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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:

Step 2: File a claim right away

To initiate a claim for your patient, fill out and submit one of the following forms:

How to file a claim.
If your patient is insured through You should fill out a
L&I

Report of Industrial Injury or Occupational Disease (ROA), either:

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

How to 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

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