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Opening Your L&I Claim and the Statute of Limitations, Washington State
Within seven years of the first closure, a claim can be reopened for all monetary and medical benefits allowable under the Industrial Insurance Act – so time loss, retraining, and permanent partial disability awards (less any amounts already paid at the initial closure). The allowable medical benefits include conservative curative (not palliative) treatment, surgery, etc.
A Closed Workers’ Compensation Claim
Final and Binding?
Once the applicable statutory protest/appeal period has lapsed (often 60 days from the date of receipt of the order, other timelines apply for things like vocational dispute resolutions) the order or decision of the department or self-insured employer becomes “final and binding,” which means it cannot be unwound or changed even if the parties disagree with the result. There are circumstances where an “unaddressed protest” may have been put into the file that can have a tolling effect on the underlying order or decision. Even if you have an order that is more than 60 days old, check with an attorney to see if such circumstances exist.
In short, a protest need only be a written statement that is reasonably calculated to say “no,” or to put the department or employer on notice that you (or your doctor) disagree with the decision. If any such unaddressed protest exists (which must sometimes be litigated itself to determine whether the writing or document in question actually serves as a protest), you may be able to take action on the decision even after the timeline for protests or appeals has ended. In that case, it leaves the possibility open to change or adjust the order or decision until it is acted upon further by an adjudicator at the department or self-insured employer. Alternatively you can make a direct appeal to the Board of Industrial Insurance Appeals (BIIA) if such a protest exists. Phew, that was a lot of dry lawyer talk.
The Aftermath of a Closed Workers’ Comp Claim
When your claim closes, it means that monetary benefits and treatment have ended. However, some special circumstances involving retraining and vocational benefits can extend beyond closure. Your claim manager should consider the findings and recommendations of your doctor prior to closure. Once the closing order is communicated to you via mail, you have 60 days from receiving the letter to protest or appeal the decision if you disagree. A note about the timeline here: the language about your receipt of such an order is soft at best. If at all possible, operate as if the timeline ends 60 days after the date of the order.
30 Days After Claim Closure
The first 30 days after closure can be crucial if you need to establish that more treatment is needed, for example, and believe your claim should remain open. You must ensure that your doctor has demonstrated to the department that further proper and necessary treatment is still available and warranted. Also, you must ensure that the doctor has communicated it to the department or employer.
It can take time to make appointments, get the doctor’s office to send records/requests, etc. This is especially true if your doctor has told you there is nothing more they can do but recommend you see a specialist. The time is NOW to get appointments lined up with the intention of gathering the medical evidence necessary to show that your claim should not be closed.
60 Days After Claim Closure
After the 60 days have passed without protest or appeal, your only option is reopening your workers’ comp claim, which means you need to show objective medical worsening. Usually, this means X-rays, MRIs, or other repeatable, demonstrable medical evidence to show that your condition is worse than it was when your claim closed.
It is important to note that several situations or circumstances may make you curious if you can reopen your claim, but they will not rise to the required level of objective medical worsening.
Some examples may be:
- Your mind changed about having surgery that was offered to you while your claim was open, but you decided against it.
- Your pain has increased, but there is no objective basis to show that increase, or if you simply realize it is harder to manage your restrictions/pain than you had originally thought.
- You would just like to see if there is any other treatment available.
Unfortunately while these seem like perfectly reasonable situations to reopen a claim, your application will be denied without objective medical evidence.
Now that your claim has been closed and you have returned to work, is your claim closed forever? The short answer is: not necessarily.
30 Days After Claim Closure
The first 30 days after closure can be crucial if you need to establish that more treatment is needed, for example, and believe your claim should remain open. You must ensure that your doctor has demonstrated to the department that further proper and necessary treatment is still available and warranted. Also, you must ensure that the doctor has communicated it to the department or employer.
It can take time to make appointments, get the doctor’s office to send records/requests, etc. This is especially true if your doctor has told you there is nothing more they can do but recommend you see a specialist. The time is NOW to get appointments lined up with the intention of gathering the medical evidence necessary to show that your claim should not be closed.
60 Days After Claim Closure
After the 60 days have passed without protest or appeal, your only option is reopening your workers’ comp claim, which means you need to show objective medical worsening. Usually, this means X-rays, MRIs, or other repeatable, demonstrable medical evidence to show that your condition is worse than it was when your claim closed.
It is important to note that several situations or circumstances may make you curious if you can reopen your claim, but they will not rise to the required level of objective medical worsening.
Some examples may be:
- Your mind changed about having surgery that was offered to you while your claim was open, but you decided against it.
- Your pain has increased, but there is no objective basis to show that increase, or if you simply realize it is harder to manage your restrictions/pain than you had originally thought.
- You would just like to see if there is any other treatment available.
Unfortunately while these seem like perfectly reasonable situations to reopen a claim, your application will be denied without objective medical evidence.
Now that your claim has been closed and you have returned to work, is your claim closed forever? The short answer is: not necessarily.
Workers’ Compensation Claim
Appealing a Denial of Your Reopening Application
Your claim with the Washington State Department of Labor and Industries, either self-insured or state-funded, can be reopened for the rest of your life… kind of. If your application to reopen is denied, you can first protest the decision, then (paying attention to the Statute of Limitations on appealing department orders) you can file a Notice of Appeal.
To appeal an order denying your reopening application, fill out an online form that has directions about listing the order or decision you disagree with, the date of that order, why you think it’s wrong, etc. This form can be found at biia.wa.gov.
What Is the Seven Year Limitation?
Reopening your workers’ comp claim can happen anytime within seven years of the first closing order that has gone final and binding. But you just said for the rest of my life – what happens if I live longer than seven years?! Well, we did say kind of, but fair enough. After seven years, your claim can likely only be reopened for medical benefits.
You will not have access to wage replacement, permanent partial disability, or vocational services. So, yes, your claim can be reopened anytime for the rest of your life, but your benefits will likely be for medical treatment only after seven years.
How to Reopen Your Claim
There are a few questions you need to have answers for. Has your claim been closed by order? Was it communicated to all parties described in RCW 51.52.050? If one or both are untrue, give us a call; your claim may not yet be closed (at least properly).
Proof of Worsening Condition(s)
If your claim is closed, you must visit your doctor. Why? Well, to reopen your claim, you need to prove an objective worsening of your accepted condition(s) on your claim.
The worsening must have occurred after closure AND must be based on objective medical evidence.
Explaining Objective Medical Evidence
What is objective medical? Objective medical is anything that a person, who is not you, can see, feel, or otherwise discern. Often imaging or a physical examination with demonstrable findings (as an example, a measurable finding by your doctor of a limited range of motion may suffice if imaging is not performed) will work to prove this.
Objective Medical Evidence Examples Include:
- X-Rays
- MRIs
- Nerve Conduction Tests
- Electromyography Tests
- Most other repeatable, measurable tests performed by or at the request of your doctor
Subjective Conditions and Reopening Your Claim
In addition to objective medical, you also likely have subjective complaints. These are symptoms you can tell your doctor about. They may include things like increased pain or soreness, but remember that an increase in pain alone is not enough to successfully reopen your claim unless it’s accompanied by objective medical evidence.
To reopen your claim in the state of Washington, click here to access the form online. Preferably, you will do this with the help of your doctor and they can fill out and file the reopening application on your behalf. If you feel unsure at any point in the process, never hesitate to speak to a legal professional for a consultation.
Explaining Objective Medical Evidence
What is objective medical? Objective medical is anything that a person, who is not you, can see, feel, or otherwise discern. Often imaging or a physical examination with demonstrable findings (as an example, a measurable finding by your doctor of a limited range of motion may suffice if imaging is not performed) will work to prove this.
Objective Medical Evidence Examples Include:
- X-Rays
- MRIs
- Nerve Conduction Tests
- Electromyography Tests
- Most other repeatable, measurable tests performed by or at the request of your doctor
Subjective Conditions and Reopening Your Claim
In addition to objective medical, you also likely have subjective complaints. These are symptoms you can tell your doctor about. They may include things like increased pain or soreness, but remember that an increase in pain alone is not enough to successfully reopen your claim unless it’s accompanied by objective medical evidence.
To reopen your claim in the state of Washington, click here to access the form online. Preferably, you will do this with the help of your doctor and they can fill out and file the reopening application on your behalf. If you feel unsure at any point in the process, never hesitate to speak to a legal professional for a consultation.
Know Your Rights and Understand Your Options
You have options if your reopening claim was ignored or rejected. You can:
- Protest the decision if your claim is rejected. Make sure to include all relevant information about why you disagree.
- If your claim has not been reopened or rejected in 90 days, call an attorney for help to have your reopening application “deemed granted.”
- You can file an appeal with the Board of Industrial Insurance Appeals if you submit a protest and the department does not rule to reopen your claim.
Reopening Your Workers’ Comp Claim with Carlisle + Byers
Chris Carlisle and Rich Byers have over 25 years of experience combined with Washington State L&I Law, having served hundreds of clients with just about every L&I issue imaginable. From getting treatment approved or securing time loss benefits to pensions and survivor benefits, Chris and Rich are well-versed in practice from the department-level adjudicators up through the Board of Appeals, Superior Court, and beyond.
If you are still waiting for a response from the department or they have rejected your reopening application, give us a call to discuss your options.
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