Filing Claims
The provider's responsibilities
If you're the first doctor to diagnose a worker for an occupational injury or disease, you're responsible for reporting to L&I or the self-insured employer.
If you aren’t sure whether you need to file, see Deciding whether to file a claim for a patient.
To file a claim, follow these 4 steps:
Step 1: Find out if your patient is insured through L&I or a self insured employer
There are 3 ways you can find out:
- Ask the patient.
- Check the self-insured employer list.
- Call L&I’s Self-Insurance section at 1-800-848-0811 toll-free or 360-902-6500.
Step 2: File a claim right away
To initiate a claim for your patient, fill out and submit one of the following forms:
If your patient is insured through You should fill out a L&I Report of Industrial Injury or Occupational Disease (ROA), either:
- Online - you can bill an additional $10 (code 1040M).
Find out why we recommend online claim-filing, how it works and how it helps your patients.- Fax a paper copy within 2 days to 1-800-941-2976 or 360-902-6690. Order forms online.
a self-insured employer Providers Initial Report (PIR). Treating L&I-insured injured workers?
- Get guidance on Filling out the Accident Report.
- You don't need to mail the ROA to the employer. You may ask the worker to deliver a copy to the employer. We'll notify the employer about the claim when we receive the ROA from you.
- If you fax the ROA, don’t mail the original to L&I, unless we request it. Save the original in your files for legal purposes.
Treating injured workers whose employers are self-insured?
- If you treat injured workers at a self-insured employer’s on-site medical facility, find out about reporting and record-keeping requirements: contact L&I's Self-Insurance Section at 360-902-6842.
Step 3: Get paid
If your patient is insured through You should L&I Find out about billing L&I, including how to submit reports.
a self-insured employer Find out about billing self-insured employers.
Step 4: Get the worker further treatment if necessary
Starting January 2013, to treat an injured worker beyond the initial visit, you must be in our network.
If you are not, you should apply to join, or refer the worker to another provider that is in our network.
Rules and laws related to filing a claim
- WAC 296-20-025(2) (www.leg.wa.gov) — Initial treatment and report of accident.
- RCW 51.28.020 (www.leg.wa.gov) — Worker's application for compensation — Physician or licensed advanced registered nurse practitioner to aid in.
- RCW 51.48.025 (www.leg.wa.gov) — Duty of employer to report injury or disease — Contents — Penalty.
- Title 51 RCW (www.leg.wa.gov) — Industrial Insurance
