How is a workers' compensation claim reviewed?

In Washington, workers’ compensation claims are reviewed by the Washington Department of Labor and Industries (L&I). When an employee makes a claim for workers’ compensation, their employer’s insurance carrier will investigate the claim to determine if it is eligible for compensation. The insurer will review the details of the incident, including the severity of the injury and the circumstances under which it occurred. They will also determine whether or not the employee was at fault for causing the injury. The insurer will then make a decision on whether or not to approve the claim for compensation. If the insurer approves the claim, the employer must pay the employee the benefits specified in the workers’ compensation policy. If the insurer denies the claim, the employee may file an appeal with the L&I. The L&I will review the case and make a decision on whether the employee is entitled to compensation. This process can take up to a few months. In some cases, it may be necessary for the L&I to hold a hearing. During the hearing, the employee can present evidence to support their claim, and the insurer can present evidence to refute it. The hearing officer will then make a final decision on whether or not the employee is entitled to compensation. In all cases, the decision made by the L&I is final and cannot be appealed. This ensures that the workers’ compensation claims process is fair and efficient.

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