WAC Changes Effective July 1, 2019
Issued by the Washington State Department of Labor & Industries 12/20/2018
Thirteen Washington Administrative Codes (WACs) related to Self-Insurance are changing effective July 1, 2019. Some of the changes are significant, while others align the WAC with current practices or statute.
Goals
Better communication to workers by:
- Providing new communication templates for self-insured employers to more clearly inform workers of actions on their claims.
- Ensuring self-insurers communicate key actions involving delivery of benefits to workers at specific points during a claim.
- Explaining to injured workers what to do if they dispute an action taken by a self-insurer.
Greater certainty for employers by:
- Encouraging injured workers to contact the self-insured employer with concerns at the time an action is taken.
- Outlining a new approach to unreasonable delay of benefits penalties that arise from wage calculation errors; presumes it is reasonable if the new communication template is used.
- Retiring the all-purpose SIF-5 form and replacing it with new purpose-driven forms, providing a streamlined way to request department allowance, denial, interlocutory, or closure of claims.
Reduced dependency on department adjudication by:
- With the exception of statutory requirements for the department to allow, deny or close certain claims, clarifying that department intervention to adjudicate claims is required only when there are disputes.
- Addressing Wage Orders and ensuring that the department only issues them when a dispute arises therefore reducing the department’s involvement in routine matters.
- Creating a new comprehensive, goal-oriented, core curriculum for those interested in obtaining a professional workers’ compensation designation and becoming a certified claims administrator.
Next Steps
We will continue to forward regular updates with information, including available training dates and locations. The department-developed forms and templates will be available by April.
If you have questions, contact LaNae Lien, Self-Insurance Claims Operations Manager at 360-902-6968 or lanae.lien@lni.wa.gov
Summary of the WACs Changing Effective July 1, 2019
WAC 296-15-266 – Penalties
Provides a new presumption that benefits won’t be considered unreasonably delayed and a penalty won’t be assessed if the self-insurer, when calculating the monthly wage for time-loss benefits, informs the worker by:
- Providing a copy of the wage calculation.
- Informing the worker they should contact the self-insurer with any questions.
- Providing information on their right to dispute.
WAC 296-15-330 – Authorization of Medical Care
Requires written explanation to workers and providers for denied bills.
WAC 296-15-340 – Payment of Compensation
Requires a statement of benefits by provided with each time-loss and loss-of-earning power payment, the statement must include:
- Type of benefit paid.
- Period of time.
- Statement of benefits for reimbursements.
WAC 296-15-420 – Requesting Allowance or Denial, or Interlocutory Order from the Department
Retires the SIF-5 and SIF-4 forms and requires the use of department-developed purpose driven forms on requests for:
- Allowance
- Interlocutory
- Denial
- Closure
WAC 296-15-425 – Communicating to Injured Workers During the Course of the Claim
This is a new WAC, it describes the purpose and definition of department-developed templates.
States department-developed templates must be completed and sent to the worker within 5 days of taking the following actions:
- Calculation of a worker’s monthly wage.
- Starting, stopping, or denying time-loss and loss of earning power.
- Acceptance or denial of a contended condition.
- Authorization or denial of treatment.
- Assessment of underpayment or overpayment.
If no dispute to these actions is received then the department will not issue an order
WAC 296-15-450 – Closure of Self-Insured Claims
Aligns the WAC with statute, limiting the 2-year look back on employer closures to:
- Clerical error.
- Benefits paid due to mistake of identity or innocent misrepresentation.
- Violation of the conditions of claim closure.
WAC 296-15-4316 – What Must the Self-Insurer do When the Worker Declines Further Vocational Rehabilitation Services and Elects Option 2 Benefits?
Aligns the WAC with statute by adding, “upon issuance of a department order confirming option 2 election terminate time-loss benefits effective the date of the department order with proper notification to the worker as required in WAC 296-15-425…”
WAC 296-15-350 – Handling of Claims
Effective 7/1/2020 each person making claims decisions outside the state of Washington is required to be a certified claims administrator. A six-month “waiver’ provision was added for those firms who have no certified administrators as a result of staffing changes.
WAC 296-15-360 – Qualifications of Personnel – Certified Claims Administrators
Changes in requirements to become and maintain a certified claims administrator certification, including:
- Requirement that a comprehensive goal-oriented curriculum to be completed prior to taking the certification test.
- Details on what a department-approved curriculum will include.
- Changes in the continuing education credit requirements.
WAC 296-15-200 – Claims Log Evaluation
Repealed
WAC 296-15-320 – Reporting of Injuries
Since the Claims Log Evaluation WAC was deleted, the statement “Upon request, produce a report of all workers’ compensation claims filed in a format required by the department” was added to this WAC.
WAC 296-15-400 – Self-Insured Rights and Obligations
Modernizes the WAC, by allowing electronic access, if authorized by worker, to:
- Workers’ Compensation Filing Information
- A Guide to Workers’ Compensation Benefits for Employees of Self-Insured Businesses
WAC 296-15-405 – Filing a Self-Insured Claim
Changes in terminology:
- Doctor to health care provider
- Physician to provider
The rules can be viewed at:
http://www.lni.wa.gov/rules/AO18/09/1809Adoption.pdf
Issued by the Washington State Department of Labor & Industries 12/20/2018