The late May sun cut sharply against Juan Maldonado’s face as he stepped onto the bridge carrying a small bouquet of purple and white flowers.
He silently led a small group of mourners to where his sister jumped to her death five years ago from a Mount Vernon overpass. Below on I-5, cars rushed past filled with vacationers heading home from the Memorial Day weekend.
Reaching the spot, he gripped the railing as tears began to fall.
“She was a skeleton with clothes,” he said through an interpreter, recalling the last time he saw his sister before she died in 2020. “Her expression was different that day. You could see the pain in her face.”
Leticia Maldonado Reyes had suffered severe pain following a 2016 workplace injury. When she struggled to return to packing fruit and vegetables for a Skagit Valley company, she tried to extend her claim for workers’ compensation — state-backed insurance that provides medical care and wage replacement payments for people injured on the job.
A year after her injury, Maldonado Reyes told her treating provider that she still felt burning pain and numbness in her left knee on a daily basis. Her case records, provided by the family, show that contract physicians for the Department of Labor & Industries pushed back on those complaints.
One wrote Maldonado Reyes had “subjective pain behavior out of proportion to objective findings,” her records state. Another doctor hired by L&I called the validity of her claims dubious.
Despite support from her own doctor, Maldonado Reyes lost her wage replacement payments. She sunk into depression and financial crisis as she appealed the decision, her brother said. She became homeless and isolated herself from her family.
“Even with her kids, she didn’t talk to anybody, didn’t trust anybody,” Maldonado said. “She felt like she was useless because she couldn’t go to work.”
Washington’s 3.8 million workers filed more than 111,500 worker compensation claims last year, most of which were approved and continued without any disagreement, according to L&I data.
But a system established to provide workers with swift medical support and wage replacement also forces many through a battery of skeptical examinations and legal challenges, leading to an appeals process that reverses L&I decisions about a third of the time. Workers told Cascade PBS longstanding barriers leave some coping with worsening injuries, financial instability or mental health issues.
Over the years, lawmakers and the state Supreme Court have directed officials to resolve disputes over workers’ compensation law in favor of the worker. Brenda Heilman, assistant director for Insurance Services at L&I, said the agency’s ultimate goal is to help workers get the care they need to recover and return to work.
“We strive to create a system that is easy to use, accessible for all workers, and treats all parties fairly,” she wrote in an email. “Being unable to work, or receiving medical treatment that isn’t helping them make progress, can cause additional suffering for workers.”
Maldonado said his own worker’s compensation claim dragged on for more than nine years due to a paperwork error. After Maldonado hurt his back and neck changing a tractor tire in 2007, L&I closed his case until his attorney discovered that a medical clinic had failed to send an MRI order.
In the time it took to get the claim reopened, Maldonado said, his injuries worsened: “My body had deteriorated even more because they weren’t paying attention.”
“I do think there’s a bias,” he said. “L&I is on the side of the employer instead of the worker.”
‘Grand bargain’
Filing a workers’ compensation claim is generally the only remedy for an injured worker.
Roughly 75% of Washington workers are covered by the state-managed workers’ compensation system. L&I pays out about $2 billion in benefits a year, according to agency data. Both employers and employees pay into the system to cover its costs. The other quarter of employees are part of the self-insured system, where companies administer their own workers’ comp insurance. L&I has some oversight over those claims.
The system operates under a no-fault system that provides workers with direct compensation for on-the-job injuries, but does not usually allow them to sue employers for additional damages. Only employers who intentionally hurt their workers can be sued.
That “grand bargain” was the heart of the 1911 Industrial Insurance Act, passed at a time when the number of factory jobs was growing and current laws were failing to provide adequately for hurt workers.
Lawmakers later added a line in 1971 codifying a principle long recognized by the state’s courts that when disagreements arise over how to apply the law, the benefit of the doubt should be given to the injured worker.
“They shouldn’t have to have a fight to get medical care. They should not have to have a fight to get the time loss benefits or other kinds of services that they are entitled to under their claim,” said Patrick Pleas, a lawyer with the Northwest Justice Project. “I have found in my work that is not always the case.”
Employers get access to injured workers’ medical information detailing diagnoses, treatments and mental health information. They can also request L&I hire a third-party doctor to give a second opinion and evaluate the diagnoses and treatments prescribed by an injured worker’s attending provider.
Not all doctors can treat injured workers; only those who join the L&I network can do so.
Heilman at L&I said officials recognize that language differences or other factors can create barriers, but the agency endeavors to create a system that is accessible for all workers and treats all parties fairly.
The agency requires medical providers to arrange for an interpreter when needed and provide document translation in a worker’s preferred language. The program also offers a comprehensive all-Spanish website and partners with a local Spanish-speaking radio station to disseminate information. The State Labor Council, with support from L&I, has a help center staffed with bilingual staff.
“I do think the system can be confusing for a worker as it gets more complex,” Heilman said. “We’re here to make sure that they get the benefits they’re entitled to, with or without legal representation.”
She said she believes workers benefit from the no-fault system because they do not have to sue to get care after an on-the-job injury.
“They don’t have to go through litigation,” she said, “to prove that they’re entitled to a workers’ compensation claim.”
Legal costs
Just before noon on Thursdays, Maldonado makes the short drive from his house to a squat gray-and-white clinic along College Way in Mount Vernon, where he gathers around a table in a windowless conference room with other Hispanic workers who have suffered injuries on the job. Each hired a lawyer as their workers’ comp claims hit roadblocks and they needed help appealing an L&I denial on medical care or time loss payments. Their goal, they say, is to reform the system to make it less biased against the worker.
At the table sat Raymundo Ponce. He uses sunglasses to conceal a twitch in his left eye that he attributes to a rough examination from an L&I doctor. The 63-year-old said chronic pain from a 2014 workplace injury has pushed him into the emergency room several times and he has suffered suicidal thoughts.
L&I has twice stopped sending Ponce wage replacement payments after doctors hired by the agency deemed him able to work, his documents show. One called his symptoms magnified and exaggerated.
In both these cases, a lawyer successfully appealed L&I’s decisions to the Board of Industrial Insurance Appeals, the state agency that adjudicates workers’ compensation disputes, and his payments restarted. Hiring that legal representation cost Ponce 30% of his wage replacement in lawyer fees, documents show.
Ponce said that while he waited for his wage replacement payments to resume, he had had to sell his truck and dip into his retirement fund. He continues to wait for a date from L&I for surgery on his right knee, and he said L&I denied a claim for mental health care.
“It makes you feel hopeless. It makes you feel it takes you to the point of wanting to take your life,” Ponce said through an interpreter. “They don’t give a crap about us. They just want us to go away.”
A worker is supposed to be able to navigate the complex system on their own, and that is often the case for non-serious injuries that require little to no time off work. Workers with more significant injuries, though, say the path to recovery is more arduous. Many hire an attorney to ensure they receive full compensation.
“If you don’t have a lawyer,” Ponce said, “you got nothing.”
Lawyers, though, come at a heavy price — often costing workers 15%-30% of their settlement. A state-funded study done by an outside firm in 2024 found that legal representation increased settlements by, on average, 2.4%, or $3,000. State data shows that three-fourths of workers filing an appeal with the BIIA hired a lawyer to represent them.
“The worst thing for the workers — and it has always been this, and it just gets worse and worse all the time — is the cost of litigation,” said Craig Stewart, a retired BIIA administrative law judge. “It is pervasive. It’s awful. People can't afford it.”
Stewart spent much of his career at the Board. He said there is not a lot of money in the system. Medical care will be covered, and maybe some vocational training, but settlements to workers who can return to work are generally small.
“People don’t understand that. They think they’re entitled to more. In the grand scheme of things, yeah, they’re entitled to more,” Stewart said, “but the schedule of benefits is not there for you.”
Appeals to appeals
Of the more than 100,000 claims L&I receives annually, the agency says it approves close to 85% of them on initial review. Of those, most continue without any dispute, while others initially accepted into the system can be challenged along the way by the agency and employer.
Throughout a claim’s life cycle, a claims manager monitors a worker’s recovery, authorizes treatment and hires doctors to evaluate diagnoses or close claims. When objections arise from these L&I decisions, either workers or employers can file an appeal with the Board. The Board reported that it received about 10,500 appeals last year, of which roughly 87% came from employees.
In more than 40% of those appeals, either L&I voluntarily agreed to reconsider its decisions or the Board reversed L&I’s decision, an analysis by Cascade PBS of data from the past five years found.
“A system that’s this inefficient and that unsuccessful is discouraging so many more workers from even bothering,” said Lee Thomas, a lawyer in Bellevue who specializes in litigating workers’ compensation appeals cases and a member of the Washington State Association for Justice.
Thomas contends that L&I measures success of treatment based on how quickly a person gets back to work.
“That’s the worst kind of way to measure treatment,” he said, “because it’s not about whether the pain is better.”
After a worker files an appeal — before it goes to the Board — L&I gets a chance to reconsider its decision. This happens in about 20% of submitted appeals, according to Board data.
For those appeals that are taken up by the Board, about a third of their final orders reverse a L&I decision, a Cascade PBS analysis of the data found.
L&I’s Heilman said agency decisions can be reversed because of new information or due to a negotiation with the worker.
“Within the category of reversals, there are subcategories,” Heilman said.
After appeals are exhausted at the Board, they may move to the local superior court system. Court decisions reverse L&I decisions about a third of the time.
Thomas noted that of the eight cases he took to trial to appeal an L&I decision last year, six involved people of color. He won seven of those. “The system is set up for English- speaking, fairly well-educated white people.”
Staff evaluating claims do not consider a worker’s life experiences, he argued, which can lead to implicit and unconscious bias of denials and improper claim management.
“That could be a big part of why it tends to be people of color, people [with] language differences that end up in the litigation mill,” he said.
‘I felt vindicated’
One of Thomas’ most recent clients spent seven years fighting for his claim. At first, Jerald McClinton said, his workers’ compensation claim proceeded without problems. He received medical care and wage replacement after his hand became stuck in a massive machine that processes toilet paper.
McClinton, who lives in Vancouver, had worked at the nearby paper mill for three years before his injury.
His claim hit an impasse when L&I closed it after the agency sent an investigator to surveil him and accused him of not being injured when they found him using his hurt hand. Court records later showed his medical provider had instructed him to increase his hand usage as part of the healing process.
“They tried to paint a picture that I was a liar, and I was manipulating my doctor,” McClinton said in an interview with Cascade PBS. “I was stuck in the machine for over 15 minutes as it ripped my palm off.”
The agency then ordered him to pay back the $40,000 in wage replacement payments he had received. He lawyered up and appealed. And appealed and appealed, as his case went through the BIIA and on to Superior Court.
McClinton said proving his case over and over was exhausting. He fell behind financially as his wage replacement payments stopped. He started driving for Uber when the pain wasn’t too bad.
A jury overturned L&I’s decision in March, ordering the agency to reopen his claim and treat him for post-traumatic stress disorder, complex regional pain syndrome and major depression, court documents show.
“I felt vindicated,” he said.
More than two months after the jury’s decision, McClinton said he was still waiting for L&I to reopen his case so medical care could begin.
“They made a decision to close my case falsely. And I won a case,” McClinton said. “Why do I have to wait so long for them to open the case up?”
Settlements
Back at the squat gray-and-white clinic, stacks of workers’ compensation files crowd Silverio Arenas’ desk. Arenas, a licensed psychologist who has treated injured workers since the 1980s, hosts the weekly meet-up with Maldonado and other workers.
The meetup serves as a place of social therapy for the Hispanic workers. Arenas alleges L&I unfairly rejects claims from Hispanic workers and relies too heavily on interpreters, instead of ensuring workers can see a doctor who speaks their own language and understands their culture.
“These guys already suffer from an extreme sense of uselessness and worthlessness, depression,” Arenas said, “On top of that, then [L&I] tries to make them feel like they’re not worth it, or that they don’t count, or that they’re making things up.”
Matt Ross, a spokesperson for L&I, said that allegation “simply is not true,” pointing to state data that show that Spanish-speaking worker claims are approved at a higher rate, 89%, over the past decade, compared to the average of 83.9% for all other languages.
L&I faced previous allegations of unequal treatment in 2011 when the Northwest Justice Project filed a lawsuit, accusing the agency of failing to provide interpreters for workers’ compensation medical appointments or send translated documents to workers who did not speak English.
A resulting settlement imposed changes to the L&I language access program, including the expansion of languages that forms are translated into.
Arenas had his own battle with L&I after the agency accused him of not properly submitting paperwork and overbilling the system by $188,000, court documents show. Arenas, who filed a civil rights complaint in federal court in response, said the agency came after him for speaking out. The two sides eventually settled on Arenas repaying $9,000.
He said he wants L&I to remove medical care from the workers’ compensation system and eliminate its role in managing and approving care. This would allow workers to see any doctor, rather than only those who are registered with L&I.
“L&I should be about paying bills,” he said, “not about treatment.”
A few months before Maldonado Reyes died, she reached an agreement with L&I accepting a $4,925 settlement in exchange for closing a claim for her left knee, documents show. Her brother said L&I had already denied a request for mental health treatment.
Maldonado said the pushback and pressure to return to work takes a toll.
“I think she got into the state of mind where she was like, I’m useless,” he said. “I can’t do anything now. I am useless. I am impaired. I can’t do this.”
