How to Fill Out and Submit the Washington L&I LEP Form

To claim Loss of Earning Power benefits in Washington, you file L&I Form F242-208-000, “Application for L.E.P. Compensation Med.” You fill in the worker section with your claim number and the pay-period dates you’re claiming, your employer completes the employment section, your attending physician certifies the medical link, and you attach a pay stub covering that period. State-fund claims go to L&I; self-insured claims go to the employer’s claims administrator. One form per pay period of reduced earnings.

Download the Washington L&I LEP form from the forms library at lni.wa.gov, or ask your claim manager to send a copy. A separate form, F242-209-000, applies only if you’re enrolled in an L&I-approved retraining plan.¹

Confirm You Qualify Before You File

Two conditions have to be met before L&I will authorize payment. Your current earnings must have dropped more than five percent compared to your wages at the time of injury. If you’re earning 95 percent or more of your pre-injury wage, you don’t qualify.² A medical provider also has to certify that the reduced earning capacity results from your industrial injury or occupational disease, not from an unrelated cause such as a plant-wide layoff or a seasonal slowdown.³

The wage drop can take several forms. You might return to a different job at a lower hourly rate. You might work your old position at fewer hours because of medical restrictions. Or you might return full-time at your regular rate but lose overtime hours you routinely worked before the injury, as long as your employer still offers overtime to other employees.² Any of these can trigger eligibility if the medical link is documented.

One trap to know going in: if your employer offers you a valid light-duty position and you take a lower-paying job somewhere else instead, L&I calculates your benefit from the wage of the light-duty job you turned down, not the one you accepted.²

Filling Out the Form Section by Section

The application has three sections: worker, employer, and attending physician. You can submit with the employer or physician section blank if there are barriers to getting them completed, but L&I still needs the medical certification before it can authorize payment, so chase it down.¹

Worker Section

Enter your L&I claim number, your date of injury, and the exact pay-period dates during which you earned reduced wages. Fill in hours per day, days per week, and gross earnings for that period. If you weren’t working at all during the period because your restrictions kept you off any assignment, put “0” in the hours and earnings fields.¹ Sign before passing the form along.

Employer Section

Your employer completes and signs this section, which verifies your hours and earnings. If your employer won’t cooperate, you can still submit the form with the section blank. When you’re claiming LEP for a period of zero work, the employer section doesn’t need to be completed at all.¹

Physician Section

Your attending physician completes the medical portion, certifying that the reduced earning capacity stems from the workplace injury or occupational disease. This certification is what separates an LEP claim from an ordinary wage dispute. If the clinic can’t turn it around quickly, submit the form on time with this section blank and keep following up; L&I would rather have the application in than hold it indefinitely, but the agency still can’t pay without the medical certification.¹

Pay Stub Attachment

Attach the pay stub covering the period you’re claiming. L&I uses it as the raw wage data for the calculation. If you’re claiming a period with zero earnings, no pay stub is required.¹

Where to Send the Completed Form

How you submit depends on your employer’s coverage. For state-fund claims, use L&I’s online Claim and Account Center or mail the form to:

Claims Section
Department of Labor and Industries
P.O. Box 44291
Olympia, WA 98504-4291⁴

For self-insured employer claims, send the form to your employer’s claims administrator. Self-insurers pay LEP directly and are required to send you a statement of benefits with each payment showing the type of benefit and the date span it covers.²

File One Form Per Pay Period

LEP is not a one-time application. Submit a new form for each pay period in which your earnings were reduced, as those periods occur. If your earnings climb back to within five percent of your pre-injury wages, LEP stops, but if they fall below that threshold again later, benefits can restart on the same claim without opening a new one.²

What Happens After You Submit

A claim manager verifies your medical restrictions and checks the wage data against your pay stub. If the five-percent earnings drop is confirmed and the medical link is in place, you’ll receive an order approving benefits. Payments usually arrive by the same method as your prior time-loss benefits, either check or direct deposit.

If your employer is self-insured, the insurer must send you a Start, Stop or Deny Compensation Benefits notice (Form F207-224-000) within five days of beginning LEP payments. If you don’t already have one, they must also send you a Calculation of Monthly Wage form (F207-227-000) showing the wage basis used for your benefits.²

Keep your address and contact information current in L&I’s system. A stale address or inactive email can hold up both notices and payments.

If L&I Denies the Claim or You Disagree With the Amount

You have 60 calendar days from the date you receive the decision to act. There are two routes, and you can go directly to either without doing the other first.⁵

Protest to L&I. Write a letter to your claim manager explaining why the decision is wrong. Put your name and claim number on every page and include any supporting medical records or wage documents. Submit through the Claim and Account Center or mail to the Claims Section at P.O. Box 44291, Olympia, WA 98504-4291.⁵
Appeal to the Board of Industrial Insurance Appeals. This is the more formal path. Include your name and claim number, the date of the decision, a description of the decision, your reasons for disagreeing, your mailing address and phone number, your preferred hearing city, and any supporting documentation. Mail to the Board of Industrial Insurance Appeals, P.O. Box 42401, Olympia, WA 98504-2401, or file online at biia.wa.gov.⁵

Miss the 60-day window and the decision becomes final. L&I may accept a late filing in rare circumstances where something truly extraordinary prevented a timely response, but the exception is narrow enough that you should treat the deadline as firm.⁶

1
Washington State Department of Labor and Industries. Loss of Earning Power – A Guide to Return-to-Work Modified Duty
2
Washington State Department of Labor and Industries. Loss of Earning Power Compensation
3
Washington State Department of Labor and Industries. Wage Replacement
4
Washington State Department of Labor and Industries. Contact Information by Subject
5
Washington State Department of Labor and Industries. Protest or Appeal a Claim Decision
6
Washington State Legislature. Chapter 51.52 RCW