Employers’ rising premiums are a result of unfair claim benefits to some of their “injured” workers. L&I industrial insurance premium rates continue to rise and employers are forced to foot the bill for their unfair decisions. Washington State law protects injured workers regardless if there is foul play or abuse of the system. Employers are being forced to accept unfair, unjust and/or abusive workers’ compensation injury decisions without proper checks and balances. The employer pays the price with high experience rating and high premium surcharges. Fraudulent claims are very common and difficult to prove. L&I RCW codes are pro “injured worker” and claim managers are required to give the “injured worker” the benefit of the doubt.
Examples of Common Unfair L&I Decisions
Palliative Care (Chiropractic & Massage)
Palliative Care is when an injured worker is relying on palliative physical services such as massage or chiropractic treatments that improve their symptoms but do not resolve or address the root cause of injury. These services can be strung out for years unchecked by the department of L&I.
Occupational Disease is a long-term condition that becomes worse over time and is caused by the performance of the worker’s job. Even though previous positions could have caused or exacerbated the worker’s occupational disease, 100% of the liability is often assigned exclusively to the current employer.
Unabating or Prolonged Claim
Without proper monitoring or intervention, a claim can remain open for long periods of time unchecked, causing additional and unnecessary costs for employers whose rates and premiums continue to suffer.
Depression, Anxiety, & PTSD
When workers are out of work for long periods of time due to injury, they lose a sense of self-worth and develop depression that they might claim keeps them from returning to work. They might also claim that they have developed anxiety from either being out of work or from the occupational cause of their injury or trauma. It can be very difficult to prove or disprove psychological distress among injured workers.
Chronic Pain is often psychosomatic and brought on by depression and opioid use. Because providers do not choose alternative treatments for the issues, they continue to prescribe opioids leading to addiction.
Chronic pain and opioid addiction are one of the largest problems in the L&I benefit system and workers falsify either the extent of injuries or injuries themselves to receive prescriptions. Often, workers become dependent on opioids after a legitimate injury and exaggerate or fabricate further injury to maintain this dependency.
Third Party Injury
Some injuries are caused by outside parties that are financially responsible for the majority of the claim costs. L&I will often overlook or not pursue collections on those claims and costs are then unfairly added to the employer’s account.
L&I and vocational counselors will frequently opt for the maximum benefit allowed to the injured worker for retraining. This is typically an equivalent of 24 months for an Associate Degree vs. a certificate training program that typically would last 10 months.
Permanent Partial Disability
L&I claims managers do not have the medical expertise to question the level of permanent partial disability to be paid to an “injured worker.” Often PPD payments will pay out amounts that are not reasonable for the injury.
Unrelated Personal Injuries
Workers may have pre-existing conditions that will slow recovery of an injury or contribute to the symptoms of that injury. They may also have post injury incident that will be added into the claim unless disputed.