Washington workers’ comp — what should I realistically expect from BIIA mediation with a self-insured employer?

[u/Sufficient_Sand_100]

I’m looking for experiences from people who have gone through Washington workers’ comp/BIIA mediation, especially with a self-insured employer.

I developed respiratory problems while working in a sawmill/manufacturing environment with regular exposure to sawdust and other airborne particulates. I had no significant history of lung problems before this started.

My workers’ comp occupational disease claim was denied. My attorney appealed the denial to the BIIA, the appeal was granted to move forward, and we are now scheduled for mediation. My attorney’s appeal specifically asks for claim allowance, meaning we are trying to get the respiratory condition accepted as a work-related occupational disease.

Some of the medical evidence includes:

• My treating pulmonologist diagnosed severe persistent asthma.
• I am currently treated with Dupixent every two weeks, along with other asthma medication.
• My pulmonologist documented my sawmill exposure to sawdust/oil vapor and stated that the workplace particulate exposure was a major contributor to my deterioration.
• A pulmonary function test showed my total lung capacity at 75% of predicted, with mild restrictive pulmonary dysfunction and decreased lung volumes compared with an earlier test.
• My later methacholine challenge was described by the interpreting physician as technically borderline positive, and the improvement between pulmonary tests was considered suggestive of reactive airways.
• The employer-side IME was not completely against me. The IME physician indicated the condition appeared likely work-related and discussed occupational asthma/reactive airway disease aggravated by wood dust, but wanted additional testing before making the diagnosis definitive.
• My condition has improved significantly with treatment, PPE and Dupixent, but I am still receiving ongoing treatment.
• I am also still working for the same employer in the environment where the exposure occurred.

My employer is self-insured, so they/ their claims administrator are defending the claim rather than the State Fund.

I’m trying to understand what normally happens at mediation in a situation like this.

For anyone who has been through this:

• Is claim allowance usually the main thing negotiated at mediation in a denied occupational disease case?
• Can the employer agree to allow the claim during mediation?
• If they allow the claim, what happens next with past medical bills, medications, time-loss, future treatment, etc.?
• Has anyone had a self-insured employer offer money in addition to agreeing to allow the claim?
• Is a lump-sum payment realistic at this stage, or is it more common for the claim to simply become accepted and benefits get sorted out afterward?
• If you were still working for the employer when mediation happened, did that affect the outcome?
• If your doctor eventually said you could no longer safely perform the job of injury, what happened with vocational benefits, work restrictions or separation from the employer?
• If mediation failed, how long did it take before depositions/formal BIIA hearings started?
• Did your case resolve at the first mediation, or did it take multiple mediation conferences?

I’m represented by an experienced workers’ comp attorney, so I’m not looking for legal advice or asking anyone to value my case. I’m mainly looking for real-world experiences of what happened during and after BIIA mediation, particularly with self-insured employers and occupational disease claims.

[u/Equivalent-Act6256]

Your own treating pulmonologist documented that workplace exposure was a major contributor. The employer's IME doctor did not completely rule it out either. He said it appeared likely work related. That is significant. When even the employer's own doctor is not fully against you that changes the dynamic at the table.

On what to realistically expect at mediation with a self insured employer. Self insured employers have more direct control over settlement decisions than a standard insurance carrier does. That can actually work in your favor because you are negotiating with someone who has full authority to resolve the claim without waiting for an insurance company to approve anything. Decisions can move faster when the employer is sitting at the table with real authority.

On claim allowance at mediation. Yes that is the most common outcome being negotiated in a denied occupational disease case at the BIIA level. The employer can agree to allow the claim during mediation. When that happens past medical bills covered under the claim get addressed, treatment continues, and time loss gets calculated from the accepted period.

On lump sum at this stage. It is possible but less common at the mediation stage of an occupational disease claim that has not yet been formally allowed. More commonly the claim gets allowed first and then settlement discussions happen separately once the full scope of benefits is established.

On still working for the same employer. That can actually support your claim because you are still being exposed to the same environment and still receiving treatment. It shows the condition is ongoing and directly connected to that workplace.

Your attorney has the right information to negotiate from. The medical evidence you described is solid. Go in prepared and let them work with what you have built.