Two laws are the underlying factor of almost every decision an L&I claims manager makes during a claim. These laws determine injury allowance, medical payments, time loss, vocational services, open reserves, permanent partial disability and pension benefits. The two laws are as follows:
- WAC 26-20-1002- Requires a claims manager to approve allowance and all treatment benefits based on the attending physicians recommended treatment plan for the injury;
- RCW 51.04.042 & RCW 51.12.010- These statutes deem that if there is doubt about the allowance of the injury, the benefit of the doubt goes to the injured worker.
An employer’s only recourse for unfair and unreasonable benefits paid is to establish a prima facie case pursuant to WAC 26-12-060 (7). This means the decision is accepted until proven otherwise. The only way to combat medical evidence is with medical evidence.
We will protest and appeal adverse decisions against your business. We bring the medical evidence and legal expertise to amplify your voice!