Filing Claims

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The provider's responsibilities

If you are the first doctor to diagnose a worker for an occupational injury or disease, you are responsible for reporting this to L&I or the self-insured employer.

To initiate the claim, for your patient, fill out and send the Report of Industrial Injury or Occupational Disease (ROA) to L&I or the self-insured employer. The ROA is also known as the 'accident report'.

For more information see Filling out the Accident Report.

Note: You may receive a different ROA. L&I has a 2 year project that changes the initiation process. This started on January 1, 2007. Read more about the ROA project.

File L&I claims faster

For L&I claims, fax the ROA to:

1-800-941-2976 or 360-902-6690

If you fax the ROA, you are not required to mail the original to L&I, unless requested to do so. For legal purposes, put the original ROA in your files.

COHE providers: Continue faxing your ROAs to COHE fax numbers.

If your patient's employer is self-insured, continue to use the Physician's Initial Report, mail it to the self-insured employer or their third-party representative.

Employer claim information

After the initial visit, you may ask the State Fund injured worker to deliver a copy of the completed ROA to his/her employer. You are no longer required to mail it to the employer.

L&I will send claim information to the employer after we receive the ROA from you. This will allow employers to get involved sooner.

Employer Reporting Pilot Project

Two-year pilot program that allows workers to initiate a Report of Accident through their employer (EF-ROA).

• This pilot is a result of joint legislation supported by Business and Labor.
• Started on January 1, 2007.
• Three hundred employers are participating in the pilot,
• The goal is to determine if having employers file workplace injury or disease claims can:
  • help identify and correct potential safety issues,
  • improve accommodating the worker with transitional or light-duty work during recovery resulting in less disability and better return-to-work outcomes,
  • assist in maintaining a helpful relationship with their injured workers.

Health Care Provider Letter (33 KB PDF)

Getting paid for your services

1. Determine if your patient is insured through L&I or through a self-insured employer.
   Find out by:
   • Asking the patient,
   • Checking the self-insured employer list or
   • Calling the toll-free hotline 1-800-848-0811 or
   • the direct line 360-902-6500.
2. Fill out the correct forms. You can preview a list of forms.
3. See Getting a Payment Adjusted for information about corrections to your remittance advice.

Deciding whether to file a claim for a patient

If you don't think the condition is work-related:

• You must file the claim anyway.
• You can indicate that the condition is not work-related on the accident report (see Determining Work-Relatedness section in the Attending Doctor's Handbook, page 7).
• You can also inform the patient that the inappropriate filing of a claim may result in delays in coverage by other insurers.

Claims should be filed even for minor injuries:

• File a claim whenever an injured worker receives treatment from a doctor.
• Provisions of RCW 51.28.010 apply regardless of the severity of the injury.

Title 51 RCW, the Industrial Insurance Act, does not distinguish between first aid and any other type of medical treatment.

If you think a condition is work-related but your patient does not want to file a claim, you are required to:

• Inform the injured worker their rights.
• Help the injured worker file a claim.
• It is not your responsibility to file a report if the worker objects after being informed of his or her rights.
• However, if a claim is not filed, L&I cannot make a reimbursement for the visit.

If your patient is afraid of retaliation for filing a claim:

• Let the patient know that they are protected against such discrimination.
• See the Attending Doctor's Handbook, page 22, for what to do if your patient has been discriminated against for filing a claim.

Self-Insured on-site medical facilities

Physicians treating injured workers at a self-insured employer's on-site medical facility, should contact L&I's Self-Insurance Section at 360-902-6842 in regards to reporting and record keeping requirements.

Also you can view a list of self-insurers.

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Additional information

Visit the Washington State Legislature web site:

• 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. (Expires June 30, 2007.)
• RCW 51.48.025 (www.leg.wa.gov) — Duty of employer to report injury or disease — Contents — Penalty. (Expires June 30, 2007.)
• Title 51 RCW (www.leg.wa.gov) — Industrial Insurance