L&I claim complications after work accident - Surgery payment options with ESD?

You're mixing up different systems here. ESD (unemployment) won't cover medical expenses - that's not what it's for. Unemployment is only for wage replacement when you're able to work but can't find a job. If you're injured and can't work, you should be getting time-loss benefits through L&I, not unemployment. As for your surgery, L&I should cover all necessary medical treatment related to your on-the-job injury. If Seattle Spine won't take L&I, you need to either find a provider who will or talk to your claim manager about getting pre-authorization for a provider who doesn't normally accept L&I. Have you spoken directly with your claim manager about this issue?

OMG this is EXACTLY what happened to my brother last year!!! The L&I system is BROKEN!!! He ended up having to switch to a different surgeon that would accept L&I but then had to wait FOUR MONTHS for the surgery because that doctor was so booked up. Meanwhile his condition got worse and he couldn't work and bills piled up!!! It's a NIGHTMARE when u r injured at work and need special care!!

There's some confusion here that needs clarification: 1. You cannot legally collect unemployment (ESD) and L&I time-loss benefits simultaneously. This would be considered double-dipping and could result in an overpayment you'd have to pay back. 2. For your surgery situation, you have several options: - Ask your claim manager for a different referral to a surgeon who DOES accept L&I - Request that your claim manager approve an out-of-network provider (this requires specific paperwork) - If your claim manager isn't helping, contact the L&I Ombuds office at 1-888-317-0493 3. If Seattle Spine is suggesting they'll "take it from your settlement," this suggests there might be a third-party claim involved (like if another driver caused your accident). In that case, you should be working with an L&I attorney who can help protect your settlement. Don't jeopardize your benefits by filing for both systems at once. Focus on getting your L&I claim handled properly first.

i had something kinda similar happen when i hurt my back at the warehouse. what worked for me was my doctor had to write a special letter explaining why i needed that specific surgeon and then L&I approved it after like 3 weeks of back and forth. have your doctor submit more documentation about why you need that specific surgeon. the magic words they used were "unique specialization" and "case complexity" or something like that.

Have you tried contacting ESD directly to ask about your situation? I was in a similar situation last year and spent WEEKS trying to get through to someone who could actually help me. I eventually used a service called Claimyr (claimyr.com) that got me connected to an ESD agent in about 15 minutes. They have a video showing how it works: https://youtu.be/7DieNd3C7zQ?si=26TzE_zGms-DODN3 The agent I spoke with confirmed that I couldn't receive unemployment while on L&I time-loss but gave me some other resources for financial assistance during medical recovery. Definitely worth talking to someone who actually knows the rules rather than guessing.

Just wanted to add my experience with the whole L&I system since I went through this last year. The whole thing is so frustrating! I ended up having to get my state representative involved when my claim kept getting delayed. Don't be afraid to escalate things if you're not getting anywhere with your claim manager. I wish I had done that sooner instead of suffering for months!

One more thing to consider - if you're dealing with both L&I and a third-party claim (against the other driver), make sure you understand how these interact. If you receive a settlement from the third-party claim, L&I may place a lien on part of that settlement to recover what they paid for your medical treatment. This is standard practice, but many people are surprised by it. Your attorney should be explaining this to you. As for finding a surgeon who takes L&I, ask your claim manager for a list of approved specialists. They should be able to provide you with options within your area that are approved providers.

Based on everything you've shared, here's what I recommend: 1. Contact your L&I claim manager tomorrow and request a list of approved spine surgeons in your area 2. Have your primary doctor submit detailed documentation about why you need a specific surgical approach 3. If your claim manager isn't responsive, contact the L&I Ombuds office 4. Withdraw your ESD application for now to avoid potential overpayment issues 5. Ask your L&I claim manager about getting your time-loss rate reassessed if it's not sufficient Don't agree to pay for the surgery out-of-pocket with the promise of reimbursement later - that's risky and not how the system is supposed to work. L&I should cover approved medical treatment directly.