You lift something at work, slip and land on your back, or twist suddenly while doing your job. You initially think the pain will go away, but it does not. So what do you do now? You file a workers’ compensation claim through L&I.

Key Takeaways:

• Workplace back injuries should be reported to your employer and then through Washington’s L&I system.
• L&I will review the claim and determine coverage.
• If you cannot return to work, light duty, transitional work, and wage replacement may be available.
• Claims can be closed after treatment completes and you may receive a monetary permanent partial disability (PPD) award if you have been left with a permanent problem.
• Workers can challenge an L&I denial with the Board of Industrial Insurance Appeals (BIIA).

Reporting a Workplace Back Injury

The workers' compensation process in Washington starts by seeking medical treatment and inform the provider that the injury happened while at work. The medical provider will file the workers' compensation claim. It is often helpful to inform your employer as well. There are a few options available for workers when filing their claim.

Do not wait to initiate the claim. Under RCW 51.28.050, the claim for injury must be filed within one year of the injury date. Filing early is especially crucial with back injuries. It is common for workers to feel relatively fine immediately after an accident. However, as time goes on, they experience worsening symptoms like increasing pain, stiffness, or numbness. The medical record should document the accident, symptoms, examination findings, and treatment. The sooner the injury is reported, the easier it is to connect the incident to the injury.

L&I Reviews Whether the Back Injury Is Covered

Once a back injury claim is filed, L&I reviews the accident details and medical information related to the injury. The medical provider’s diagnosis and treatment plan are crucial for connecting the injury to the work event. Workers' compensation only covers medical care directly related to a workplace injury. If the worker has a pre-existing back condition, it may complicate the claim. A workers’ compensation attorney can assist when there is a dispute over whether the work incident caused or contributed to the claimed injury.

Medical Treatment for a Workplace Back Injury

The initial workplace-injury medical visit is covered even before the claim is approved. For subsequent treatment, the worker generally needs to use a provider within L&I's network. That attending provider is responsible for coordinating the worker’s treatment. They may refer the worker to a specialist, depending on the specific injury and treatment requirements. Treatment can continue while the claim remains open and the accepted injury still requires care.

What Happens If You Cannot Return to Your Regular Job?

Workers with back injuries commonly have restrictions that prevent them from performing work that requires lifting, bending, standing, or other physical restrictions. It is the worker’s attending provider that determines these restrictions. Depending on the restrictions, they can directly impact the worker’s ability to perform their regular job functions.

Light Duty or Transitional Work

One option is for the employer to offer an alternative in the form of light duty or transitional work. This can include reduced hours, less physically demanding duties, different duties, or workplace modifications. The worker’s provider must approve the employer’s light duty offer before the worker can accept. This ensures that the new duties do not violate the worker’s restrictions.

Wage Replacement

If the worker cannot work because of the injury and the doctor certifies that they are unable to work, they may qualify for time-loss compensation. Time-loss benefits generally replace a portion, rather than all, of the worker's wages. Workers who are able to return to light duty or transitional work and are subsequently earning less may qualify for loss of earning power (LEP) benefits.

How a Back Injury Claim May End

Each accident and injury is unique, and L&I treats them that way. This means that workers cannot predict how their claim may end when compared to other back injury claims. L&I may close a claim when treatment is complete and the worker’s condition has stabilized. At the time of closure a worker may receive a permanent partial disability (PPD) award. This generally happens when the worker has permanent loss of function even after treatment. A qualified doctor provides the PPD rating.

Washington allows workers to protest the claim closure or request to reopen the claim. There is a 60-day deadline for protesting a closure. Reopening a claim after that period involves additional requirements.

What if L&I Denies or Disputes Part of Your Back Injury Claim?

It can be frustrating when you have done everything required, and L&I denies your back injury claim. Unfortunately, denials can and do happen. L&I could question whether the injury qualifies for workers’ compensation coverage. It may accept coverage, but limit the conditions allowed on the claim. There may be a disagreement about the required treatment. In some situations, it may determine that wage-loss benefits should end while you still have a need for them.

Thankfully, Washington’s L&I system has a process for challenging these denials. Generally, injured workers can protest unfavorable L&I decisions to L&I or file appeals with the Board of Industrial Insurance Appeals (BIIA). Absent an exception, written protests or appeals must be mailed or electronically filed within 60 calendar days of receiving the decision.

Do Not Assume Your Back Injury Claim Is Straightforward

There is a lot to keep track of after a workplace back injury. You have the accident itself, medical appointments, work restrictions, bills, lost income, and L&I correspondence. It is easy to focus on getting through the next appointment and overlook the bigger picture of your claim. Pay attention when L&I makes a decision about your benefits or treatment. If something does not make sense or you believe the decision does not reflect what happened, Robinson & Kole can look at the claim with you and explain where things stand and what steps may be available.

Schedule a consultation online today or by calling 360-671-8112 to discuss your claim. Se habla Español.