Questions About Third Party Claims?	en español

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General questions most often asked about Third Party Claim Cost Recovery:

• What is a "third party"?

  If a workplace injury or occupational disease was caused by a defective product, a defective machine or someone who is not a co-worker, this "third party" be asked to pay for the injured worker's medical treatment and other claim expenses. (See Third Party main page.) Examples include: The driver of the car that hit the worker (not an employee of the worker's company). The manufacturer of a defective product that injured the worker. A property owner who failed to properly maintain a safe workplace. A fall that was not the employer, employee, or co-worker's fault. (Example: Another contractor on the job site whose negligence caused the worker's injury.) The owner of an animal that bit a worker.

• What is a "third party action"?

  A legal action against the person or company (other than the employer or co-employee) who causes an industrial injury.

• How can I determine if a third party action is being taken?

  If you are unsure whether a third party claim is active at L&I, you may call L&I's main third party number at 360‑902‑5100. If your employer is self-insured, contact your claim manager instead.

• How is third party recovery distributed?

  The attorney is paid reasonable fees and costs.  The injured worker receives 25 percent of the net recovery. L&I or your self-insured employer is then reimbursed for benefits paid, less its proportionate share of fees and costs. Any remaining balance is paid to the worker. The amount of this remaining balance, less L&I's or self-insurer's proportionate share of fees and costs, is subject to offset against any future benefit entitlement under the claim.   (See RCW 51.24.060 (www.leg.wa.gov) for the statutory distribution formula.)

• Can providers charge injured workers over and above the fee schedule in third party cases?

  No.  RCW 51.04.030 (www.leg.wa.gov) authorizes the department to promulgate rules and establish a fee schedule.  The statute prohibits providers from making contracts greater than those in the schedule.  Pursuant to WAC 296-20-020 (www.leg.wa.gov) providers may not bill the injured worker, or accept payment, for the difference between the allowable fee and the customary charge.

• What does L&I do with the third party settlement information?

  Issues an order confirming the distribution of the recovery per RCW 51.24.060 (www.leg.wa.gov)(6).

• Where do I send payments?

  If the worker is settling the case and is not represented, the insurance adjuster will pay the lien claim directly to L&I, and pay the balance of the settlement directly to the worker. If the worker has an attorney, the insurance adjuster will pay the attorney the full amount of the settlement. (Do not put L&I's name on the check -- our lien attaches to the recovery.) If L&I is settling the case, pay directly to L&I the full amount of the settlement. (Do not put the worker's name on the check. We will distribute the recovery according to statute.)

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Find many more questions below that are often asked by:

• Injured workers

  I was sent a "Third Party Election Form".  Why was I sent this form? Because your injury or illness may have been caused by a third party. I no longer have the form (or I never received one).  What do I do now? You can print the Third Party Election Form from this web-site.  After reviewing the information in the Frequently Asked Questions, please make your decision, sign the form, and mail it to the department. What is a third party action? A legal action against the person or company (other than the employer or co-employee) who causes an industrial injury. Do I have to pursue a third party action? No. However, the law does require you to make a choice. You must either pursue the action yourself, with or without an attorney (Option A), or assign the action to the Department of Labor & Industries (Option B) What if I do nothing? You are required to complete the Third Party Election Form. Failure to complete this form and return it to the department within the required time may result in assignment of third-party action to the department. Any further action is at the discretion of the department. What are my responsibilities if I decide to pursue the action myself (Option A)? First, you must notify the department of your election to pursue the action. The law also requires that you or your attorney notify the department when a lawsuit is filed and keep the department informed of the progress of the action. In fact, if the action is not diligently pursued, the department can petition the court to have itassigned to the department. What if I'm ready to settle my case with the third party, or their insurance company?  The law requires that you or your attorney obtain department approval of a settlement under certain circumstances.  If a settlement is insufficient to cover the costs (past and future) of your industrial insurance claim, the department can deny approval or can declare void any settlement to which you have agreed.  Call the department before you settle your claim to ensure it is sufficient, or to obtain the necessary approval if it is deficient. Can I settle the case just for my pain and suffering, and leave L&I to try and settle separately for the benefits it paid to me? No, there is only one cause of action, and it may not be settled separately.  Any recovery you make must include all damages.  Any settlement that does not cover the benefits paid by the department is void unless approved by L&I in writing.  In addition, the department has a lien for benefits paid against any recovery you make.   However, once a case is settled, separate checks may be sent to you and L&I for the amount due to each.  What do I do when I settle my case? The law requires that you or your attorney advise the department of the amount that has been recovered and the attorney fees and costs associated with the recovery, and repay the department for your industrial insurance benefits. What are my responsibilities if I decide to assign the action to the department (Option B)? The department will decide whether to pursue the action. Your help may be necessary in making this decision. In addition, if an action is filed, your deposition testimony or in-court testimony may be required. This, of course, is true whether you assign the action to the department or pursue it yourself If I assign the action to the department, what will the department do? When you assign the action to the department, you are freed from personal responsibility to pay the legal costs involved in such actions. However, you also give up your right to control the action. The department will decide whether to pursue the action. If the department pursues the action, it will attempt to recover the full amount of damages available under the law. If a recovery is made, the department will distribute the recovery in compliance with the statute and issue an order and notice confirming the distribution How does the third party action affect my industrial insurance claim? You are entitled to workers’ compensation benefits regardless of fault. However, your industrial insurance benefits must be repaid from any third party recovery. Workers compensation benefits may stop once you've recovered from the third party depending upon the amount recovered. How does the third party action benefit me? You will receive a portion of any recovery made. The law specifies how a recovery is to be apportioned among you, your attorney (if any) or the department’s attorney (if any), and the department on behalf of the industrial insurance funds.

• Employers
  • L&I State Fund-insured

    How do third party recoveries benefit all employers? The underlying purpose of the third party law is to shift the costs of industrial insurance onto the responsible third party. Third party recoveries replenish the workers' compensation trust funds.   All employers benefit when these costs are controlled. How does a third party recovery benefit me? If a third party recovery is made, the charges under a claim are reduced or eliminated depending upon the amount of the recovery. This may reduce your workers' compensation experience factor and the rate you payfor industrial insurance. What should I do if I believe a third party caused my employee's accident? When you complete the employer portion of the workers' compensation Report of Accident: Answer "yes" to the question that asks if a third party caused the accident Describe the 4 W's:  Who, When, Where, and What Preserve evidence:  Keep broken chairs, ladders, etc, (notify the department so that we can secure and maintain the chain of custody of evidence). Why am I being charged for this claim when someone else caused the accident? Workers' compensation is a "no fault" insurance.  Workers who are injured on the job are entitled to workers' compensation regardless of questions of fault. You are charged for all claims made by your employees. However, if the department is notified of a third party claim and there is a reasonable potential of recovery, you are entitled to receive a 50% prospective credit under the claim on current charges that may affect your experience rating now. When a recovery is made you will receive a credit based on the actual amount of the recovery on charges that may affect your experience rating. How can I determine if a third party action is being taken? If you are unsure whether a third party claim is active at the department, you may call the department's main third party number at: (360) 902-5100. What can I do as an employer? It is a worker's right to seek recovery of damages. Only the worker may elect to pursue the third party or assign their cause of action to the department. If the cause of action is assigned to the department, the department will review and evaluate the case, and may pursue recovery from the third party. However, any information that you can provide concerning the third party and the circumstances of the accident will assist the department in evaluating the factual and legal issues of the case when deciding whether to pursue recovery from the third party. I'm in a retro program. How am I affected? Your claim charges are adjusted based on either the 50% prospective credit or the actual recovery. At the time of your retro evaluation, depending on the status of the third party case and the amount of any recovery, your retro program will be affected accordingly. My employee has settled the third party claim. Why is the department still paying benefits? If a settlement is not sufficient to cover all past and future claim expenses, the department is obligated to continue to pay benefits if the worker is otherwise entitled. Deficient settlements must have the department's written approval. This accident happened over a year ago. How long does it take for these matters to settle and to get the actual credit? The worker has up to three years to file a lawsuit for most types of liability cases in the state of Washington. However, many cases are settled prior to a lawsuit ever being filed. More severe injuries with complex factual and legal issues of liability will generally take a longer time to settle. When the case settles, the department issues an order confirming the distribution of the recovery and making a demand for any unpaid lien amount. An adjustment to your claim charges is generally completed in the month following issuance of the order. Who should I call to find out how my rates are affected if I know there's been a third party recovery? If you know there's been a third party recovery and it's been confirmed by department order, you should contact your Policy Manager at the department to determine the effect to your industrial insurance premium rates.

  • Self-Insured

    An injured worker notified me of their intent to pursue recovery of damages from a third person. What do I do? Send L&I a copy of the written indication of the worker's election per WAC 296-15-495 (www.leg.wa.gov). An injured worker settled a third party case.  What do I need to do now? Send L&I the following: Signed settlement agreement, or court order Total amount of attorney fees and costs Total amount of benefits paid, including time loss, permanent partial disability, and medical, excluding payments for IME's. If the claim is a medical-only claim, please include a copy of the Self-Insurer's Report of Accident (SIF-2) form. What does L&I do with the third party settlement information? Issues an order confirming the distribution of the recovery per RCW 51.24.060 (www.leg.wa.gov)(6). Does L&I get any of the money from a third party recovery under a self-insured employer's claim? Whenever cost of living adjustments are paid to workers under a claim, these moneys come out of the state supplemental pension reserve fund (either directly through pension payments or indirectly through quarterly reimbursements for time loss compensation payments).  The department will have a lien against the recovery for payments made from the State Fund.  Check with L&I to find out how much has been paid. Can I use the department's election form for my employees? The language on the Department's election form is not suitable for use by a self-insured employer. However we have modified a version of the L&I form to make it useable by a self insured employer. The form is not available in print, but can be accessed here. You may print the form for your own use.

• Attorneys for injured workers

  When I take a personal injury case, how do I know if the department is involved? If it is a work-related injury, the worker files a claim with the department or self-insured employer.   Ask your client if a claim has been filed and, if so, note the claim number. You will need this for all future communication with the department.   If a question remains as to whether your client has filed a claim with the department and what the status is, call us at our main phone number, (360) 902-5100, and we will let you know. If the department is involved, what is the first thing I should do? Notify us if your client decides to pursue recovery from the third party. Our address is: Third Party Unit Department of Labor & Industries PO Box 44288 Olympia, WA 98504-4288 Once I have notified the department of my client's election to pursue recovery from the third party, what further is required? Chapter 51.24 RCW (www.leg.wa.gov) sets forth the statutory requirements in third party claims. Primary requirements are that you must reimburse the department for benefits paid when a third party recovery is made, and any settlement which results in less than the entitlement under the claim must have the written approval of the department. What is meant by "Option A" and "Option B"? The department may require an injured worker to exercise their right of election and choose whether they will pursue recovery from the third party or assign the cause of action to the department. The terms "Option A" and "Option B" simply refer to these two options on the department election form. "Option A" refers to an election by the worker to pursue recovery from the third party. "Option B" refers to an election by the worker to assign the cause of action to the department. How do I know how much the department's lien is, and whether I need your approval to settle a claim? If we are notified of your client's election to pursue the third party, we will keep you apprised of workers' compensation benefits paid under a claim. When preparing to settle a claim, ask the department what the amount of the entitlement is. We will let you know whether the proposed settlement requires written approval. What if I arrange for a mediation? Notify the department immediately upon scheduling of the mediation. Whenever possible, the department will have a representative present at all mediations. In most cases this will be the third party staff attorney. In some cases this will be the third party supervisor or a third party adjudicator. Call the assigned adjudicator to coordinate department attendance. When I settle the claim, what do I need to do? If you settle the claim prior to filing a complaint, and the settlement results in more than the entitlement, you simply need to: Notify the department of the fact and amount of the recovery (provide copies of the signed settlement documents) Provide the department with a copy of your fee agreement and an itemized list of costs, and Distribute the recovery in compliance with the statute. How is a third party recovery distributed? The attorney is paid reasonable fees and costs. The injured worker receives 25 percent of the net recovery. L&I is then reimbursed for benefits paid, less its proportionate share of fees and costs. Any remaining balance is paid to the worker. The amount of this remaining balance, less the department's proportionate share of fees and costs, is subject to offset against any future benefit entitlement under the claim. (See RCW 51.24.060 (www.leg.wa.gov) for the statutory distribution formula.) How can I be sure of the amounts to be distributed? The department is required to issue an Order confirming the distribution of any recovery. We recommend you not reimburse the department until you receive this Order so the proper amount is paid, and unnecessary refunds or demands are avoided. Does this mean I have to wait for the department to issue an Order before I can give my client their share of the recovery? No. You may distribute money from the recovery to your client prior to the issuance of an Order. However, we recommend you hold in trust at least the amount of the benefits paid by the department until you have an Order showing the proper amount due the department. Once you know the exact amount for distribution and it has been confirmed, if a further sum is due your client you may distribute this additional amount at that time. It is always easier to pay your client more than to tell your client they have to pay more. In deciding whether to settle a claim, what if I need information concerning the net reimbursement amount due the department? For settlement negotiation purposes you may use the worksheet calculator for estimating the distribution shares based on information you provide, or you may request the department provide you with estimated draft worksheets. However, these amounts may vary and be subject to change due to verification of the provided information, approved costs, or increased claim benefits. If you settle, do not send a check to the department for the amount of the estimate. Send the necessary documentation but wait to send the check until you have received the Order confirming the exact amount due the department. Does the department want insurance companies to send a separate check to the department for the amount of their lien? Preferably not. When workers are represented by an attorney, it is more practical for the insurance company to pay the full amount of the settlement to the attorney, and for the attorney to reimburse the department the exact amount due. It is the duty of the person to whom any recovery is paid to advise the department of the fact and amount of such recovery, and to distribute the recovery in compliance with the statute. What documentation does the department provide me for proving damages in a personal injury case? The fact that the injured worker is entitled to workers' compensation shall not be pleaded or admissible in evidence in any third party action according to RCW 51.24.100 (www.leg.wa.gov).    The department will provide you with a printout of medical payments along with documentation of compensation payments made to the worker to substantiate the department's lien, which may be useful in evaluating damages.  However, the actual determination of damages and corresponding proof is to be handled as you would any other personal injury action.   Some third party defendants and their insurers require a release from the department.  Is this necessary? No.  Absent an assignment of the cause of action to the department, our lien attaches to the recovery made, not to the third party.  However, if settlement becomes impeded for lack of a department release, we are willing to assist in providing consultation or a statement to help facilitate settlement.  If settling the case will result in less than the entitlement, what do I do? Contact the department to request our written approval.  Whenever possible, provide written documentation to substantiate your request for approving a deficient settlement.  In situations where time constraints exist and greater flexibility is needed, we may verbally authorize you to settle, then we will follow-up with a written approval. An example of such an instance may be, when a settlement is pending at the courthouse steps.  If I settle a case without your written approval and it's deficient, what happens? By statute, the settlement is void.  The department may petition the court for an order assigning the cause of action to the department.  Do I need to let you know when I file a complaint? Yes.  You are required to give notice to the department when the action is filed. We also ask you to send a copy of the complaint to the third party section. The department may file a notice of interest.  If so, copies of motions and pleadings, etc., thereafter must be sent to the department. Can providers charge injured workers over and above the fee schedule in third party cases? No.  RCW 51.04.030 (www.leg.wa.gov) authorizes the department to promulgate rules and establish a fee schedule.  The statute prohibits providers from making contracts greater than those in the schedule.  Pursuant to WAC 296-20-020 (www.leg.wa.gov) providers may not bill the injured worker, or accept payment, for the difference between the allowable fee and the customary charge. What if my client agrees to pay a provider a greater amount than in the fee schedule when a third party recovery is made? Pursuant to RCW 51.04.060 (www.leg.wa.gov) an injured worker cannot be exempt from the burden, or waive the benefit, of Title 51.  An injured worker who may want to pay a particular provider the customary rates would be barred from doing so; ( for example, from a third party recovery).  What about outstanding bills not received by the department? Any bills that have not been paid by the department will be excluded from the department's lien but will become the worker's responsibility to pay from any excess third party recovery.  We encourage providers to bill the department promptly, especially vocational service providers when they are aware of a pending third party action.  How will my client's future benefit entitlement be affected by an excess third party recovery subject to offset? When you settle a personal injury claim the third party defendant is released from liability.  However, the department is not released from its statutory obligation under Title 51.  Therefore, any future entitlement due the injured worker is offset by the remaining balance from the recovery after the statutory deductions.  This means your client is going to need to use the money from the recovery, if further benefits are entitled, until the excess recovery has been expended.  If the claim is open, or needs to be open, it is important your client maintain communication with the department.   The department will continue to adjudicate entitlement under the claim and credit the excess recovery. Providers should continue to bill the department. The department will adjudicate the bill, credit the excess, and notify the providers of the amount that has become your client's responsibility to pay.  When the entire amount of the excess recovery has been credited, the department will begin making payments on behalf of your client, if otherwise entitled.     Do distribution Orders need to be issued on self-insured claims? Yes.  The statute requires that the distribution of any recovery be confirmed by department Order.  The recovery notification duty under the statute in this case is to the self-insured employer.  The self-insured employer is responsible by rule to notify and provide the necessary documentation to the department.  However, you should be aware that the department may still have a lien and interest in certain time loss or pension cases concerning benefits paid out of the Supplemental Pension Reserve Fund administered by the department for cost of living adjustments.   Can I obtain files from the department for injured workers I represent for the third party action? If your notice of representation is on record with the department, you can request a microfiche copy of the file directly from the third party section via phone, fax, e-mail or letter. This service will be provided at no charge. Request for hard copy or multiple file requests must be sent to: Public Disclosure Unit PO Box 44285 Olympia WA 98504-4285. Phone 360 902 4937, Fax 360 902 5529. A per-copy charge will be made for hard copies. Subpoenas or stipulations for records must also be sent to the Public Disclosure unit.

• Attorneys interested in the Special Assistant Attorney General program

  What is the Special Assistant Attorney General (SAAG) program? Under RCW 51.24.110 (www.leg.wa.gov) L&I contracts with private attorneys who have been appointed to this program to litigate certain third party cases assigned to the department. (See also WAC 296-14-900 through 940 (www.leg.wa.gov)) How do I apply? You can fill out and print an application.  Once you have completed and printed a copy, sign the form and mail to the address given.  Otherwise, contact the Third Party Unit and an application will be mailed to you. How will I be notified of the results of my application? You will receive an appointment letter from the senior assistant attorney general for L&I indicating that you will serve at the pleasure of that office.  You should sign the letter to indicate that you agree with the terms, and forward the letter to the Third Party Unit.  Your name will be placed on the list of attorneys eligible for referrals.  Referrals are generally made by county on a "next on the list" basis. What are my responsibilities if I accept appointment to this program? Unless you are representing the department in a specific case, you must not refer to yourself as a "special assistant attorney general" or include that designation in any correspondence or pleadings relating to your services.  When under contract, you must comply with department performance requirements.  Violation of these conditions may result in removal from the list of eligible attorneys and could lead to cancellation of your appointment.    How often do I get referrals? The contract manager keeps a list of names by county.  Referrals are made on a next-name-on-the-list basis.  The rate of referrals varies depending upon the number of new third party cases at L&I and the number of attorneys on the list in any particular county.  What happens if I accept a case? You will be sent a contract.  The contract sets forth the terms and conditions of your services and the performance requirements.  You should carefully read the contract, sign, and return to the Third Party Unit.  Do not start work on any case until you receive a copy of the properly executed contract from L&I. Who do I represent if I accept a case? You represent the Department of Labor & Industries.  L&I is your client.  Any legal action you bring will be in the name of the injured worker, but the real party of interest is the department who has been assigned the cause of action. The department makes the decisions on the case, including pre-approving threshold costs, authorizing settlements, proceeding to trial, and other pertinent aspects.  What role does the injured worker play? When the assignment is made to the department, the injured worker becomes an unrepresented witness.  The worker is involved to the extent that his cooperation is needed to provide factual information.  The worker also receives a statutory share of any recovery.  You may not help or represent the worker with his worker's compensation claim.   What damages do I pursue? You pursue both special damages (wage loss, vocational services, medical payments) and general damages (pain and suffering).  You do not pursue any loss of consortium claims.  What is the amount of my fee for services, and when do I get paid? Our fee schedule is 25% before filing suit, 33 1/3% after suit, and 40% for an appeal.   These may vary for medical and legal malpractice suits.  Costs are advanced by the attorney and reimbursed pursuant to department policy.  Attorney fees and/or costs are paid at the time the recovery is distributed by L&I.

• Insurance adjusters

  How do I knowif the injured party is covered by L&I? If the injured person is in the course of employment or furthering the business of their employer at the time of the occurrence, they are eligible for L&I benefits. This applies to your insured as well as parties that are injured by your insured. The L&I benefits are primary before PIP, UIM or BI liability coverage. Some business owners or executives may elect to waive L&I coverage for themselves. To confirm if an L&I claim has been opened, you can contact the Third Party Unit directly. If a workers' compensation claim is involved, who should I contact? Under Title 51 RCW employers are allowed two ways to insure their workers' compensation claims. They may insure under the State Fund, or self-insure if they qualify. Find out who the worker's employer is and ask whether they insure with the State Fund or self-insure. If they self-insure, ask for the phone number of the claims department. If they insure with the State Fund, call the Third Party Unit at 360-902-5100. With whom do I settle the personal injury claim with? Under RCW 51.24.070 (www.leg.wa.gov) and 080 (www.leg.wa.gov) the worker must notify L&I or the self-insurer if they elect to seek recovery of damages from the third person. If they don't elect, then L&I or the self-insurer may seek recovery of personal injury damages under RCW 51.24.050 (www.leg.wa.gov) in the name of the injured worker. Call L&I (or self-insurer) to find out if an election has been made. If the worker elects to seek damages, work directly with the worker (and coordinate with L&I) to resolve case. If the worker elects not to seek damages and the action is assigned to L&I, work directly with L&I to resolve the case. The injured worker has filed a workers' compensation claim. Do I need L&I's approval before I settle the personal injury claim? Yes, depending upon the circumstances. Under RCW 51.24.090 (www.leg.wa.gov) if a settlement results in less than L&I benefits paid and estimated to be paid in the future, approval for the settlement must be obtained. Otherwise, the settlement is void. Don't settle without checking with L&I first, and getting written approval, if necessary. If the injured worker is represented by an attorney, is L&I's approval still needed before I settle the personal injury claim? Yes, when an attorney is representing the injured worker, any settlement (after fees and costs are deducted) that results in less than L&I benefits paid and benefits estimated to be paid in the future, must be approved. Settlements above this amount do not require approval. I paid PIP benefits before discovering there is workers' compensation coverage. What do I do now? WAC 296.20.020 (www.leg.wa.gov) mandates that the providers must bill L&I when treating injured workers. In cases of questionable eligibility where the provider has billed the worker or other insurance and the claim is subsequently allowed, the provider must refund the worker or insurer in full, and bill the department for services according to the medical aid rules and fee schedules. The third party settlement is not subject to subrogation from the insurance carrier. We are willing to provide a billing history to minimize duplicate billings between L&I and PIP payments. I know the injured worker is receiving workers' compensation, but I have not received subrogation notice from the department. Do I still have to pay? Yes, L&I's lien is statutory, and must be repaidk. Notice of subrogation is not required. There was no liability insurance coverage for this accident. I will be paying damages under a UIM policy. Does the L&I have a right to be reimbursed? RCW 51.24.030 (www.leg.wa.gov) (4) only permits the department to assert a lien for reimbursement from UIM when the owner of the policy is the employer. We cannot assert a lien for UIM when the policy is owned by the injured worker. How can I find out how much has been paid in workers' compensation benefits? You can call the Third Party Unit at 360-902-5100 for benefit payment information. You can also go to our directory for individual third party adjudicator phone numbers or e-mail addresses. My insured was at fault for the auto accident but his policy has a clause that will not pay for subrogation by L&I. Does L&I still have the right to be reimbursed? Yes, in Washington the courts have held that insurance contracts with language that limits the department's statutory right of recovery are void and unenforceable as against public policy. The worker was injured in a state other than Washington. Does your lien for reimbursement still apply and how will the amount of damages be determined and distributed? The personal injury laws that apply in the state where the injury occurred will determine the liability and amount of damages owed by the third party. However, the laws of the state that pays the workers' compensation benefits apply to the reimbursement. Therefore, our lien will always attach to the worker's recovery, and distribution will be subject to RCW 51.24 (www.leg.wa.gov) as if the injury occurred in Washington. How do I know if a release of all liability signed by the injured worker or L&I is binding? The injured worker has authority to execute releases under RCW 51.24 (www.leg.wa.gov) if the settlement does not result in less than L&I benefits paid and estimated to be paid in the future. If an attorney represents the injured worker, the release may be executed if the net amount of the settlement after deducting attorney fees and costs does not result in less than L&I benefits paid and estimated to be paid in the future. If the settlement does not meet this criteria, the claimant must obtain our written approval before the release is authorized. When L&I has the cause of action, we will have a signed election form giving us the authority to settle the claim in the name of the injured worker (RCW 51.24.050 (www.leg.wa.gov)). In addition, L&I also has authority to settle the claim when the injured worker fails to respond within 60 days to our certified demand for an election option, i.e., to choose to try and settle or give to L&I to try and settle the claim. When L&I has the cause of action, what damages are sought? Under RCW 51.24.050 (www.leg.wa.gov) if a worker elects not to proceed against the third person, the entire cause of action is assigned to L&I. We seek to recover the full damages available under the law in the name of the injured worker. Therefore, our demand takes into consideration special damages (wage loss, vocational services, cost of medical care, etc.) and general damages (pain and suffering). In contrast to the liability carrier, the workers' compensation carrier is not released when a settlement is reached. Excess recoveries (settlements over the amount of L&I's lien claim) are paid to the worker, but are used to offset future L&I claim benefit obligations. What if we can't reach a settlement with L&I? Under RCW 51.24.110 (www.leg.wa.gov) L&I may refer cases to private attorneys on contract with the L&I if unable to resolve. Where do I send a check? If the worker is settling the case and is not represented, the pay the lien claim directly to L&I, and pay the balance of the settlement directly to the worker. If the worker has an attorney, pay the attorney the full amount of the settlement. (Do not put L&I's name on the check -- our lien attaches to the recovery.) If L&I is settling the case, pay directly to L&I the full amount of the settlement. (Do not put the worker's name on the check. We will distribute the recovery according to statute.)

• Health care providers

  Does a worker need to complete a Workers' Compensation Report of Accident when a third party with other insurance causes the accident? Yes, providers must assist an injured worker in filing a claim for workers' compensation even when other insurance coverage may be involved.  RCW 51.28.020 (www.leg.wa.gov) Who should I bill for treatment of an injured worker when a third party insurance carrier is responsible? Always bill the department.  Industrial Insurance is statutory coverage and provides benefits to injured workers that otherwise don't exist under other contractual policies, such as motor vehicle personal injury protection (PIP) or liability insurance. Title 51 RCW Can I bill a third party insurance carrier for the difference between what L&I pays and my usual fee? No, providers are prohibited from making contracts for greater fees than those in the fee schedule.  Providers may not bill the injured worker for the difference between the allowable fee and the customary charge.  RCW 51.04.030 (www.leg.wa.gov)  WAC 296-20-020 (www.leg.wa.gov) What if an injured worker agrees to pay me for my usual fee out of the third party settlement? An injured worker cannot be exempt from the burden, or waive the benefit, of Title 51.   An injured worker who may want to pay a particular provider the customary rates would be barred from doing so, even, for example, from a third party recovery.  RCW 51.04.060 (www.leg.wa.gov)  What happens when the worker settles a third party case and there is an excess third party recovery subject to offset of further benefit payments by L&I? If the Industrial Insurance claim is still open, you must continue to bill the department. The department will adjudicate the bills according to the fee schedule, credit the excess recovery, and send you remittance advice indicating the amount that has become the injured worker's responsibility to pay. The worker is only responsible for payment of the adjusted fee. If there is a third party claim involved and I have questions about billing L&I, who do I call? We recommend that you call the provider hotline at 1 (800) 848-0811.

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Submitting HIPAA compliant transactions to the department Contact the Electronic Billing Unit: E-mail ebuLNI@Lni.wa.gov, or Call 360-902-6511. Privacy Contact Carole Mathews E-mail matc235@Lni.wa.gov, or Call 360-902-5740.