What If Your Symptoms Aren’t Improving During an L&I Claim?

By Benjamin McCay, DC, CCSP

Published November 8, 2026

Most work injuries gradually improve with appropriate treatment, activity, and time. Recovery is not always perfectly linear, however. Symptoms may temporarily flare, improvement may occur more slowly than expected, or a worker may reach a point where treatment that initially helped no longer seems to be making a difference.

When this happens during a Washington L&I claim, the answer is not necessarily to continue the same treatment indefinitely. Persistent symptoms should prompt a closer look at the diagnosis, treatment plan, functional progress, work activities, and other factors that may be interfering with recovery. The goal is to determine why recovery has stalled and what, if anything, should be done differently.

Some Work Injuries Take Longer to Recover

Not every worker recovers at the same rate. The severity of the original injury, the type of work performed, age, general health, physical demands outside of work, and many other factors can influence recovery.

There can also be temporary setbacks. A worker may improve for several weeks and then experience increased symptoms after returning to heavier activity or attempting additional work duties. A temporary flare does not necessarily mean that the underlying condition has become worse or that treatment has failed. What matters more is the overall trend.

Over time, there should generally be some measurable indication that recovery is occurring. Depending on the injury, that might include improved mobility, strength, tolerance for activity, ability to perform work duties, reduced medication use, or decreased pain and other symptoms. If there has been little or no meaningful improvement over an extended period, the diagnosis and treatment plan may need to be reconsidered rather than simply continuing the same care.

The Diagnosis May Need to Be Reconsidered

One of the first questions when recovery is not progressing as expected is whether the original diagnosis still adequately explains the worker's continuing symptoms.

Many work injuries initially receive relatively broad diagnoses such as a lumbar strain, cervical strain, shoulder strain, or knee sprain. Those diagnoses may be entirely appropriate early in the claim, when advanced testing is not yet necessary. If symptoms persist longer than expected, however, additional information may become important.

For example, continuing leg weakness or numbness after a low back injury may raise concern for a lumbar disc injury or nerve-root involvement. Persistent shoulder weakness may suggest a rotator cuff injury rather than a simple shoulder strain. Ongoing knee symptoms could raise concern for a meniscus or ligament injury.

This does not mean that every worker with persistent pain needs an MRI. The diagnosis should continue to make sense in light of the worker's symptoms, examination findings, response to treatment, and progress over time.

Additional Testing or a Specialist Referral May Be Appropriate

When the diagnosis remains uncertain or treatment is not producing the expected improvement, the Attending Provider may consider additional diagnostic testing or referral to another provider. Depending on the condition, this could include imaging such as an MRI, electrodiagnostic testing such as an EMG, or consultation with an orthopedic surgeon, neurologist, sports medicine physician, physiatrist, or another appropriate specialist.

Washington L&I allows Attending Providers to arrange most medical specialist consultations without prior authorization, although there are exceptions. Mental health consultations require prior authorization, and Independent Medical Examinations are arranged by the insurer rather than the treating provider.

A specialist can help clarify the diagnosis, determine whether additional testing is appropriate, or recommend another treatment approach. A referral does not necessarily mean surgery is being considered; many workers are evaluated by specialists and ultimately continue with nonsurgical treatment.

For more information about imaging and referrals, see MRI, Specialists and Referrals on an L&I Claim.

The Treatment Plan May Need to Change

Sometimes the diagnosis is correct, but the current treatment has reached the limit of what it can accomplish. Treatment that was useful during the first few weeks of an injury may not necessarily be the best approach several months later.

As recovery progresses, care often needs to shift from primarily managing symptoms toward restoring strength, mobility, endurance, and tolerance for normal activity. For musculoskeletal injuries, this may mean greater emphasis on active rehabilitation, exercise, physical therapy, work conditioning, or a structured return to activity. It can also mean reducing or discontinuing a treatment that is no longer producing meaningful or lasting improvement.

Washington L&I requires covered treatment to be curative or rehabilitative. In general, treatment should produce lasting improvement in the effects of the accepted condition or help restore functional activity. Treatment is not intended to continue indefinitely when its effects are only temporary.

Changing the treatment plan does not necessarily mean that the worker has reached the end of medical care. It may simply mean that a different approach is needed.

Other Factors Can Delay Recovery

Sometimes the physical injury is only part of the reason recovery has stalled. A worker may be concerned that activity will cause another injury, have difficulty obtaining appropriate light-duty work, experience problems with an employer following medical restrictions, become less active after months of pain, or have disrupted sleep and increasing frustration about the claim.

These factors do not mean that the symptoms are imaginary or that the injury is psychological. They can influence how successfully someone recovers from a physical injury and returns to normal activity.

L&I recognizes that behavioral and psychosocial factors can sometimes interfere with recovery and return to work. In appropriate cases, services may be available to address fear of reinjury, difficulty returning to normal activity, or other barriers to recovery. Identifying these problems early can sometimes help prevent a relatively straightforward injury from developing into prolonged disability.

Work Restrictions May Need to Be Reassessed

Work status should be reconsidered as the worker's condition and functional abilities change. If the worker is improving, restrictions may gradually be reduced. If particular work activities consistently aggravate the condition or exceed the worker's current functional abilities, the Attending Provider may need to modify the restrictions.

The Activity Prescription Form (APF) is one of the primary ways the Attending Provider communicates work status, functional capacities, physical restrictions, treatment plans, and changes in those restrictions to L&I and others involved in the claim.

Being completely removed from work for a prolonged period is not necessarily the best solution for every injury. When medically appropriate, modified or light-duty work can allow a worker to remain active and connected to the workplace while continuing treatment. The appropriate level of activity depends on the injury, objective medical findings, and the worker's actual functional capabilities.

L&I May Request an Independent Medical Examination

An Independent Medical Examination (IME) may become part of an L&I claim when the insurer needs additional medical information to make a decision. Under Washington law, an IME may be requested to address issues involving claim allowance or reopening, a new medical issue, an appeal, case progress, permanent disability, or work restrictions.

An IME is performed by a provider who is not treating the worker. The examiner receives an assignment describing the purpose of the examination and the questions that need to be answered. Those questions may involve the diagnosis, relationship of a condition to the work injury, need for additional treatment, work restrictions, permanent impairment, or whether the condition has reached maximum medical improvement.

An IME does not automatically mean that L&I intends to close the claim. After the report is issued, the Attending Provider can review the findings and provide additional medical information when appropriate, including explaining why they disagree with an examiner's conclusions.

Persistent Symptoms Do Not Automatically Mean You Are “Fixed and Stable”

A worker does not reach maximum medical improvement simply because symptoms have lasted a long time or because some symptoms remain.

Washington L&I uses the terms maximum medical improvement (MMI) and fixed and stable to describe the point at which no fundamental or marked improvement in the accepted condition is reasonably expected, with or without additional treatment. A worker can therefore continue to have pain, stiffness, weakness, or fluctuations in function and still eventually be considered fixed and stable.

Conversely, persistent symptoms alone do not establish that the worker has reached maximum medical improvement if additional appropriate treatment is reasonably expected to produce meaningful improvement. The important question is not simply whether the worker still hurts, but whether additional treatment is reasonably expected to produce a fundamental or marked improvement in the accepted condition.

If meaningful improvement is still reasonably expected, additional treatment may be appropriate. If no such improvement is expected, the condition may have reached maximum medical improvement even though some symptoms remain.

What If Permanent Problems Remain?

Some workers complete treatment without returning completely to their pre-injury condition. If treatment has been completed and the worker has a permanent loss of function, a qualified doctor may perform a permanent partial disability (PPD) rating. If a compensable permanent impairment exists, L&I may issue a PPD award before closing the claim.

A permanent impairment does not necessarily mean that the worker is unable to work. Some workers can return to their original occupation despite residual impairment, while others have permanent restrictions that prevent them from returning to the job they were performing when injured.

When permanent restrictions prevent a return to the job of injury, vocational services may become involved to evaluate whether the worker can return to other employment or may need vocational retraining. Workers with eligible State Fund claims may also qualify for the Preferred Worker Program, which provides incentives to employers who hire or retain workers who meet the program's requirements and have permanent work restrictions.

These issues generally arise later in the claim, after reasonable medical treatment has been completed and the worker's long-term functional abilities have become clearer.

What Should You Do If Your Work Injury Is Not Improving?

If your symptoms have stopped improving, tell your Attending Provider. Continuing exactly the same treatment for another several months is not necessarily the answer. Your provider should be able to explain the current diagnosis, whether your recovery is progressing as expected, and what the next step may be if it is not.

Reasonable questions to discuss include:

• Does the current diagnosis still adequately explain my symptoms?
• Have my examination findings or functional abilities improved?
• Is the current treatment still helping?
• Would different treatment or more active rehabilitation be appropriate?
• Is additional imaging or other diagnostic testing indicated?
• Would a specialist or second opinion be helpful?
• Are my current work restrictions still appropriate?
• Is something else interfering with my recovery?

The purpose of these questions is not to pursue testing or treatment simply for the sake of keeping the claim open. The goal is to make sure there is a logical medical plan for moving forward.

The Goal Is Recovery, Not Indefinite Treatment

An L&I claim can become complicated when symptoms persist much longer than expected. Continued symptoms should prompt reassessment rather than automatically leading to either indefinite treatment or premature claim closure.

Sometimes additional testing is appropriate. Sometimes a specialist consultation is needed. In other cases, the treatment approach, work activities, or other barriers to recovery need to be addressed. Eventually, some workers reach a point where additional treatment is unlikely to produce further meaningful improvement.

The Attending Provider's role is to continually evaluate these issues and help determine the appropriate next step. The important question throughout the process is not simply whether symptoms remain, but whether the worker is continuing to recover and whether there is a reasonable medical plan for further improvement.