The Self-Insurance Program at L&I oversees self-insured employers' provision of industrial insurance benefits to their employees.
The Self-Insurance Program's oversight includes three key regulatory actions:
We conduct regular audits of self-insured employers. There are three different kinds of audits: performance-based audits; issue-based audits, and complaint-based audits.
Performance-based audit
The Performance-based audit is conducted on a 2-year cycle. It begins in even-numbered years and includes 3 tiers.
Tier 1:
All self-insured employers are audited at the Tier 1 level. The area of performance reviewed may vary with each audit cycle, and is unique to Tier 1. A pass or fail threshold is set. A failed audit at Tier 1 requires the employer to participate in a Tier 2 audit.
Tier 2:
Only the employers who do not pass Tier 1 are required to participate in Tier 2. Generally, this review includes a different, but connected area of performance.
Tier 3:
Employers who do not pass Tier 2 are reviewed in Tier 3. Multiple related areas of performance are reviewed in Tier 3.
Issue-based audit
An issue-based audit reviews a specific compliance requirement. This may be across the board for all self-insured employers or third-party administrators or limited to a smaller group. The type of requirement and the scope of the audit are evaluated with the advice of the Audit Governance Committee and assigned at L&I's discretion.
Complaint-based audit
A complaint-based audit reviews specific matters about an individual self-insured employer or third-party administrator that are brought to L&I's attention. The type of requirement and the audit scope are determined based on the nature of the complaint that is registered.
If you have questions, call us at 360-902-6840.
Self-insured employers are required to allow or deny a claim within 60 days.
Self-insured employers submit the request to L&I to review workers' compensation claims for allowance or denial. In some cases, a temporary order may be issued by L&I extending the time for decision while additional information is gathered.
For specific claim questions
Call 360-902-6901 and ask for the claim adjudicator assigned to the claim.
Adjudicating a workers' compensation claim requires the use of judgment, and there is not always agreement about the claim-related decisions that are made. If an injured worker and their self-insured employer cannot agree about a claim-related outcome, injured workers can ask L&I to intervene.
To make that request, an injured worker can:
- Report the dispute online through our Customer Service Portal.
- Send a written dispute to:
Department of Labor & Industries
Self-Insurance
PO Box 44892
Olympia, WA 98504-4892
FAX: 360-902-6650
Claim questions?
Claim-specific questions: Call 360-902-6901 and ask for the claim adjudicator assigned to the claim.
General claim questions: email us at SITrainerquestions@Lni.wa.gov
Self-Insurance provides an annual update to review Certification Services changes and to provide an overview of the annual assessment rates.
Self-Insurance Financial Rules Presentation - December 1, 2021