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Archive | Industrial injury

Money isn’t everything – Don’t let your insurer short your medical bills

One of the most common reasons injured workers contact me is because their doctor is asking for specific treatment and the self-insured employer refuses to pay. Obviously if the treatment is for a non-industrially-related condition, this would make sense. Sadly, these self-insurers play games and offer faulty excuses to get out of paying for the treatment of related conditions as well; a rather deceitful attempt to wiggle out of the deal struck in 1911 between legislators, businesses and labor leaders, most of whom represented the mammoth lumber industry which employed three-quarters of Washington’s workers at the turn of the 20th century.

History class aside, the purpose of the Industrial Insurance Act was and is to provide “sure and certain relief for workers, injured in their work…” To that end, the legislature has created a penalties provision to hold self-insured employers accountable for making timely payments of monetary benefits including time-loss payments and permanent partial disability awards. Unfortunately, this legislative protection has only been offered for monetary benefits and not medical or vocational benefits.

Thankfully the Board of Industrial Insurance Appeals, or BIIA, has recently addressed this issue. In the 2012 BIIA decision, In Re: Coston, the term “benefit” was broadened to include both monetary and medical benefits as well.

This is a fantastic tool which all injured worker representatives should be using to stop self-insured employers from delaying or refusing to pay for necessary treatment for industrially-related injuries and conditions.

If you have a question about benefits, need to protest a decision or you’re unsure about the next steps in your claim, call us at (509) 228-7011 or use our contact form  to set up a free consultation.

Blast from the past

Are you experiencing aggravation from a pre-existing injury (aka “lighting up)?

Unless you’re under 25 years old (and maybe still then) you probably have some old injury or complaint from your past. If you’re lucky, the sore neck from that fender bender, or injured knee from a brutal high school soccer game years ago, or other accident – will not come back to bother you.

Unfortunately, people with pre-existing injuries have to work just like the rest of us, and all too often, a workplace injury or repeated exposure can aggravate those injuries. Insurance companies (like the Department of L&I) often try to point the finger at old injuries to avoid coverage.

Here’s what you need to remember if that happens to you in an L&I claim: If an injury or repetitive use of a joint aggravates, lights up, or makes active a latent or quiescent infirmity or weakened physical condition, then the resulting disability is to be attributed to the injury, and not to the preexisting physical condition. More simply stated, if your workplace injury, occupational exposure, or repetitive joint use at work makes an old condition worse, the Industrial Insurance Act likely affords you L&I coverage.

If you’re having trouble getting treatment or L&I claim allowance because you have had some previous injury, call Carlisle & Byers for a free consultation.

 

 

Quiz: industrial injury vs. occupational disease – what’s the difference?

Say you’re having back pain. Would that be considered an industrial injury or occupational disease?

Let’s start with injury – RCW 51.08.100 says “injury” means a sudden and tangible happening, of a traumatic nature, producing an immediate or prompt result, and occurring from without, and such physical conditions as result therefrom. Confused yet? In sum, an injury is what results when something sudden happens and you have symptoms immediately or shortly thereafter, i.e. a fall from a ladder, broken bone, etc.

How is injury different than occupational disease? RCW 51.08.140 says “occupational disease” means such disease or infection as arises naturally and proximately out of employment under the mandatory or elective adoption provisions of this title. This one is a little easier to read, but still not abundantly clear. In basic terms, an occupational disease happens over time from continuous exposure in the workplace, i.e. repetitive motion leading to joint damage, asbestosis, carpal tunnel, etc.

So, whether you’ve been injured or are suffering from symptoms related to exposure at work, go see your doctor, then call Carlisle & Byers for a free consultation.