for performing the exam and completing the paperwork, whether the claim is ultimately reopened or not. If the physician recommends a diagnostic study to complete the exam, the request should be forwarded to the Department along with the reopening application. The Department will approve many diagnostic procedures in order to gather all the medical information necessary to review the reopening application. Again, if the Department authorizes such a study, they will pay for it. The Department will likely schedule you for a medical exam, called an Independent Medical Exam, or IME. (We can discuss some other time whether there is anything ‘independent’ about these exams)
When in this process should you talk to an attorney? There is no hard and fast rule, although I tend to be in the ‘earlier is better’ camp. The Department will issue an Order either reopening the claim or denying the application. You can protest or appeal a denial, and an attorney will most definitely be helpful, if not indispensable. However, earlier involvement has its up side. An attorney with a good relationship with the Department can nudge a claims manager in the right direction, help make sure all necessary diagnostic studies have been done (on the Department’s nickel), help the attending physician articulate the objective findings which have worsened or respond coherently to an IME report. It is, of course, quicker and less expensive if your claim can be reopened without having to litigate the matter. Getting an attorney involved early in the process will only serve to make sure all possible avenues are being examined before the Order is issued.
WELCH&CONDON 
I am truly searching for direction. My claim seems to be stalled. Some of your information is giving me a much needed insight.
Thank You,
Marion
I slipped on wet floor at work. Tore shoulder rotor cuff and ligaments. Three months later lower back problems started.
L&I doctor would not suggest any tests at their costs. I have been to emergency 3 times. Now in process of independent exam. Spoke with claims manager who told I could go in for 12 additional shoulder sessions. They did pay for MRI but I believe will not work with me for back. What else can I do?
Unfortunately, there is one key piece to the puzzle which you did not mention. Does your attending physician believe the low back condition is related to the fall at work? At a very basic level, it does not matter what you or I believe. Without medical evidence of a causal relationship between your fall and your low back complaints the Department will not accept the diagnosis under the claim, and will not be responsible for treatment. If, on the other hand, your treating orthopedist will state that, on a more probable than not basis, the fall injured your back, or even aggravated a pre-existing condition, then we have something to work with. I would suggest a careful review of your chart notes or emergency room reports to look for any mention of back pain, stiffness or symptoms. When did this first show up in the medical records? Talk to your medical provider about the mechanism of your fall, how you landed, when the symptoms started, and how they progressed. All of this information is important for the medical provider to have in order to formulate an informed opinion on whether the condition diagnosed in your low back is causally related to your fall at work. Again, with medical evidence and testimony we have something to work with to help get the condition accepted under the claim and treatment authorized.
In 2005 I began having trouble with elbows, due to repeative lifting. A claim was eventually opened, but for a year my employee had me to countinue to do same job. After therapy failed to help, I then had elbow surgery by a general orthopedist. I didn’t recover well and an IME Dr. recommended a more involved operation and referred me to a Hand Surgeon. After that surgery my wrist became very painful and my hand surgeon sent a request to my claims manager for a bone scan and a MRI arthrogram on my wrist. These ended up being requested 2 different times and I would call and leave messages to check the progress. Nothing was ever approved and my claim was closed. I appealed and was finally granted a mediation hearing. It was agreed on that I should get the diagnostic tests done.(14 months of pain since the first request.) It turns out I have a tear in the cartiledge in my wrist with degenerative changes. I have a phone conference next week with the judge and my employers hired attorney.I still would like to get my claim reopened. There is surgery to correct this problem. This is my dominate extremity. I’m feeling like I need to get some support from an attorney. Should I wait to see what the attorney has to say then set up a meeting with someone from your office? I have a lot of paperwork that you might be interested in. P.S. My employer is privately insured.
With the information in hand from the recent diagnostics studies the employer’s attorney may be willing to agree to set aside the closing order and send the claim back to the Department for treatment and benefits. If they are not willing to do this, you should definitely contact an attorney for help. By the way, your rights are the same whether your employer is self-insured or not.
Hello, I injured my lower back, (2 herniated disc’s), in 2003 and spent 2 years dealing with L&I, doctors, therapists, specialists and even an accupuncturist. After a long, (2 year’s), and frustrating battle my claim was closed with a small settlement and me being declared with a permanent, partial disability of the injured area.
I have suffered with this since then and just recently re-injured the same discs to the point of seeking medical attention for the pain and lack of mobility.
Am I allowed to re-open this claim since it is an old injury rearing it’s ugly head?
And what are my rights as far as treatment goes? I am not seeking any type of compensation other than whatever medical treatment I may need. Also, I am no longer employed with the employer that this was filed under at the time of my injury as they “let” me go after the case was closed.(they were a privately insured school district)
thank you so much!
Teri
You can file an Application to reopen your claim, and if the claim is reopened you may receive both medical treatment and time loss, if appropriate. Although, I noticed you said you “reinjured” your back. If your condition was made worse by a new injury, this is a new claim –assuming you reinjured it at work. A Reopening Application is more designed to cover those situations where the condition has worsened over time, with no intervening event, accident, or injury.
my husband applied for ssdi in 2007 .
6/24/09 . he went to the ssi office today to see if he could followup and get ssdi now that he is 65 . they told him he was “all set” in 2007 they said they sent a 30 and 60 day letter and never got a reply . so, they said now there is nothing he can do.
he has not worked , he still is disabled . how come he cannot appeal , or re apply. ??????
what can we do
My hubby injured his knee at work and work cover closed the claim cuz my hubby found work elsewhere. We had scans etc done and there was a lot of fluid and swelling etc, but no one could operate. The swelling went down and the pain became bearable but just in the last week it has flared up in the same spots again and we just need some advice on what we can do. We just want our lives to go back to normal! Work cover QLD discust me, they said even if nick lost his leg, too bad soo sad deal with people are out there working with out arms too just be greatful! what a load of rubbish. Can anyone offer insight. beckelljess@hotmail.com
Hard to tell from the information provide – but my best advice would be to return to an orthopedist, get a full exam of the knee, and file an application to reopen the claim if there is an objective worsening of the work related condition. It may very well be that the condition is worsening over time, and is now in need of treatment.
Hello, I have had a lower back problem for sometime now, the claim was closed 2 1/2 years ago. Last year, I was feeling better and was working when it had snowed out and twisted with some ice melt on my shoulder and felt the pop again. I had a MRI and a spinal injection, witch helped a lot might I add, I had an IME and he said that it was at MME and that I was never going to get better and to learn to deal with what I have without medication for pain management, he then told me that it was closed last time with a PPD and I was settled with some small award, my question is, will they award again for this injury or what is the rule’s for awards. I was only wanting to get better but if they are going to close it at the same category as last time they should pay me for the disablility, Right? Or will they look at it as if they have already paid for this once and won’t do it again?
I am confused on this and really appreciate any help that you can give me.
It sounds as if your low back claim was closed with a small Permanent Partial Disability (PPD) award, and that you have a new claim or reopened your first claim as the condition had worsened. If your condition is again at maximum medical improvement (MMI) the Department will issue an order closing the claim. The first PPD award you received acknowledged you did have some permanent disability from your work injury. For this discussion let’s say it was a Category 2 impairment, which is 5% of TBI (total bodily impairment). It is assumed you still have this level of impairment. You will only receive an additional PPD award if your current level of impairment is greater than what you have already been rated and paid. If your current impairment were rated as Category 2, you would not receive an additional PPD award when the claim is closed. If your current impairment were rated as a Category 3 or above, you would receive an additional PPD award when the claim is closed. Hope that answers your question.
I feel of my motorbike at work 1.5 years ago and landed on my knee. I went on work cover and that paid for physio. It was detrtmined I didn’t break anything. But badly bruised. It has never fully gone away. They never done an ultra sound. Just x rays. Recently I’ve started to feel sharp pains down the my knee. I’m not sure what to do. Any suggestions?
You don’t say so, but I gather your claim is closed? If so, you should go to a physician and have your knee examined and have an Application to Reopen the claim filed. The Application has a part for you to complete and a part for the doctor to fill out. The appointment will be paid for by the Department even if the claim reopening is denied. If your physician feels you need additional diagnostic studies, like a MRI, the Application to Reopen should still be filed, along with the doctor’s chart note requesting authorization for the study. You’ll have a better idea what to do after you get the knee examined and get a sense of what’s wrong. Could be nothing at all related to your fall, or it might be some residual that wasn’t diagnosed before. You won’t know until you see the Physician.
I have a son who had a eye injury on the job, that has left him with a blind spot and catracts, and the eye surgeon says more then likely when he gets older he will be blind in that eye. He is 25 and his goal was to get his CDL to drive truck, that now is not possible because the eye is worse that 20/40 and is not correctable with glasses. Does L&I pay for any education for a different career, that he can do with is vision? the Doctors say he was the 3rd worst eye injury in WA, and can’t believe he has any vision at all in the eye.
Just a worryed mother!
Whether or not your son receives any assistance from L&I for retraining depends on a number of factors. Assuming your son is not working, and is unable to return to work at his job of injury, the Department will assign a vocational counselor to his claim. That vocational counselor will conduct an Ability to Work Assessment. The outcome of that assessment will determine whether further vocational services, including retraining will be made available. In a nutshell, vocational services are only provided where an injured worker can not return to their job of injury, and does not have the transferable work skills to obtain any work within their physical restrictions. If your son has questions or concerns he should talk to an attorney.
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What happens when you have received a PPD award and your condition get worse. It’s only been a year since they closed my case. Can I still reopen?
It does not matter if you received a PPD award when your claim was closed. You can still file a reopening application. I would suggest you return to your attending medical provider for the claim and get an updated medical evaluation of your industrially related conditions. There must be objective findings on exam that your condition has worsened since the date of claim closure. Have your physician help you complete the reopening application, there is a portion for each of you to fill out. If your physician believes diagnostic studies are necessary to fully evaluate your condition they should contact the claims manager for authorization. There is no specific rule of thumb that certain conditions worsen or not within certain periods of time. Medical conditions are as individual as you are, and you won’t know if your condition as objectively worsened until you get a thorough medical exam.
Hi Terri, I have moved to another state since my claim was closed. Am I able to have another Doctor evaluate my current condition where I live now? I was told my next step would probably be a fusion, which I have been putting off till now. Thank you, Denny
You can get medical treatment wherever you are – the trick is finding a medical provider. The medical provider needs to get an L&I provider number. This is easy to do. The provider should call the provider hotline 800-848-0811 to get instructions. If you see a medical provider who does not have a provider number, the provider cannot get paid, and the department will not recognize them as your attending provider. You may be able to find a medical provider in your area who already has a provider number by calling your claims manager and asking for a list of local providers. You can then contact these providers and see if they are willing to see you. If a provider already has a number, this means they have treated a Washington state injured worker in the past, but it doesn’t necessarily mean they are willing to do so again. I’ll be honest, sometimes it is really hard and time consuming to find an out of state physician, especially a specialist like an orthopedic surgeon. Just keep making calls. Ask the front desk at the providers office to call the Department. Most of the time, if they do, they’ll find out the reimbursement rates are respectable and the processes isn’t too onerous.
Once you find a new physician, you’ll need to have that first evaluation and file an Application to Reopen your claim, if it has been closed. It will be helpful if you take a copy of the closing medical exam along with you. Your Physician is going to need to compare your current findings on exam to those documented at the time the claim was closed to determine if there has been a worsening of your condition. If the Physician gets a provider number the Department will pay for that initial exam, whether the claim is ultimately reopened or not. They may also authorize and pay for a diagnostic study requested by your Physician if that is necessary.
Note – even pharmacies need a provider number. We’ve found that the big chain, multi-state pharmacies are generally agreeable to getting a provider number so you can fill your prescriptions and they can bill directly.
I WOULD LIKE SOME ADVISE ABOUT WHAT DIRECTION TO GO, I SLIPPED AND FELL IN 2007, RUPTURED MY HAMSTRING, GRADE 3 WENT TO DR. HE SAID IT LOOKS LIKE A BAD ONE, MIR SHOWED A TEAR, WAS SENT TO THERAPY, DID NOT HELP, THEY SAID IT WAS TO LATE TO DO AN AVUSION, WHICH AT THE TIME I DIDN;T HAVE A CLUE, WENT THROUGH 5 OR 6 INJECTIONS DID NOT WORK . THEY SENT ME TO IME, SAD THERE WAS NOTHING MUCH WRONG, SO BACK TO DR. ONOTHER IME LOOKED AT ME SAID THERE WAS A MAJOR PROBLEM, MY HAMSTRING STILL HAS A 5 CM TEAR THAT CAN;T BE REPAIRED, SETTLED WITH STATE, SAID I WAS 29% DISABLED, NOW I HAVE A GREAT DEAL OF SCIATICA, CANNOT SIT WALK VERY FAR I AM MISRABLE, AND MY ATTENDING DR. QUIT WHAT SHOULD I DO, ANY INFO WILL HELP THANKS
If you are in Washington, you didn’t ‘settle’ – your claim was closed with a PPD award. You can file an application to reopen your claim. There must be medical evidence that the condition covered in your claim has objectively worsened. In your situation, it sounds like you need to find a new physician, and ask whether your current sciatic problems are related to your hamstring injury. I’d suggest you find an orthopedist or physiatrist, make an appointment, and take in the medical records from your prior treatment. Tell the physician you would like to file a reopening application. You can download the form from L&I’s home page, or many doctors have them in their offices. There is a portion you fill out, and a portion the physician completes. The department will pay for the initial exam, whether or not the claim is reopened. The department may also authorize any diagnostic studies which are necessary to evaluate your condition. Whether your claim is reopened, or whether you have a good case worth hiring an attorney to help with, really depends on what the physician tell you about your current condition, the relationship to your original injury, and whether any condition related to your injury has worsened since claim closure.
I injured my back on the job back in 2003 I had surgery to repair a bulged disc at L2 L3. I was left with permanent nerve damage and severe muscle atrophy of my right buttock and quad area down to my right knee. I was retrained and given a permanent disability rating of V. My back continued to hurt the surgery did nothing to relieve my pain and recently due to the atrophied muscles my leg gave out resulting in a torn meniscus of my right knee. I have also had a CT scan of my back because the job that I was retrained to do requires me to sit 8 hours a day which kills my back. The neurosurgeon said I have degenerative disc at the S1 L5 and L4 and suggest a fusion because my back is so unstable. I’m wondering since my back is degenerative but aggravated by sitting 8 hours a day does L&I share in responsibly for my low back condition even if its not directly related to the injury? The degenerative disc were noted before I was retrained and L&I has paid for several injection into the S1 L5 disc area.
I gather your claim is closed, and you are debating whether to pursue a reopening application. The answer to that question really turns on what your physician says. If your condition is the natural progression of the initial injury and surgery, and there are objective findings on exam that your condition has worsened since claim closure – then yes, by all means, file an application to reopen your claim. If you need treatment or time off work you will want the claim reopened so you receive the benefits you are entitled to receive. It sounds like the degenerative disc disease has been present for some time, both while the claim was open and continuing. I think your stumbling block will be showing the condition has worsened, based on objective findings. This requires more than an increase in subjective symptoms or difficulty with sitting at work. If your claim was closed with a Category V PPD, then you had some significant findings on exam at the time your claim was closed. Your physician will have to demonstrate that these findings have worsened or progressed since claim closure. Talk to your physician about this question, and then you’ll have a better idea how to proceed.
Good morning,
This site is sure giving me hope! I am trying to decide which way to go with this, as I do not know. I USED to work for an ambulance company. Due to the nature of the job, (lifting heavy patients) both of my shoulders are shot. I had a sprain in my left shoulder in 09, that was treated by L & I and closed. An injury in my right shoulder in 2010 that lead to surgery and PPD, being out of work for almost a year due to it. (I was let go by my employer after that injury) That case is also now closed. And now, my left shoulder is causing me INCREDIBLE amounts of grief again. I have not returned to work because I cannot find a job, so I’m in pain from doing simple, everyday tasks, and my left shoulder is getting worse. I don’t know what to do. I cant even sit at a table or desk because it hurts so much. Do I start with my usual physician, the attending at the time of injury, or see you (i live in Puyallup)? On a different note, my shoulders are a MESS ever since working with the ambulance company that I did!!! 😦 I cannot do simple things I used to do like vacuume, cut thru meat, chop wood, etc., etc., with my right side, or else I am in pain for the next few days. I am in such a mental mess at times, I just wish I had my life back before all the shoulder injuries.
Thank you in advance for the help, any questions, please ask.
You should start by returning to your physician to determine if either of your shoulders have objectively worsened on exam since your claims were closed. I would suggest returning to your surgeon, as that provider would likely have the strongest ability to do an exam, order any necessary diagnostic studies, and express an opinion on whether the shoulder has objectively worsened. Let the physician know you are considering filing an application to reopen your claim, they should have the application in the office. There is a portion for you to complete and a portion for the Doctor to complete after the exam. The Doctor can request authorization for diagnostic studies, the department will generally authorize and pay for these if necessary to evaluate whether your condition has worsened.
Keep in mind it is not enough that you feel like you are in more pain, or that you have not been able to return to work. There must be findings on a physical exam which are worse now than when the claim was closed.
If your physician agrees the shoulder has worsened and you have filed the Application to reopen, that would be a good time to get an attorney involved.
I injured my knee at work the dr saying it was a sprain .I was off work four mo ti ally was able to walk without crutches and told the dr it still hurt but he said it would take a long time to heal they closed my claim almost immedialtely upon my return to work….but the pain has now affested my whole leg from my hip to heal and still have sharp pain in the knee if I move the wrong way..want to reopen the claim to get an mri …never got any settlement rating cuz the dr wrote down that I was fine even tho I told him it still hurt but could work.what do I do now?I have a different orthodox now.
Your orthopedist should be telling you what’s wrong with your knee, and whether it is related to your industrial injury. If the condition is related, and if the physician feels the condition has worsened since claim closure, you should file an Application to Reopen the claim. If you did not protest or appeal the closing order within the 60 day appeal window, then that order is final. You cannot fight about whether you should have received a permanent partial disability award or whether you should have received additional treatment. If the closing order is final, your only option is to file an Application to Reopen.
Hello my nane is Sheriy, I am a wsitress an two yrs ago a coffee pot very large one over flowed (exspoledreally) on to my hand I webt mre then a yr woyh 3rd Burman on the top of my left hand finaly I wss tld I cld have deburstment an tiuess replacement surgery, after this my hand seem worse its my lft hand an im lft handed I can not go back to serving do to the fact I can not hold that much.wieght in my hand, the LNI Gabe me a ppd but it was hardly nothing Frm this iv lot everything, they say I can do other Wrk but my hand has worsened, I cant even hold a pen
First, it is important you protest or appeal the Department Order which awarded the PPD and closed your claim. You have 60 days from when you received the order to file. Filing a protest or appeal will stop the clock from ticking, and allow you an opportunity to regroup and get some legal advice. If no appeal or protest is filed in 60 days, there isn’t much you can do, other than file an application to reopen the claim, which requires medical evidence of a worsening in your condition.
Whether you received all the benefits you are entitled to receive will depend on what the medical providers are saying. Is there additional medical treatment which will improve your condition? What limitations do you have on the use of the hand? What other types of work can you obtain and perform within those limitations? I would encourage you to talk to an attorney and find out if there are additional benefits which you are entitled to receive based on the medical evidence.
L&I stopped my time loss payment because my file was missing an “up to date objective medical finding”. The payment was stopped without notice and my claim is not closed. When I questioned L&I they said they needed a APF before my payment would be released. Is the lawful? I wasn’t released for full duty, I wasn’t returning to work.
The claims manger does need current medical information which certifies Time Loss. Generally, your physician should be sending in a chart note with each visit which documents your current condition, objective finding on exam, treatment plan, and whether or not you are released for work. If you are not seeing your physician regularly, than this information is not making it into the claim file. The short hand way for the claims manager to get the information is to send an Activity Prescription Form (APF) to your physician. Your doctor can quickly fill this out, fax it back to the department, and time loss should be resumed. (assuming you have not been released to work) Unfortunately, no advance notice is required when time loss benefits are stopped. Although as a practical matter, if someone (you or an attorney) is paying attention, you can anticipate potential problems and avoid these types of interruptions.
I harp on this a bit, but you must be proactive when you have an open workers compensation claim, are receiving treatment and are not released to return to work. You have to follow up on referrals for testing or treatment; you have to see your physician regularly and talk about a return to work, modified work, or even part time work; you have to check your claim file regularly; you have to respond to request for information, complete your worker verification forms, and return phone calls. I completely understand that an injured worker is, well, injured. Things are not right, you don’t feel well. You are in pain, overwhelmed and maybe scared. But this is a complicated administrative system, and it doesn’t function well on autopilot. If you find yourself overwhelmed – get help.
hi i had an injury on or about 9-30-08 i had a steel door dropped on my head it slammed me into an excavator and pinned my neck 90 degrees form my body and head and shoulders pointed 180 degrees from each other. and the employer left me there hanging by my neck after awaking from passing out from the pain i finally got my shoulders to where my head was.i heard every tendon in my neck tear trying to accomplish that then fought to get out from underneath the door i guess what one of my questions is couldn’t i sue the employer for leaving me after he dropped the door on my head?i also had my neck fused from the accident c4 thru c7 plus l-4 l-5 s-1 the disks are tore and about 6 herniated disks in my t spine.i have been harassed by L N I detectives.they park in front of my house and take pictures of my lawn maintenance man mowing or weeding my lawn.i have a 9Th grade education.the surgery helped a little it keeps my chin from resting on my chest but i have little motion in my neck.movement in my neck causes arm and hand painsi cpould go on. my t spine aches all the time the low back comes and goes still get bad head aches. i lost two teeth from the impact of the door they were shatterd i have an attorney but he is local in the area and i feel I’ve made a big mistake hiring him because he has ties to my ex employer. the good ole boys clubi have been thinking about settling and going on SS but i am confused and not much feed back from my attourney.would like any suggestions thanks
I would strongly suggest you make an appointment with your attorney. Arrive with a list of questions. This is the best way to remember what you want to ask and to organize your thoughts. Ask about the status of your claim, what you can expect next, and where the claim is likely to head in the near future. If you have an attorney who is familiar with workers compensation it does not matter if it’s a small town, or whether the attorney knows the employer. The attorney works for you.
Some quick and easy answers: You cannot sue your employer for a work related injury. The only exception is for an intentional injury; You can apply for Social Security Disability while you are collecting L&I benefits. You do not have to ‘settle’ your claim first. You should talk to the Social Security Administration about the effect of receiving benefits now versus waiting for retirement age. If you are not likely to return to work it may make sense to apply; You cannot do anything about L&I investigators who watch you from public areas. I generally tell my clients to wave, smile, politely introduce yourself. Don’t give them any information or answer any questions, just let them know you know they are there. They generally decide they aren’t going to get anything helpful once you know they are watching.
Claim was closed , past 7 year . L&I gave me a catagory 3,Now my back is worse.
Had on the job reinjury had to have a fusion in same spot as first injury. I did no won’t to go through red tape with L&I, so I went with my private insurance. Can I still get L&I to pay. I am now very much disabled.
You have a year from the date of your new re-injury to file an Application for Benefits with the Department, 2 years if this is an occupational disease claim (but that’s not what it sounds like) If it has not been a year – file right away, and get to an attorney. You will have some hurdles since the claim was not filed at the time of the accident. In these cases it is sometimes difficult to prove an injury happened at work, if you were telling the physicians something different.
I injured my knee at work when I fell off a pallet jack. Opened an LnI claim, did surgery and claim closed. Now I don’t work for this employer no more and knee is starting to flare up from time to time. Can I still reopen this same claim even if I don’t work for the same company? Any how are they gonna pay for workers compensation??
You can file an application to reopen your claim even if you no longer work for the same employer. If there are objective medical findings which show the condition has worsened, and there has been no intervening injury which has worsened the condition, then your employer remains liable. Because the employer has paid premiums into the State Fund, your condition continues to be covered regardless of where you work. However, at some point the employer’s experience rating is no longer effected by your claim, even if you are continuing to received medical treatment or benefits.
My mom has an open LNI case after she injured her elbow on the job while lifting a patient with denied help from a co-worker and instruction by a supervisor to lift and move the patient herself.
She is 2 months recovering from a surgery her doctor said was not very likely to help, but was recommended. Now she has constant pain and has just started physical therapy. She is in so much pain from the physical therapy that she fears going back again. She did voice when they were hurting her and they have made a referral for “pain management”.
My mother doesn’t want to take pain medication and has told me she will not take them. After her surgery they gave her Hydrocodone at 750mg and she couldn’t even drive.
Does she have options with taking the medications or with physical therapy in order to not deem her LNI claim as Non-Compliant?
She is a strong woman but she had tears in her eyes coming out of physical therapy. She said she felt they were very aggressive.
She is 61 years old and would work the rest of her life if she could.
Is there any advice you can offer?
I just don’t want her to have to suffer threw this if she has any other options.
Thank you for your time.
-Julie
Washington State
about 6 years ago, I damaged my ankle at work, after 4-6 months or rehab it wasn’t getting any better and was sent in for an MRI, the ankle specialist that preformed the MRI told me that my ligaments both inside and out were stretched so far, and I hade end torn one, that I needed to have surgery to repair my ankle. I was 25 and the though of surgery really scared me. The doctor told me that I was young, and that I could have the surgery any time. He would close the case. but that he would put in my information, that I needed to have the surgery, and could reopen it at any time. Now I have a 3-year-old and with my ankle giving out on me on a daily basis it has become a safety issue for her. When I went to reopen the claim to have the surgery, the occupational meds doctor saw in my notes that the specialist put that I needed the surgery, and added the information that it gives out on me daily, and told me this should go through no problem.
But L&I had canceled my request to reopen the claim saying that the injury hasn’t worsened, so I don’t needed it. But that wasn’t the issue, it is an ongoing problem that I was told needed to be taken care of. The ER doctor who saw me the last time my ankle gave out said that my ankle is so bad if it gives out again I will probably brake my ankle because there is nothing to stabilize It because they ligaments are so damaged from the initial injury and even put that in their report.
What can I do to get this taken care of and the surgery that I need? you can rely here or e-mail me at htch_99@hotmail.com
I’m going to assume this is a Washington State L&I claim, the response is different if you are in a different jurisdiction. Unfortunately, there is no mechanism to keep a claim open so a recommended surgery can be obtained years in the future. Washington claims have very distinct open and close dates. When a claim is closed, no medical treatment can be provided (except in those limited situations where there is a pension with a treatment order)
In order to get your surgery, the claim has to be reopened. Unfortunately, there is a legal standard which has to be met before a claim can be reopened. Your medical condition must have objectively worsened since the claim was closed. It is not enough that surgery was recommended years ago, and now you want that surgery. Your physician will need to document that objective findings on exam have worsened. Subjective complaints of falls or increased pain, will not be enough. The doctor should order the appropriate diagnostic studies to document a progression or worsening of your findings. He should not simply rely on the earlier surgical recommendation. That surgery was recommended before, will not be enough to get the claim reopened.
If you received an order denying the reopening application you have 60 days to send a written request for reconsideration or protest to the department. You can do this on your own, or hire an attorney, but in either case you will need to have medical evidence that the condition has worsened since claim closure.
In 1998 I fell off a ladder at work doing danged to my wrist and hand having two operations I loss tract of time so my case was closed in 2005 in 2010 it started hurting me went to my doctor had p/t for 8mos to build up my strength my emplorer sent me to there doctor who wanted to lock my wrist I said no Soviet was sent back to work know in Jan 2014 facing same problem what can I do
You don’t say whether your claim was reopened in 2010 when your condition worsened. If the claim was reopened, has it been reclosed? If the claim is closed, you are past 7 years for reopening a claim for full benefits. A claim can be reopened after the 7 year cut-off for medical benefits only. If an over 7 claim is reopened, the Director of the department does have discretion to provide full benefits, including time loss. That discretion is exercised sparingly. You may see a discretionary award of full benefits where a claimant had continued to work, and treatment after the claim is reopened requires time away from work.
You can file an application to reopen your claim. If there is objective medical evidence that your condition has worsened, then the claim will likely be reopened. If the reopening is denied, you have to decide how much time and money you want to invest to get a claim reopened for medical benefits only. Unfortunately, if you litigated the reopening denial, and win, you are still responsible for the litigation costs. These are not reimbursed by the department when they have incorrectly denied a reopening. It may be more cost effective to get treatment under your private health coverage (If you don’t have any, contact the State’s exchange and enroll before the end of March!)
If I had a claim that was closed in 1996 and the injury has worsened to the point I need to go see a medical professional, but I cannot find any of my claim documentation. Is there some way I can locate my claim number? Would I be required to provide the claim number to the doctor?
You can call the Department and they will look up your claim number. 360-902-5799
If your claim was closed in 1996 you are looking at a medical only re-opening. Although, the Director does have discretion to award full benefits after the claim has been reopened in certain circumstances. Generally, where the worker has remained employed, but will be, or is, unable to work because the related condition has worsened and needs treatment.
I had a slip and fall on the ice in 2009 and opened a claim, but it quickly closed due to the fact they don’t cover slips and falls in the parking lot. After 6 and half years of severe low back pain, I had xrays and found that I have severe degenerative disc disease in my L5-S1 (which has caused spinal stenosis) and severe arthritis in my L4-S1. Can or should I reopen the claim? My quality of life has gone the drain since the fall…and it’s getting progressively worse as the years go on
I suspect your claim was rejected, not closed. Injuries in parking lots are not generally covered industrial injuries(there are some interesting exceptions or workarounds, but that’s a topic for another day) If a claim is rejected, there is no claim to reopen.
Well the claim was open and they paid for some of my chiropractic treatments while my claim was opened. Would they still reject the claim after they paid for the medical?
It is possible some medical bills would be processed and paid before the claim was rejected. In that case the money paid would have been recouped from the medical provider. The provider may then have billed you or your private medical insurance. If you want to know for sure whether the claim was allowed then closed versus rejected, call the Department of Labor&Industries and ask them, or look at your claim file on-line through the Department’s Claim and Account Center.