New Washington Administrative Code (WAC) rules that set guidelines for independent medical examinations (IME) take effect on April 23, 2022.…
If your Washington L&I claim has been denied in the past and you’re looking to see if you’re eligible to reopen it, there’s still a chance. Read my summary below to see if you are eligible for “good cause.” If you need help reopening an L&I claim, feel free to reach out to myself or any of the experienced Seattle L&I attorneys at Washington Law Center.
“Can I Reopen My L&I Claim?”
RCW 51.32.160(1)(d) provides that an application to reopen an L&I claim shall be granted if the Department of Labor & Industries does not issue an order of denial within 90 days of the Department’s receipt of that application.
However, there is one exception to this rule.
According to Labor and Industries Washington state rules, upon “good cause” the Department may extend the time for making its final determination on the injured worker’s application, but then may only extend the original 90 day period by an additional 60 days. Effectively, therefore, all applications to reopen must be formally approved or denied within 150 days or else the law will “deem” any such remaining applications to have been granted by operation of the applicable statutory text.
“Good cause” to extend the consideration phase to the full 150 days may exist if:
- The Department is unable to schedule and obtain the results of an Independent Medical Examination
- The attending provider has failed to respond to Department requests for clarification or additional information
- There is some other unanticipated barrier to making the prompt consideration otherwise required within the first 90 days following most applications to reopen.
There have been instances in which the Department or Labor & Industries has attempted to cheat the “deemed reopening” rule. These have led the Board of Industrial Insurance Appeals and higher courts to clarify the law with respect to what the Department may or may not do, as well as under what circumstances.
For example, if the Department denies an application to reopen and then enters an abeyance order on its own motion in order to give it up to 180 additional days to act. This is allowed under RCW 51.52.060 with respect to other types of Department orders. The Board and courts will likely “deem” the application to have been granted within the time frames listed in RCW 51.32.160. Thus, the application to reopen should be “deemed granted” at 90 days if there was no good cause for taking longer than necessary to decide, and at 150 days if there did exist good cause.
If the Department receives an injured worker’s application to reopen after the Department has issued an order closing the worker’s L&I claim but before that closing order has become final, the 90 days the Department has to act on the application to reopen begin to run as soon as the claim closure order does become final and binding.
If you have filed an application to reopen and you are waiting to obtain a response from the Department, you should carefully time any inquiries as to the status of your pending application so that you don’t accidentally alert the Department to the fact it must act immediately. If you have been waiting for the application to be decided and more than 90 days have gone by, first contact your medical provider’s office to determine the date upon which the application was actually transmitted to the Department (because this may have been well after your reopening application medical exam). Remember, the Department is under no legal obligations to act until it has received sufficient information, from which its experienced employees should have recognized that an application to reopen was being filed.
If you have confirmed the date upon which your medical provider transmitted your application to reopen to the Department, but you still have heard nothing back from the Department at least 100 days thereafter, please contact Washington Law Center for a free consultation so we can enforce your “deemed” right to have your case reopened. Just because your application may be “deemed” by operation of law to be reopened does not mean the Department will voluntarily agree. At that point, it is time to retain a counsel experienced with applications for reopening.
ABOUT THE AUTHOR:
Spencer Parr is a litigation and trial attorney at Washington Law Center focused primarily in the areas of Labor & Industries claims and injury pension benefits. Before co-founding Washington Law Center, Spencer served in the U.S. Army. He has litigated major issues in the law, represented clients from coast to coast, and dedicated his professional life to assisting the injured and disabled. Click here to learn more about Spencer. View More Labor & Industries and Work Injury Resources.