Washington State Labor and Industries  Industrial Injury Claim

How it Works:

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STEPS:

1.  Call us or fill out the form below to set an appointment at one of our       17 convenient service areas.

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2.  We will send you a confirmation letter and work history form to complete and bring with you to your appointment.

• On the work history begin with your most current employment working backwards to high school.
• If you do not have this information it can be acquired through the social security administration (form available) or through your local employment security offices.
• Even if you do not get your work history form completed be sure to come to your first appointment anyway and we will assist you.
  

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3.  1st Appointment- Our technician will go through:

• a health history questionnaire
• your work history
• and complete a hearing test.

If you qualify, he will complete all the required forms and paperwork. He will discuss the style of hearing aid devices that best fit your hearing needs and make impressions of your ears.

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4.  The completed packet of forms must be taken to a medical doctor to be signed.

• You can go to your primary physician or we can refer you to a doctor that specializes in hearing loss claims.
• The doctor will review the forms and may test your hearing again to complete his portion of the forms.
• He will mail the required documents to the Department of Labor & Industries or to the appropriate agency.

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5.  You should receive a card or letter from the Department of Labor & Industries stating that you now have a industrial injury claim in process.

• If you receive anything from L&I requesting additional information to be sent to them, please give us a call so we can help you to fill out any forms.
• It is important to make 2 copies of all papers before returning them to L&I (one set for your records and one copy for our file) sometimes things get lost in the mail!

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6.  Next, we wait for L&I to do their investigation and make a decision on your industrial injury claim.

• The Department of Labor & industries also determines if you are to be awarded a settlement for your hearing loss.
• An approved Labor & Industries hearing loss claim will cover the cost of all authorized hearing instruments, batteries, repairs and or replacements for the rest of your life.

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Once your Claim is Approved, you will receive notification by mail that your claim has been allowed.

This means we can now order your new hearing aids at No Cost to you.

Call 1-800-924-1577 today to select your new style of hearing aids!

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For this service we ask:

When your hearing loss claim is approved, you acquire your hearing aids from our company Federal Certified Hearing Center.

By law you are free to choose any provider. Thank you for choosing us. This is the only way that we get compensated for all the hard work we do, in helping you complete your claim.

Remember, you do NOT pay for the hearing aids - it is all covered by your approved hearing loss claim.

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This Form cannot be submitted until the missing fields (labelled below in red) have been filled in

Call us or fill out this form for a FREE Hearing Aid consultation.

Please note that all fields followed by an asterisk must be filled in.

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