April 2006 SBH Quarterly Newsletter
PDF FormatNew Administrative Rules Affecting Washington Self-Insured Employers
By Linda Conratt
The Department revised administrative rules involving Chapter 296-15 that
became effective April 1, 2006. Some of these rules involve general
housekeeping issues. However, a number affect how you process a claim. The
following is a summary of the pertinent changes:
WAC 296-15-021 Self insurance certification requirements and application
process.
This amended rule now applies to all employers applying for self insurance,
regardless of the type of business. It also clearly specifies the steps for
the application process and responsibilities of the applicant and the
Department in the process.
WAC 296-15-266 Penalties.
This new rule requires a self-insured employer to pay penalties on or before
the date the penalty order becomes final.
WAC 296-15-320 Reporting of injuries.
This new rule specifies the self-insured employer’s responsibilities to
ensure the reporting of injuries. These responsibilities include:
establishing procedures to assist workers in reporting and filing claims,
immediately providing SIF-2 forms upon request or upon knowledge of the
existence of an injury/occupational disease, ensuring timely delivery of
completed SIF-2 forms to the administrator, designating individuals, in
organization and who have knowledge of industrial insurance, to address
employee questions, and maintaining a claim log of all workers’ compensation
claims filed.
The Department did not specify the method the self-insured employer provides
the employee the SIF-2 form. Furthermore, the claim log must contain
specific information including: the full name of the injured employee, the
date of the injury or date of manifestation of the disease, claim number on
the SIF-2, the date the claim is closed, and indicate whether the claim was
medical only or a timeloss claim. The third party administrator may maintain
the log for the self-insured employer based on a written agreement between
the administrator and the employer. The Department must be provided
information on the location of the log and a copy of the agreement if kept
with the administrator.
WAC 296-15-330 Authorization of medical care.
This new rule outlines the requirements for authorization of medical care
and payment of bills. The self-insured employer must provide a written
explanation of benefits to the provider for any adjustments other than those
made solely to conform with the fee schedule. The employer/administrator
must also establish internal procedures to ensure the prompt response to
inquiries regarding authorization decisions and bill adjustments.
WAC 296-15-340 Payment of compensation.
This new rule provides timeloss must be paid in accordance with Title 51 RCW
and the rules and regulations of the Department. The self-insured employer
must select biweekly, and report the selected method to the Department. The
self-insured employer must also provide the Department a detailed written
description of any practice of paying regular wages in lieu of timeloss
compensation or of paying employees any benefits including sick leave,
health and welfare insurance benefits, or any other compensation in
conjunction with timeloss compensation.
WAC 296-15-350 Handling of claims.
This new rule outlines basic requirements for proper claims handling such as
ensuring that incoming correspondence is date stamped.
WAC 296-15-360 Qualifications of personnel.
This new rule outlines how an individual can become a Department approved
claims administrator.
WAC 296-15-420 After a self-insured claim is filed.
This rule was amended. It now includes provisions for claims where the
employee is kept on salary. The Department requests any submission of the
claim file exclude bills unless specifically requested. Another change
involves the termination of timeloss. The self-insured employer must now
notify the employee in writing the reasons for the termination of timeloss
no later than the date of the termination.
WAC 296-15-430 Vocational services.
This new rule reduced how often an Employability Assessment Report (“EAR”)
must be submitted to the Department. An EAR is no longer required after 90
days of timeloss. If a worker is ineligible for vocational services and
timeloss terminated because he has returned or was released to the job at
injury, an employer is not obligated to complete an EAR. The rule also
addresses how to create, submit, and complete a vocational rehabilitation
plan. The rule replaced WAC 296-15-500 and WAC 296-15-510.
WAC 296-15-450 Closure of self-insured claims.
This amended rule was cleaned up to reflect current standards.
WAC 296-15-470 When a worker files for reopening.
This new rule requires the self-insured employer to forward a reopening
application to the Department within 5 days of receipt.
WAC 296-15-480 When a self-insured claim is protested.
This amended rule limits its application to protests.
WAC 296-15-490 When a self-insured claim in on appeal.
This amended rule now contains the previous rule of forwarding a copy of the
employee’s appeal to the Department within 5 days of receipt.
[Note: You can view a
complete copy of the
revised administrative rules on the Washington State Legislature web
site.]
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