Medical Liability Benefit Attorneys

Medical treatment for accepted conditions

Once your claim is open, L&I or the Self-Insured Employer (SIE) must pay for medical treatment for the conditions related to your work injury. L&I or the SIE will only pay for treatment that is curative or rehabilitative as opposed to palliative. It is important to note that L&I will only pay for treatment for accepted conditions—conditions that are causally related to your work injury. Whether a condition is accepted on your claim is often hotly contested. Reach out to our office if L&I or your SIE is denying a condition that should be accepted on your claim.

When does my entitlement to medical treatment stop?

L&I or your SIE must pay for medical treatment that is directly related to your work injury until a doctor certifies your injury has reached maximum medical improvement (MMI). You have reached MMI when your work injuries are “fixed and stable”—When further treatment is no longer curative for your related conditions. Whether your work injury conditions have reached MMI can also be strongly contested by L&I or your SIE. Contact our office if you are being denied the further treatment you need.

Attending Provider (AP)

Your attending provider, also known as the attending physician, is the primary doctor for your work injury claim. This doctor is responsible for managing your treatment, getting conditions accepted on the claim, reporting your progress to your claim manager, and determining your ability to return to work. Under Washington workers’ compensation legislation and case law, your attending provider’s opinion is given special consideration. Thus, it is crucial to have a supportive attending provider who understands the complexities of your injury, and who is genuinely willing to help coordinate your care.

How do I find an attending physician?

Finding a good, supportive attending provider is a challenge for many injured workers. Your attending physician must be a member of the L&I network. Not every doctor is a member. Many doctors specifically choose not to be in the L&I network for a number of reasons. If your doctor is not in the network, search for a new doctor who is in the L&I network here: L&I Provider Network.  If you have an established relationship with a doctor and he or she is not in the network, you can ask him or her to join by following the process here: Join L&I network.

Changing your attending provider

RCW 51.36.010 gives injured workers the right to choose their attending provider. However, a transfer of an attending physician must be approved by the insurer. Approval should be given unless there is a legitimate reason for denial. A denial must be well documented and justified. If you need a new attending physician, fill out a transfer of care form and submit it to L&I or your SIE.

Independent medical exam (IME)

An independent medical examination, commonly abbreviated to IME, is a medical exam requested by L&I or your SIE. An IME is supposed to be an objective medical exam in which an unbiased doctor determines the status of your work-related conditions. However, that is not the reality of IMEs.

In almost all cases, L&I or your SIE schedules you for an IME to deprive you of some workers’ compensation benefit. IMEs operate as means for L&I or your SIE to obtain a medical opinion that is adverse to your claim. The IME doctor’s opinion is bought and paid for by the insurer (L&I or your SIE). Many injured workers are found to be at maximum medical improvement (MMI) by the IME doctor, which can result in a premature closure of their claim. This is wrong—Fight back. Contact our office if your recent IME resulted in a negative development in your claim.