F245-224-000 - (L&I), Washington State - WA 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the designated fields, including your name, address, and contact details. Ensure all information is accurate to avoid delays.
  3. Next, provide details regarding your medical exam appointment. This includes the date, time, and location as specified in your notification letter from L&I.
  4. If applicable, indicate any necessary documents you need to bring to the exam, such as x-rays or MRIs. This ensures that the examining doctor has all relevant information.
  5. Review all entered information for completeness and accuracy. Incomplete forms may be returned for correction.
  6. Once satisfied with your entries, submit the form electronically through our platform for free. You can also print it out if you prefer a physical submission.

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Can I Sue LI? You cannot sue LI, even if you are unhappy with how they handle your claim.
When reporting, you can: Call 1-800-423-7233. Fill out a DOSH Complaint Form and: Submit the form to our secure file upload. You can also use this link to send us photos, videos, documents, and all other supporting information along with your form. or. Mail or Fax it to your local LI office.
A Labor and Industries disability pension is a special category of pension only awarded to the most severely injured workers in Washington state. If you are eligible for an LI disability pension, you will receive a non-taxable payment every month for the rest of your life.
Can I Sue LI? You cannot sue LI, even if you are unhappy with how they handle your claim. Washington state workers injured on the job cannot sue their employer for negligence, instead, they must file a workers compensation claim with Labor and Industries.
LI Time-Loss Compensation In such cases, the Washington State Department of Labor and Industries (LI) will reimburse you for lost time and wages typically between 60-75% of the workers earnings prior to the injury or disease up to a maximum cap.

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Joel Sacks, Director LIs mission is to keep Washington safe and working. The agency administers many vital programs including the states workers compensation system and its occupational safety and health program.

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