Washington Administrative Code

Employers are required to pay accident fund, medical aid stay-at-work and supplemental pension fund premiums according to chapter 296-17 WAC. Standard premiums are the premiums an employer pays to the accident and medical aid funds under chapter 296-17 WAC for employment during t…

We will include your industrial injury claims with a date of injury that falls within the coverage period.We will include occupational disease claims with a date of last injurious exposure with you (prior to the filing of the claim) that falls within the coverage period.For an em…

We determine your losses at the time of an adjustment.To determine your losses, we first determine the case incurred losses for your claims. To these, we apply discounted loss development and expected loss ratio factors and your single loss occurrence limit to determine your loss…

If a claim is closed, we will use the actual losses for the claim as defined in WAC 296-17-870(1). If the claim is open, we will use either the case reserve amounts or the actual losses, whichever are higher.Where not in conflict with these rules, we will use the rules for valuin…

(1) Calculating the initial loss incurred:For each of your claims, we will multiply the case incurred loss by the appropriate discounted loss development factors to determine the initial loss incurred.If you have a fatality, we will use $591,600 as the claim's initial incurred lo…

If the sum of the losses incurred for your claims divided by your standard premiums and multiplied by the performance adjustment factor is greater than the maximum loss ratio you selected, your incurred losses will be reduced accordingly. If it is less than the minimum loss ratio…

(1) Each risk classification is assigned to a hazard group, as shown in WAC 296-17-901. To determine your hazard group, we will first multiply your standard premiums in each risk class by the hazard group index for that risk class. This is called the adjusted standard premium. Ha…

The department uses performance adjustment to ensure equity between employers that participate in retrospective rating and employers that do not. The goal of performance adjustment is to make sure that overall, after adjustments, retro participants pay the same share of their los…

Our actuaries compare standard premiums and losses of employers in retro with those of employers not in retro to determine a target refund amount that would result in the groups of retro and nonretro employers funding the same percentage of their claim costs. In doing this, the a…

There is no particular significance to the performance adjustment factor being less than, greater than, or equal to 1.0000. The performance adjustment factor is influenced by many things, including overall premium rates, large losses by either retro or nonretro employers, and wha…

If at the time of an adjustment you are disputing a decision affecting a claim's losses and you want us to recalculate your adjustment after that dispute has been resolved, you must protest the adjustment and identify the claim and dispute pending. We will issue a further order i…

To participate in retrospective rating, you as an employer or group sponsor need to have an account in good standing. This means that you need to have an open industrial insurance account with our industrial insurance program, have filed all required reports, and have paid all in…

(1) Employers and group sponsors must not engage in claims suppression as defined in RCW 51.28.010(4).(2) Employers and group sponsors must not pay medical service providers for medical services related to an industrial injury or occupational disease. Payment of monthly direct fe…

If you as a sponsored group receive a net assessment for two consecutive coverage periods, you will be placed on probationary status. We will review your workplace safety and accident prevention plan and your methods of cooperation with the department's claims management activiti…

If, after the final adjustment for a coverage period, it is determined that an employer enrolled in retrospective rating is entitled to a refund of standard premiums for any reason other than the recalculation of experience provided for in WAC 296-17-870(3), we will adjust the am…

We will notify you if we need more information to make a decision about your application.We will also notify you of our decision to enroll or deny enrollment.[Statutory Authority: RCW 51.16.035, 51.16.100, 51.04.020(1), and 51.18.010. WSR 10-21-086, § 296-17B-750, filed 10/19/10,…

Individual employers and sponsored groups enroll for one-year coverage periods. Coverage periods begin on the first day of a calendar quarter. Employers may join a sponsored group after its coverage period has begun, beginning on the first day of the next calendar quarter and con…

An employer that shares common ownership with one or more other employers cannot enroll in retrospective rating unless all employers sharing common ownership that are within the same industry category also enroll. Employers sharing common ownership can enroll individually or as m…

When you are required to submit a document (application, report, etc.) it must be received in the Tumwater labor and industries office by 5:00 p.m. on the date due. Documents may be mailed, faxed, or hand delivered. If the due date falls on a Saturday, Sunday, or holiday, it is d…

At the time of adjustment, our actuaries determine discounted loss development factors by claim type, fund and enrollment period. Loss development factors account for the fact that claims ultimately cost the state fund more than they have cost to date, and more than they are esti…

An expected loss ratio factor is a factor applied to case incurred loss amounts of claims and discounted loss development factors so that the ratio of discounted developed loss to standard premiums for the entire state fund used in the actuarial calculations equals the expected l…

The following claim types are considered when calculating the discounted loss development factors:(1) Fatality;(2) Total permanent disability pension claim;(3) Structured settlement claim with ongoing, lifetime payments;(4) Structured settlement claim with fixed, periodic payment…

Retrospective Rating Standard Premium Size RangesEffective January 1, 2026Size Group NumberStandard Premium Range From: To:16,110-7,12927,130-8,06938,070-9,06949,070-10,169510,170-11,319611,320-12,569712,570-13,909813,910-15,309915,310-16,8191016,820-18,3891118,390-20,0491220,050…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 1Effective October 1, 2023 Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8416.8278.8154.8039.7933.7833.7739.7650.7565.7484.7406.7331.72582.8367.8223.8092.7972.7861.7757.7658.75…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 2Effective October 1, 2023Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8461.8331.8212.8104.8002.7908.7818.7733.7652.7574.7500.7428.73582.8415.8278.8154.8040.7934.7835.7741.765…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 3Effective October 1, 2023Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8616.8506.8406.8313.8225.8143.8064.7989.7916.7847.7780.7715.76522.8575.8460.8354.8256.8164.8077.7994.791…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 4Effective October 1, 2023Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8659.8558.8465.8378.8297.8220.8147.8077.8010.7945.7883.7822.77642.8622.8515.8417.8325.8240.8159.8082.800…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 5Effective October 1, 2023Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8751.8662.8578.8500.8426.8356.8289.8224.8162.8101.8043.7986.79302.8717.8622.8534.8452.8373.8299.8228.815…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 6Effective October 1, 2023Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8773.8690.8612.8540.8472.8408.8346.8286.8229.8174.8121.8069.80182.8742.8653.8572.8495.8423.8355.8290.822…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 7Effective October 1, 2023Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8848.8776.8709.8646.8587.8530.8476.8424.8374.8326.8278.8232.81882.8820.8744.8673.8607.8544.8484.8427.837…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 8Effective October 1, 2023Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8906.8843.8785.8730.8677.8627.8579.8533.8488.8444.8402.8361.83202.8882.8815.8753.8694.8639.8586.8535.848…

Premium-Based Plan, with no Single Loss LimitInsurance Charge TableHazard Group 9Effective October 1, 2023Maximum Loss RatioSize40%50%60%70%80%90%100%110%120%130%140%150%160%1.8955.8901.8850.8802.8757.8714.8672.8631.8592.8554.8517.8480.84452.8934.8876.8823.8772.8724.8677.8633.859…

(1) What does it mean to say an injured worker is employable?(a) "Employable" means having the skills and training that are commonly and currently necessary in the labor market to be capable of performing and obtaining gainful employment on a reasonably continuous basis when cons…

The department may, at its sole discretion, authorize vocational rehabilitation services that are necessary and likely to enable the industrially injured or ill worker to become employable.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, 51.36.110. WSR 03-11-…

In exercising its discretion the department considers, but is not limited to:(1) Whether the worker took advantage of and utilized vocational rehabilitation services offered in this or other claims;(2) The worker's ability and willingness to participate in and benefit from vocati…

The attending health care provider, department, self-insured employer, employer, worker and vocational rehabilitation provider have the following responsibilities in assisting the worker to become employable at gainful employment:(1) Attending health care provider. The attending …

(1) All vocational rehabilitation services must be preauthorized. For state fund claims, the department may make one or more of the following type of referrals: Vocational recovery; ability to work assessment ("AWA" or "assessment"); plan development; plan implementation; forensi…

WAC 296-19A-060, 296-19A-080, 296-19A-098, 296-19A-118, and 296-19A-125 through 296-19A-137 pertain only to referrals for vocational rehabilitation services made by the department for state fund claims.[Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.095, 51.36.100, and 51.3…

(1) Vocational recovery services are intended to ensure appropriate support is provided to an industrially injured or ill worker so that they return to work, continue to work, or are enabled to become employable at gainful employment consistent with the priorities listed in RCW 5…

(1) The vocational provider must engage the worker to develop a vocational recovery plan. The vocational recovery plan should include the needs and goals of the worker and steps or strategies to address these. The plan may change as appropriate for the worker's needs and goals. A…

(1) Workers may be referred to a vocational provider for assessment activities at the discretion of the department or self-insured employer to determine if a worker is eligible to receive vocational rehabilitation plan development services. Assessment activities will generally oc…

(1) The assessment report must include information and evaluation of the worker's:(a) Age;(b) Education, including information about education level, courses or transcripts, licenses, and certifications or registrations that the worker may have obtained in the past;(c) Complete w…

(1) The vocational rehabilitation provider must submit a written progress report to the department, and upon request, to the employer and the worker or his or her representative, every thirty calendar days from the date of the electronic referral or upon request of the department…

Vocational rehabilitation plan development services are authorized to obtain the vocational rehabilitation provider's assistance in producing a vocational rehabilitation plan for a worker. The vocational rehabilitation provider will work with the worker in the development of the …

The vocational rehabilitation provider must submit the completed plan within ninety calendar days of the date the worker was notified by letter that plan development services were authorized. The ninety-day requirement may be extended only for good cause. The vocational rehabilit…

(1) When the plan cannot be completed and submitted to the department within ninety calendar days (see WAC 296-19A-092), the vocational rehabilitation provider seeking an extension must submit a written request to the department for state fund claims or the self-insured employer.…

(1) The department will determine whether good cause exists on a case-by-case basis.(2) The department will grant an extension of time for good cause when there is a significant delay in the plan development process and the cause is beyond the worker's or vocational rehabilitatio…

(1) The vocational rehabilitation provider must submit a written progress report to the department every 30 calendar days from the date of the electronic referral or upon request of the department.(2) The first progress report must document the assigned vocational rehabilitation …

When plan development services are completed, the vocational rehabilitation provider must submit one of the following reports:(1) Vocational rehabilitation plan. The vocational rehabilitation provider must address the return to work priorities listed in RCW 51.32.095(3) in the pl…

Vocational rehabilitation plan implementation and monitoring services are those services a vocational rehabilitation provider provides to assist a worker to successfully complete a vocational rehabilitation plan. These services may include, but are not limited to, the following:(…