If the Department of Labor and Industries (L&I) closes your L&I claim or your workers’ compensation claim, you may be able to reopen it. However, if your L&I claim has been closed, it is important to note that L&I does not automatically reopen claims. In fact, your case must meet certain criteria to reopen an L&I claim. However, many work injury claimants get discouraged and give up instead of trying to apply to reopen their workers’ compensation claim.
My L&I claim was closed. Now what?
In fact, some medical providers believe that L&I does not reopen claims. Other treating professionals think that the reopening process is too difficult. This is simply not true. It is important for both people with a work injury claim and medical providers to fully understand the reopening process and requirements.
In physical work injury claims, to reopen a workers’ compensation claim, you must show that certain conditions objectively worsened between the final dates. If you want to determine if these criteria are met, you must first understand some workers’ compensation concepts. These three basic concepts are: (1) Terminal dates; (2) Causal relationship of the conditions; and (3) Objective worsening.
Terminal dates in a workers’ compensation claim
When you file an application to reopen an L&I claim, the term “final dates” refers to two important dates. The earliest termination date is when L&I most recently closed your claim. The second date is when L&I denied the most recent reopening request. Take the more recent of the two dates. We denote this terminal date as T1. Then, the second end date (which we call T2) is the date you filed the most recent request to reopen your workers’ compensation claim.
Causation in L&I claim
We say conditions are “causally related” if the industrial injury or occupational disease is the proximate cause of the conditions. Here proximate cause means a cause that, in direct sequence, produces the condition. The law recognizes that there may be more than one proximate cause. Therefore, the work accident or occupational disease must be one of the causes of the condition. In other words, it does not have to be the only cause. In addition, a condition can also be causally related if the work accident or occupational disease aggravated or worsened it.
The causal relationship requires medical reasoning. Here, you must obtain a written medical opinion to show that the work-related injury or illness caused the condition. In other words, you need to find a competent doctor or medical expert to say that there is a causal connection and explain why. Remember, reopening requires aggravation of causally related conditions. Therefore, we must first identify the condition and the causal relationship.
L&I sometimes reopens claims for worsening of a condition. For example, if doctors did not diagnose or link a condition to the claim before the claim was closed. If the medical evidence supports that the condition is related to your work injury, or that the condition worsens and requires treatment, then L&I will reopen the claim.
Objective worsening in labor accident
If you have a workers’ compensation claim, then L&I considers everything you say to be subjective. For example, saying that you are experiencing increased pain is subjective. It is insufficient for purposes of reopening claims. Alternatively, objective findings are those that a medical provider can see, feel, or measure. To reopen a claim, a medical provider must show that the causally related conditions worsened between the two terminal dates. In addition, these conditions must require treatment or increase your level of disability.
Here is an example. Let’s say he was injured at work and his work injury caused a herniated disc. Doctors can clearly see the herniated disc on the MRI. In practical terms, doctors can measure the actual size of the hernia. Based on the initial size, they determine that the disc is not impinging on the nerves. Therefore, you do not need surgery and your treatment is over.
The claim is then closed. Over time, the hernia worsens and causes additional symptoms. The doctors get a new MRI where they see the hernia is bigger. Now the disc is impacting the nerves and needs surgery. At that time, you must file an application to reopen with L&I and L&I must grant it. Additionally, if the reopening occurs within 7 years of the initial claim closing, you may receive additional monetary benefits such as lost time compensation and increased PPD.
concluding remarks
If you want to reopen an L&I claim or workers’ compensation claim in Washington state, you need to understand some basic terms. However, it is not difficult to learn and understand them. It is also not difficult to reopen your claim. If the conditions related to your claim objectively worsened, then you should apply to reopen your claim. Also, with objective worsening, there is no reason for L&I to deny your claim reopening request.
This article was first published at https://tarareck.com/l-and-I-claim-closed/