What Catastrophic Industrial Injury Benefits Are Available?

Catastrophic Industrial Injury Benefits in Washington Include:

• Artificial Eyes pursuant to RCW 51.36.020(2) and (3)
• Prosthetics and Limb Replacements pursuant to RCW 51.36.020(2) and (3)
• Tooth Restoration and Implants pursuant to RCW 51.36.020(3)
• Eyeglasses and Lenses Restored or Replaced Pursuant to RCW 51.36.020(4)
• Hearing Aids pursuant to RCW 51.36.020(4)
• Crutches, Braces, Belts, Casts and any Mechanical Appliance or Equipment pursuant to RCW 51.36.020(5)(a)
• Reasonable Travel Expenses to Obtain or Replace Medical Aid Devices or to Obtain Hospital Care or Services pursuant to RCW 51.36.020(5)(b) and (6)
• Medical, Surgical and Hospital Care and Services pursuant to RCW 51.36.020(6)
• Residence Modifications in the Director’s Discretion pursuant to RCW 51.36.020(7)
• Motor Vehicle Modifications pursuant to RCW 51.36.020(8(a) and (b)
• All Other “Proper and Necessary” Treatment, Services or Devices per RCW 51.36.010.

The umbrella term “proper and necessary” covers any and all medical aids and services that will assist injured workers to obtain increased functionality in any domain of life. In one catastrophic injury case handled by Washington Law Center, ongoing nurse case management services were denied by the Department after the Department’s Claims Manager determined that the injured worker was “outside the acute injury phase.” This is no sufficient legal reason for denial. The Claims Manager next took the position that no further Nurse Case Manager services were needed as any and all additional care coordination could be effectively advocated by the injured worker’s attorney. We appealed to the Board of Industrial Insurance Appeals because advocacy by the injured worker’s attorney is different than care coordination by a specially-trained nurse working in the field together with the injured worker’s physician. 

In that same case, the Department also denied opioid pain management via implanted pain pump because the Department said its medical aid “guidelines” only permitted ongoing opioids and pain pumps in cancer cases. We appealed this further denial to the Board of Industrial Insurance Appeals because the Department’s “guidelines” don’t cover the universe of what can be determined to be “proper and necessary” treatment, including in non-cancer pain cases.

Again in the same case, the Department denied reimbursement for a specialized outdoor wheelchair with gun mount that would allow the catastrophically injured worker to hunt independently to the best of his abilities despite having no use of his arms or legs. When so catastrophically injured, being able to participate in outdoor sports to the highest degree possible conveys critical mental health benefits, so we again appealed to the Board and argued that reimbursement was required under the “proper and necessary” standard.

In the above three examples, the state’s attorney ultimately conceded that the optics of a Board bench trial or Superior Court jury trial (if necessary) would not favor the state’s denial positions such that the end result would be authorization. The state’s attorney then convinced his client, the Department of Labor & Industries, to agree to capitulate. Please see the attachment here in which the Board’s Industrial Appeals Judge entered a favorable Order on Agreement of Parties (“OAP”) on behalf of our catastrophically-injured client.

If you are catastrophically injured due to industrial injury, please consult with the experienced attorneys of Washington Law Center. Our successes on behalf of catastrophically injured workers not only include the attached OAP linked above, but we (as of the time of this writing) also hold our state’s record for the largest third-party settlement ever entered into on behalf of a catastrophically-injured Washington worker: $25,500,000.00. In that case, the worker was actually injured in Oregon, so our personal injury case was handled in Oregon with the assistance of an Oregon-based law firm that we enlisted for our client, but we also established a Washington L&I claim for our client based on the fact that his employer hired him in Washington State (giving Washington the requisite jurisdictional authority).

Catastrophic injuries devastate all aspects of life for both the injured worker and their family, but legal remedies are available to assist in the worker’s recovery to whatever extent remains possible. Washington Law Center is known for our excellence and tenacity in handling many of this state’s most complex industrial injury cases, including for catastrophic injury clients. If you or a loved one has such a case, please call our firm for a free consultation today.