Washington Administrative Code

(1) If a self-insured employer is considering subjecting a fund covered under Title 51 RCW to any responsibility or burden as a result of a structured settlement agreement, the self-insured employer will: (a) Notify the department in writing and give the director or the director'…

Any outstanding protests on a claim with a final settlement agreement are deemed to have been resolved by the agreement.[Statutory Authority: RCW 51.04.020, 51.04.030, and 2011 1st sp.s. c 37 § 305. WSR 12-07-065, § 296-14A-070, filed 3/20/12, effective 4/20/12.]

Periodic payment for the purpose of RCW 51.04.063 structured settlements means payments that are made monthly unless the parties agree to a different payment schedule. In no case will payments be made more often than every two weeks.[Statutory Authority: RCW 51.04.020, 51.04.030,…

(1) How can I get a copy of a prior settlement agreement? The department must keep copies of all final structured settlement agreements. Any party who is actively negotiating a new structured settlement agreement can request a copy of prior agreements involving the same worker, i…

(1) "Self-insurance electronic data reporting system (SIEDRS)": SIEDRS is a computer system that collects claim data electronically from self-insurers. Effective July 1, 2008, all self-insurers must send timely and accurate claim data to SIEDRS in the required format.(2) "Substan…

(1) What factors does the department consider whether an employer qualifies for self-insurance certification? The department will consider whether:(a) An employer satisfactorily demonstrates:(i) Stability: Has been in business for three years prior to applying for self-insurance …

(1) What if an individual firm is a subsidiary of a corporation?(a) If an individual self-insured firm has a parent (owner of fifty percent and/or having controlling financial interest), the parent must provide the department with its written guarantee, L&I form F207-040-000, to …

(1) What is surety? Surety is the legal financial guarantee each self-insurer must provide to the department for its self-insured workers' compensation program. Failure to provide surety in the amount required by the department will result in the withdrawal of the self-insurer's …

(1) To maintain certification, a self-insured employer must remain in good standing with department reporting requirements and payment of assessments, and continue to demonstrate they have the ability to promptly provide benefits to its injured workers based on an analysis of the…

(1) What is a default? A default occurs when a self-insured employer no longer provides benefits to its injured workers in accordance with Title 51 of the Revised Code of Washington, or is determined to otherwise fail to meet the requirements of a self-insured employer under Titl…

(1) When is a self-insurer charged for audit expenses? The self-insurer must reimburse the department for all travel, per diem and documented expenses as related to the audit when the department representative travels outside the state of Washington.(2) How much will the self-ins…

(1) Surety for public entities must be provided on a department developed form consistent with WAC 296-15-121(2). The original will be kept by the department. Required surety must cover at a minimum one hundred twenty-five percent of the expected workers' compensation claim costs…

(1) How does the department determine the required surety level for a group self-insurer?The department will require that each group provide an actuarial report prepared by an independent qualified actuary (associate or fellow of the casualty actuarial society) that shows the fol…

(1) When must a self insurer provide funding for a permanent total disability (pension) or fatality claim? Within 60 days of receipt of the department's order, the self insurer must fund the pension or fatality claim.(2) What types of funding may a self insurer use for a pension …

(1) What happens when a self-insurer defaults on (stops paying) workers' compensation benefits and assessments? When a self-insurer stops paying workers' compensation benefits or assessments, and the default is not due to a claims administration decision, the department will take…

(1) What information must self-insurers report to the department? Each self-insurer must provide the department:(a) The name, title, address and phone number of the single contact person who is the liaison with the department in all self-insurance matters. This contact will be se…

(1) The administrative assessment covers the department's administrative costs, including direct and indirect expenses of each department division, the University of Washington environmental research facility, and the board of industrial insurance appeals. The assessment is paid …

(1) The second injury fund assessment is based on anticipated second injury fund costs. The fund is used to relieve employers' costs related to pensions that result from the combined effects of the industrial injury and another prior injury, preferred worker claims, and job modif…

(1) The insolvency trust fund assessment is paid by all insolvency trust members to cover claim payments made by the department on behalf of insolvent self-insurers. The assessment is paid quarterly at the same time a self-insurer submits its quarterly report.(a) Self-insured sch…

(1) The SPF relieves employers from cost-of-living increases on benefits paid to workers. The SPF assessment is paid quarterly at the same time a self-insurer submits its quarterly report.(a) The SPF rate is determined annually for each calendar year.(b) The total SPF assessment …

(1) What is SIEDRS? SIEDRS is a computer system that collects claim data electronically from self-insurers. Effective July 1, 2008, all self-insurers must send timely and accurate claim data to SIEDRS in the required format.(2) How often must a self-insurer report claim data to S…

(1) Self-insurers are required to report medical bills incurred from their workers' compensation claims according to department guidelines.(a) All bills associated with qualifying claims must be reported, and the department will establish a minimum threshold percentage for report…

(1) This section applies only to proceedings to withdraw certification or for corrective action instituted by the director in response to a petition filed with the department pursuant to RCW 51.14.090. This section shall not apply to actions instituted by the director to withdraw…

(1) This section applies to withdrawal of certification or corrective action instituted by the director pursuant to RCW 51.14.080 and/or 51.14.095.(2) The director or the director's designee shall take corrective action against a self-insured employer if the director determines t…

(1) Corrective action against a self-insured employer shall be by order and notice. A notice of corrective action shall include the nature and specifics of the findings and may include the following:(a) Probationary certification status for the self-insured employer for a period …

(1) Under what circumstances will the department consider assessing a penalty for an unreasonable delay of benefits? Upon a worker's or beneficiary's request or based upon its own motion, the department will consider assessment of an unreasonable delay of benefits penalty for:(a)…

(1) For all penalties assessed per WAC 296-15-266, RCW 51.48.017, 51.48.080, or 51.14.180, the penalty amount shall be determined by weighing the following factors:(a) Amount of delayed payment.(b) Length of time of the delay.(c) History or past practice.(d) Whether the departmen…

(1) If a self-insured employer (SIE) or third-party administrator (TPA) subject to the good faith and fair dealing duty manages the workers' compensation claim in a manner which demonstrates a greater concern for the self-insured employer's interest than the worker's interest, th…

(1) If a self-insured employer (SIE) or third-party administrator (TPA) subject to the duty of good faith and fair dealing intentionally engages in any of the following actions, the SIE/TPA is in violation of its duty to engage in good faith and fair dealing if it fails to:(a) Pr…

Every employer certified to self-insure is obligated to comply with the provisions of Title 51 RCW and the rules and regulations of the department, and to have the necessary administrative processes in place to manage its self-insurance program. Each self-insurer is ultimately re…

What elements must a self-insurer have in place to ensure the reporting of injuries? Every self-insurer must:(1) Establish procedures to assist injured workers in reporting and filing claims.(a) Immediately provide a Self-Insurer Accident Report (SIF-2) form F207-002-000 to every…

What are the requirements for authorization of medical care? Every self-insurer must:(1) Authorize treatment and pay bills in accordance with Title 51 RCW and the medical aid rules and fee schedules of the state of Washington.(2) Provide a written explanation of benefits (EOB) to…

What are the requirements for payment of compensation? Every self-insurer must:(1) Pay time-loss compensation in accordance with Title 51 RCW and the rules and regulations of the department.(2) Provide to workers a statement of benefits with each time-loss payment, to include the…

What elements must a self-insurer or third-party administrator (TPA) have in place to ensure appropriate handling of claims? Every self-insurer or TPA must:(1) Establish procedures for securing the confidentiality of claim information.(2) Have sufficient numbers of certified clai…

(1) What is a certified claims administrator? An experienced adjudicator who has been certified by the department to meet the requirements of WAC 296-15-350(2).(2) How do I become a certified claims administrator for self-insured claims?(a) Under the mentorship of a certified cla…

When must a self-insurer notify the department about changes in its administrative organization? Any changes to the self-insurer's established administrative organization must be reported to the department in writing, within ten days of the effective date of the change.[Statutory…

How must a self-insurer notify its workers of their rights and obligations under the industrial insurance laws?Self-insurers must notify workers of their industrial insurance rights and obligations at the following times:(1) Within thirty days of hire, provide a form substantiall…

(1) What form is used to report a self-insured worker's industrial injury or occupational illness?The reporting form for a self-insured worker's industrial injury or occupational illness is the Self-Insurer Accident Report (SIF-2) L&I form F207-002-000. Self-insurers must obtain …

(1) How must a self-insurer request claim allowance on a time-loss compensation claim?Within sixty days of notice of claim, a self-insurer must:(a) Send a department-developed form1 requesting allowance to the department (may be submitted electronically or paper copy), and attach…

(1) How does a self-insurer communicate claims administration actions to workers?The self-insurer must communicate in writing using a department-developed template to inform workers of actions involving delivery of benefits.(2) What is the purpose of the department-developed temp…

The Self-Insurance Vocational Reporting Form replaces the Employability Assessment Report (EAR) and is used as a cover sheet for all vocational reports submitted to the department by the self-insured employer.Note:A Self-Insurance Vocational Reporting Form is not required if the …

(1) A self-insurer must submit a Self-Insurance Vocational Reporting Form and the assessment report to the department within ten working days after receiving the completed report. A completed report is one that, in the opinion of the department, meets the requirements in WAC 296-…

No later than ninety calendar days after the date the department determined the worker was eligible for vocational plan development services, the employer must submit a Self-Insurance Vocational Reporting Form and a completed vocational plan for the worker.If the plan cannot be c…

The vocational rehabilitation plan must meet the requirements in WAC 296-19A-100.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.32.099 and 51.32.0991 (2007 c 72). WSR 08-06-058, § 296-15-4308, filed 2/29/08, effective 3/31/08.]

The vocational rehabilitation plan may be denied if the plan does not meet the requirements in WAC 296-19A-100 and the department cannot make a determination based on the information provided.If the plan does not meet the requirements or is denied as incomplete, the self-insurer …

The self-insurer must:(1) Notify the worker or the worker's representative of the time-loss termination as required in WAC 296-15-420(9).(2) Submit a Self-Insurance Vocational Reporting Form to the department within ten working days of the date time-loss benefits ended. The Self-…

When a vocational rehabilitation plan ends before successful completion, the vocational rehabilitation provider will submit a closing report to the self-insurer.(1) Plan not completed due to causes outside the worker's control. Within ten working days of receiving the vocational …

When the department approves a rehabilitation plan, the department will notify the worker in writing of their right to decline further vocational rehabilitation services and elect option 2 benefits. The worker must make an election within the time frame required in WAC 296-19A-60…

The self-insurer must submit a quarterly report to the department on a form stipulated by the department listing the total retraining costs paid to date for each worker since the option 2 benefit was granted. These quarterly reports must document all funds expended and funds that…

What will the department consider when resolving a dispute to a scheduled independent medical exam (IME) in a self-insured claim?(1) The department will consider whether:(a) The notification letter included the self-insured employer's need for the IME consistent with RCW 51.36.07…