- Claim history requests.
- Fax claim documents. Save printing and mailing costs!
- Fibromyalgia not an Accepted Condition.
- Micrographics Conversion Project: get more historical claim documents on the Claim and Account Center.
- Plan approval forms changes.
- Travel reimbursement.
Claim history requests
Self-Insurance has a new and quicker fax process for claim history requests!
You will now receive the claim number, date of injury and accepted injury conditions for each claim history request via fax instead of snail mail. If you have made more than one claim history request, you will receive those all on the same fax transmittal, unless a 2nd fax is needed.
Claim history requests can be made to the Self‑Insurance Section by either:
- Faxing to 360-902-6900.
Or - Mailing to:
Labor & Industries
PO Box 44892
Olympia, WA 98504-4892.
Fax claim documents. Save printing and mailing costs!
You can now fax claim documents directly to the Self‑Insurance Section. Not only will this save printing and mailing costs, documents will be available in the Claims and Account Center (CAC) sooner. Instead of waiting a week, documents will be in CAC within 48 hours.
You'll need fax software or a dedicated fax line to send large quantities of claim documents directly from your electronic system to L&I's fax line.
To ensure claims are imaged to the correct claim file either:
- Send each claim file separately.
Or - Use a "stop" or "end of transmission" signal between each claim.
Please consider the following when faxing:
- If you've already sent us the claim file, send only the updated or new documents.
- Large files should be broken up into chunks of 200 pages or less.
- Consider faxing early in the morning or late in the afternoon or evening so that your documents transmit quickly.
Try it out, fax documents to the Self-Insurance Section at 360-902-6900.
If you have questions about faxing documents, contact Thomas Thomas at 360-902-5823.
Fibromyalgia not an Accepted Condition
In response to a Court of Appeals decision (Grant v Boccia, 2006), L&I and self-insured employers do not accept fibromyalgia as an industrial injury or occupational disease.
Aggravation to a pre-existing fibromyalgia condition will not be accepted as there is not sufficient medical data to establish a causal relationship between an injury and/or an occupational disease and worsening of a pre-existing fibromyalgia condition.
If fibromyalgia is retarding recovery from an accepted industrial injury or occupational disease, L&I or self-insured employer may authorize temporary treatment per WAC 296-20-055. Temporary treatment can only be authorized when all of the following conditions are met:- The accepted industrial injury and/or occupational disease are not stable.
- Fibromyalgia is directly retarding recovery of the accepted industrial injury or occupational disease.
- A thorough explanation of how fibromyalgia is affecting the industrial injury and/or an occupational disease must be included with the request for authorization.
The provider must obtain prior authorization to treat fibromyalgia as an aid to recovery.
Micrographics Conversion Project: get more historical claim documents on the Claim & Account Center
What are historical microfiche?
Historical microfiche are all documents received by the Self-Insurance Section prior to the 2007.
What is our goal?
Our goal is to have more claim file documents available in the Claim & Account Center (CAC) 
. In order to meet that goal, we are in the process of converting our historical microfiche documents to imaged documents. Once the historical microfiche is converted to an imaged document, it will be available in CAC.
When looking at a claim file in CAC, you will find these historical (prior to 2007) documents in the category called "micrographics conversion." The converted documents will be organized by first date of each year received. This means there may be multiple micrographics documents for a single claim file depending on the date of injury.
This project will reduce the need to order microfiche and expand your ability to quickly review the documents we have on a claim.
Plan approval forms changes
There have been recent changes in the required forms for plan approval with the goal of increasing the likelihood of successful plan completion. Use the new Accountability Agreement for retraining plans, with updates to emphasize the responsibilities of the worker and vocational rehabilitation counselor (VRC) in plan implementation.
Workers whose plan fails or may fail without "good cause" risk having their benefits suspended and in some cases, their claim closed.
Vocational rehabilitation counselors need to:
- Be aware of the training sites attendance/performance policies and meet with the worker within one week of the start of each quarter to review these expectations.
- Report non-cooperation timely and clearly so that L&I can take appropriate action.
- Carefully document all factors pertaining to non-cooperation.
- Provide clear documentation regarding the worker's current vocational status by addressing the following questions:
- Is the worker currently employable based upon the training completed to date?
- Is it possible to modify and salvage the current plan?
- Would a new plan be required utilizing the remaining time and funding?
- Could any feasible plan be identified when considering factors such as time, money, current transferable skills, labor market, and physical capacities?
The Self-Insured Employer or their third party administrator (TPA) need to:
- Assure that the worker has been given proper written warning regarding the non-cooperative behavior.
- Send warning letters that meet requirements specified in WAC 296‑14‑440 (www.leg.wa).
- Give the worker 30 days to show good cause and explain his or her situation.
- If there are no feasible vocational options due to the worker's actions or failure to comply with the accountability agreement, then closure of vocational services and/or the claim can be considered.
Please contact Peter Edgerton, Self-Insured Vocational Services Specialist, at 360‑902‑6913 for further assistance.
Travel reimbursement
Reimbursement rates
Effective October 1, 2010, the maximum lodging and meal rates for several Washington state locations have changed. You can find the new rates at:
Reimbursement Rates for Lodging, Meals, and Privately Owned Vehicle Mileage (25 KB PDF) (www.ofm.wa.gov).
The state Per Diem Rates map also reflects the new rates and is available at:
Travel Resources (www.ofm.wa.gov).
Rule change
Effective September 1, 2010, the rule addressing mileage reimbursement for worker pre-approved travel changed. For additional information about the change, refer to WAC 296‑20‑1103 ‑ Travel Expense.
What changed?
- Workers must travel more than 15 miles one way from home to be reimbursed for mileage to:
- The nearest adequate treatment.
- A vocational retraining site (for plans approved on or after September 1, 2010).
- The first 15 miles of a one-way trip aren't payable.
- The first and last 15 miles aren't payable on an authorized round trip.
What hasn't changed?
Workers can still be reimbursed for:
- All miles traveled for exams requested by the insurer (for example, independent medical exams and performance-based physical capacities evaluations).
- All miles traveled for vocational services (except the first and last 15 miles of travel to retraining sites in plans approved on or after September 1, 2010).
Note:
Trips to a pharmacy to fill or pick up prescriptions aren't reimbursable.
Travel reimbursement on closed claims
Reasonable travel is payable for repair, replacement, or alteration of prosthetics, orthotics or similar permanent mechanical appliances (except hearing aids) after claim closure (RCW 51.36.020(5)(b)).
- The appliance must have been originally purchased by L&I or the self-insured employer.
- The travel must be more than 15 miles one way from the worker's home, and the first and last 15 miles of travel aren't payable.
Workers may be reimbursed for all reasonable travel expenses on closed claims when L&I or self-insured employer requires a worker attend medical examinations or vocational evaluations.
