Helpful Information


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.

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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.


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L&I claim number on claim-related outgoing correspondence

L&I, workers, and providers often receive correspondence from self-insured employers or their third party administrators that doesn't include L&I's claim number. Many self-insured employers assign their own claim number and don't include the L&I's claim number on correspondence about the claim.

Failure to include the L&I claim number has resulted in delays, confusion, and additional administrative expenses for L&I, injured workers, and medical providers.

L&I let the self-insured community know on January 15, 2012 about its plans to begin issuing penalties for claim related communication that both:

  • Originates from the self-insured employer or their third party administrator, and
  • Doesn't include the L&I claim number.

In addition to the L&I claim number, the self-insured employer or their third party administrator may choose to also include their assigned claim number.

Reference: WAC 296-15-350 (7)(www.leg.wa) states in part:

  • Handling of claims.
  • What elements must a self-insurer have in place to ensure appropriate handling of claims? Every self-insurer must:
    • (7) Include the department's claim number in all claim-related communications with workers, providers, and the department.

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Medical Bill Interest Calculator

This calculator should be used to determine interest due for any medical bill paid more than 60 days past the date the bill was received, or 60 days past the date of the claim allowance if the bill was received before then — see RCW 51.36.085 (leg.wa.gov).


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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.


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Out of Country Payments

We are advising self-insurers and third party administrators to contact the Office of the State Treasurer (OST) (treasury.gov) directly to make sure they are complying with regulations on payments to workers or alternate recipients who are residing out of the country. This includes any party residing out of the country but receiving warrants at an address within the United States.

Note: If you are not paying a benefit due to Office of Foreign Asset Control (OFAC) regulations please make sure you document the claim file with that information.

If benefits are paid to a person on the Specially Designated Nationals and Blocked Persons (SDN) list, OFAC can assess penalties to the entity or person OFAC deems responsible for issuing the payment. The types of penalties are:

  • Criminal Penalties
    • Fines ranges between $50,000 and $10,000,000.
    • Imprisonment ranging from 10 to 30 years.
  • Civil Penalties
    • Fines range between $250,000 and $1,075,000.

Notes

Workers compensation benefits include:

  • Timeloss benefits.
  • LEP benefits.
  • PPD benefits.
  • Alternate recipient payments.
  • Warrants that are re-mailed.
  • Warrants that are re-issued due to statutory limitations.

Transactions subject to OFAC compliance include, but are not limited to:

  • Currency.
  • Letters of Credit.
  • Checks/Warrants.
  • Cashier's Checks.
  • Money Orders.
  • ACH (Direct Deposit) Transactions.
  • Wire Transfers.
  • Stored Value/Prepaid Card Transactions.

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Pension Review Process for Self-Insured

The Self Insurance Pension Adjudicators work hard to consider and provide resolution to requests for pension review within 90 days. However, this goal is only possible when we receive all the information we need at the time of the request. Otherwise, the pension adjudicator spends hours reviewing claim files and requesting additional information. Sometimes, they review a claim multiple times and have to make several requests for additional information before they can make a final determination about a pension. This rework takes time, and delays a final pension determination on the claim.

To make more efficient use of pension adjudicators' time, we have developed some new processes, which will go into effect on April 23, 2012.

Pension Review Coversheet

All new requests for pension will require that the employer complete the Pension Review Coversheet (139 KB PDF). A sample of the form is attached, and we will post the form on our webpage soon. Using the coversheet will help ensure all needed information is submitted to the department.

Only complete requests for pension review will be referred to the Pension Adjudicator

Support staff will review incoming requests to confirm all the necessary information is attached. If any documentation is missing, support staff will notify the employer what documentation is still needed, and will only forward the pension request to the pension adjudicator if that additional information is received. The request for pension will be considered withdrawn If the necessary information is not provided.

Note: Requests for pension will not be considered "received" until all documentation has been submitted; the received date will be the earliest date used by the Department for the pension effective date.

The SIVRF will not be considered a request for pension review

Previously, a Self Insurance Vocational Report Form (SIVRF) that indicated a worker was not eligible for vocational services due to "combined effects," or "direct effects of the industrial injury" was considered a request for pension review. We will no longer consider a SIVRF to be a pension request. Instead, support staff will acknowledge receipt of the SIVRF, and remind employers that if they would like to request pension review, they need to submit the Pension Review Coversheet, along with all necessary documentation.

Worker requests for pension will be referred to the employer for input

When workers or their attorney request review for pension, we will notify the employer of the request, and ask that the employer respond. The employer can either agree that the claim is ready for pension review and submit all necessary documentation or disagree and provide an explanation why the claim is not ready for pension. This will allow us to avoid requesting documentation on a claim that is not actually ready for pension review, saving time for the pension adjudicator and providing resolution for the worker if their request cannot be addressed.

If you have any questions about our pension processes, please feel free to contact Scott Corvin (360‑902‑6911) or Beth Hall (360‑902‑6937), the Self Insurance Pension Adjudicators.


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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.


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Releasing Claim Information: Employer Requests

Employers or their authorized representatives may review any claims of their own injured workers as long as there is a claim pending with the requesting employer. This includes claims against other employers regardless of whether the pending claim involves the same condition or area of the body.

When making a claim information request, make sure the department has your updated mailing address. The department will provide claim files for other employers. If the other employer is also a self-insured employer, more claim file information may be available from the self-insured employer; and the requestor should be advised to ask the self-insured employer for any additional claim information.

 


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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.


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