L&I - Workers Comp Claims
If you were injured during the course of your employment, it is your choice whether or not to file a worker’s compensation claim. However, your employer can not legally stop you from filing. If you have made the decision to file a claim, please see your human resources department for further instructions on how to proceed.
Our Bellevue orthopedics practice will help you file workers compensation claims so you can get the care you need. For more information regarding workers’ compensation in Washington state, please visit the Labor and Industries website.
If you have not yet opened a worker’s compensation claim, you will need to contact your employer’s human resources department. Please do so before your first visit to determine whether your employer is covered through Washington State Labor and Industries or if they are self-insured. If your company is self-insured, your management or human resources department will have the appropriate paperwork to file your claim. However, if they are covered by WA State L&I, we will give you the Report of Accident claim form for you and your physician to fill out. Your company is required by law to provide you with the appropriate workers’ compensation paperwork. Many times this information can be found in common areas. It will usually take 4-8 weeks to determine whether or not your claim will be accepted or denied. The more information you can provide in the application process the better chance you have of an earlier determination. Until your claim is allowed, there is no guarantee that your bills will be covered.
Claims that are in the process of being re-opened are considered closed until we are otherwise notified by the insurance company that they have re-opened and allowed your claim for the accepted diagnosis. This process can take 30-120 days or longer depending on the condition and the amount of information to consider.
If you have filed your claim elsewhere and do not know if it is allowed yet, you will need to bring all the information regarding your claim to your visit. This includes a copy of your report of accident application, any documentation you have from other doctors or facilities on your injury and any radiology or testing done to the injured area. If your claim is already open and allowed, our office will provide you with a ‘transfer of care’ card. This will move your claim from your original provider to the provider you choose in our office. If you do not wish to move your claim here and are here solely for a second opinion, your attending physician needs to contact your claims manager and pre-approve the visit with our office. It is important to understand that many workers’ compensation claims are typically correlated to one body part or diagnosis, and any body part not covered under that claim will have to be authorized or billed through your personal health insurance plan.
If your claim is accepted, you will have no financial responsibility. However, if you are treated and your claim is rejected, we will bill your private health insurance. You will then be held responsible for any fees or charges that may arise from the plan between you and your health insurance company.