Category Archives: Medical Care

DLI News: Telehealth Update

Washington State Department of Labor and Industries has issued a Telehealth Update. The changes are introduced, on a temporary basis, in response to the Coronavirus pandemic.

TeleSIMP and Telerehab Payment Policies Now Available 

Effective March 25, 2020, Labor and Industries (L&I) is temporarily allowing Structured Intensive Multidisciplinary Program (SIMP) services to be delivered as part of telehealth. This Telehealth Update is part of L&I’s Chronic Pain Management payment policy. This temporary TeleSIMP policy allows SIMP services to continue, while helping to slow the spread of coronavirus (COVID-19) outbreak by reducing in-person appointments. SIMP providers may use telehealth to deliver certain services for workers enrolled in their program. This policy isn’t intended to replace Chapter 34: Chronic Pain Management.

Effective March 20, 2020, L&I is also temporarily allowing the delivery of rehabilitation services using telehealth, called telerehab. Physical therapists, occupational therapists, and speech language pathologists may use telehealth to delivery services for established patients in outpatient settings.

L&I’s current payment policy and fee schedule already covers phone calls between providers and workers, see Chapter 10: Evaluation and Management Services for more details.

Both of these temporary policies will allow the use of the worker’s home as an origination site when they are receiving services. See L&I’s Temporary Telehealth Payment Policy for additional details. 

Updates and corrections are periodically posted on L&I’s Medical Aid Rules and Fee Schedules website. Both of these policies are available here.

Please note: a temporary telehealth policy is under consideration for brain injury rehabilitation services. If adopted, a future Telehealth Update will be issued.

Questions on the payment policies? Contact L&I at

Prior Post About Telehealth Services


Physical Medicine Best Practices Project

The Physical Medicine Best Practices Project undertaken by the WA Department of Labor and Industries seeks to bring increased standardization of care and care reporting by physical and occupational therapists. The pilot project is a collaboration with community experts to implement best practices that ensure workers receive:

  • Effective physical and occupational therapy services.
  • Clinically meaningful improvement in function.
  • Focusing on return to work.

Learn more about the Physical Medicine Best Practices Project, including the stakeholders involved in the project, and watch the video, below, for an overview.

Understand How Your Providers Report to DLI

Under the Physical Medicine Best Practices Project, your physical or occupational therapist will report to your attending physician and your claims manager on a regular basis. Your therapist will use the Physical Medicine Progress Report form to document your treatment, progress, and functional ability levels. If you have an assigned vocational counselor, this report form may be used to clarify your physical abilities for purposes of documenting your ability to work. The form is currently used by your therapist on a voluntary basis, but it will be phased in and will become mandatory soon.

In addition to standardizing care and reporting, this project and, by extension, the reporting form, encourages your physical or occupational therapist to engage with you, the patient, and your doctor. Your therapist’s suggestions for evaluation by additional types of providers or for additional treatment services can be noted and shared using this form.

Best Practices Quick Reference Card

Although meant for medical providers, the Department’s Best Practices Quick Reference Card provides an injured worker with clear information about the intent of the Physical Medicine Best Practices Project. It shows the focus on patient engagement and increased communication, and outcome documentation and tracking.

Reviewing the quick reference card will give you a clear understanding of the goals and expectations for your progress in physical therapy.

Violence Research By UW

“In May, the State of Washington awarded $1 million to the UW School of Medicine for the formation of the Firearm Injury & Policy Research Program. The program seeks to answer urgent questions involving firearm risks, injuries, policies and programs in Washington state.” – UW Medicine

Violence research by UW Medicine researchers provides findings that support the contention of ongoing impacts to physical and mental health subsequent to experiencing violence. Workplace violence is increasingly prevalent, with immediate and long-lasting consequences for the victims of this violence.

The lasting effects of workplace violence can require ongoing medical and psychiatric care, can impede the victim’s ability to return to work and, in some cases, can result in permanent impairments. In my experience, the mental health impacts can be the most insidious and difficult to overcome. The difficulties are compounded if an injured worker encounters pushback from the Department of Labor and Industries, sometimes in the form of treatment denials, other times through not recognizing the difficulty in returning to work or not acknowledging the presence of permanent impairment.

UW Medicine recently released the news of the completion and presentation of the researcher’s findings. Violence research findings that span every age and a variety of circumstances, but findings that can be applied to workplace violence cases, as well. The full text of the UW Medicine release can be read here, and is excerpted, below:

Violence has complex, far-reaching impacts on health

A new paper by UW Medicine researchers offers a broad, updated look at the interrelated impacts of violence on physical and mental health across age groups, from infants to elderly people.

The authors compiled recent compelling findings about health effects of child abuse, bullying, youth violence, adult interpersonal violence, and elder abuse, among others.  The paper was published Oct. 7 in Health Affairs. Its authors represent the Firearm Injury & Policy Research Program, based at the Harborview Injury Prevention & Research Center.

“Violence has important consequences for physical and mental health. These consequences vary with the type of violence and age, but all of them can be severe, debilitating and lifelong,” said Dr. Fred Rivara, the paper’s lead author. He is a professor of pediatrics at the University of Washington School of Medicine and adjunct professor of epidemiology at the UW School of Public Health.

“The findings of our review point out the need to both treat the victims of violence and prevent these types of violence from occurring in the first place,” Rivara said.

By organizing their findings by age group, the authors highlighted the cumulative, interrelated harms of violence across the lifespan. For example, research has found that victims of child abuse have an elevated risk of depression, suicidality, drug use, and certain chronic illnesses later in life. Because of that risk, they are also more likely to later experience intimate partner violence, which in turn heightens risk of depression, anxiety, asthma, gastrointestinal disorders, chronic pain, and other health issues.

An overview of many types of violence also helps broaden research and policy perspectives beyond the immediate physical trauma, and draws attention to long-term health impacts. These harms affect not only individuals, but also indirectly traumatize family, friends, and communities.

Badly Burned on the Job? New Center of Excellence at Harborview Hospital in Seattle, WA

Burns are among the most painful on-the-job injuries. Each year, hundreds of workers in Washington are burned on the job so severely that they require specialized medical care. The care and support these injured workers receive are key to their recovery and return to work.

The Department of Labor & Industries (L&I) and Harborview Medical Center opened a new Center of Excellence for medical care for burns in August, 2017. The agreement expanded workers’ access to a range of specialists who collaborate throughout the worker’s recovery.

“Getting the right care at the right time is crucial for these catastrophically injured workers,” said Joel Sacks, director of L&I. “We hope to make their recovery better and a little easier by improving access to specialists.”

“The new Center of Excellence for Burns will help us streamline multi-disciplinary care to Washington’s workers who sustain devastating burns,” said Dr. Nicole Gibran, director of the Regional Burn Center at Harborview Medical Center, part of University of Washington (UW) Medicine. “By coordinating care with providers who understand burn injuries, we facilitate physical and psychological recovery.”

National data has shown that nearly 50 percent of adult burn patients do not return to work two years after injury and 28 percent never return to work. In contrast, a recent study in the Journal of Burn Care & Research showed that 93 percent of workers with work-related burns who were treated at the UW Medicine Regional Burn Center at Harborview returned to work on average 24 days after injury. The research attributes these dramatically improved outcomes to the broad support the worker receives from employers and workers’ compensation claims staff, and to the specialized and comprehensive burn care at Harborview.

To streamline care for burned workers insured by L&I, a group of highly-trained staff from the agency manages catastrophic claims. They will coordinate closely with UW Medicine and with staff wherever workers continue treatment.

The new center is part of an L&I project  to improve care for catastrophically injured workers. This is the second center of excellence; the first, for amputations, was established in early 2016.

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