Commonly Seen Errors In Department Audits And How To Fix Them.

Rights & Obligations  WAC  Within 30 days of Hire  Substantially Similar/WAC  Problems Found in Audits  Not using form  Modifying form  Not providing form to all new employees

 Recommendations –Form available on L & I website – Add to orientation checklist

 When Worker Files A Claim –Provide Department booklet –Names, address, phone number of person or organization handling claim Problems Found in Audits –Not providing booklet –Timely providing

 Recommendations –Booklet available on Department website or can be ordered from Department –Provide with SIF-2

Claim Filing Procedure Errors  WAC  Problems Found in Audits –Providing Self-Insurer Accident Report (SIF-2) when notified of injury or illness –Timely delivery of completed (SIF-2s) to claim management entity –Only Department provided SIF-2s may be used

Notice of self-insurance RCW (1) Problems Found in Audits  Substantially identical form  Listing person or position on site  State Fund Notices  Reasonable number of notices

 Recommendations –Form available on Department website

Claims Log  WAC  Designate location of official log in writing  Problems Found in Audits Date claim closed by Order and Notice Whether claim is time loss or medical only Unreported claims

Onsite Medical Treatment  Medical facilities and employers who treat their workers at their onsite medical facility  Treatment by physician, nurse practitioner, physician assistant, or registered nurse under doctors standing orders  Provide injured worker with opportunity to file claim form (SIF-2)  Documentation of refusal and notification of one-year filing statute.

 Treatment log for medical only claims with treatment exclusively at employer’s medical facility.

Date stamping incoming correspondence  WAC (8)  Legibly date stamp with date received and where received  Includes doctor notes, activity prescription forms, state fund accident reports, physicians initial reports, and other reports received by employer or claims management entity  Punch dates are not legible

Failure to request allowance or denial within 60 days from date claim filed  RCW and WAC  Check for allowance orders  Does not apply to medical only claims unless requesting denial or interlocutory order  Penalty per RCW and RCW

Payment of first time loss within 14 days  RCW (3)  Payment within 14 days after notice of a claim  Notice of claim or claim arrival date –Injured worker makes application for benefits –Claim elements-description of injury, diagnosis of medical condition, treatment or treatment recommendation –Hospitals and employers with onsite medical facility

 Recommendations –Review process of filing claims –Communication, communication, communication –Training employees

Benefits Not Paid as Entitled  RCW  Communication, communication, communication  Learn the employer’s payroll system  WAGES/ RCW –Obtain & review daily payroll records to determine employment pattern –Averaging hours Use full weeks and full months

 Multiple rates of pay –Substantial number of hours at different rates of pay, treat each as separate rate of pay –Rates of pay at time of injury –Change of circumstances Raises Change of jobs Change of shifts

 Health Care Benefits (medical, dental, vision)  Bonuses  Loss of Earning Power Benefits –Communication, communication, communication –Determine if eligible any time return to work light or modified duty –Eight hours versus average daily hours –Updated date of injury wages –Bonuses

 C.O.L.A. – July 1

Return to Modified or Light Duty Work  RCW (4)  Communication, communication, communication  Provide worker with copy of light duty job description when contacting physician for release to light duty  Document light duty offer and injured worker’s decision  Determine if LEP due

SIF-5 Information  WAC and WAC  Required for Department to monitor claim and make determinations  Should report what has taken place at time of completion

 Most common SIF-5 errors –Date of first payment –Release for work date –Return to work date Final report includes all dates- light duty, full duty

Employer Closures  RCW (9) (a)  Jurisdictional errors –Did not return to work with employer of record –Null and Void Orders WAC (6) –Untimely filing of EC Order and Final SIF-5

Medical Only Claims  Communication, communication, communication  May become compensable claim  Determine if LEP due for return to work light duty  Verify return to work full duty

Worker Hours Salaried Employees  WAC (2) –Report all salaried employees by same method –Actual hours worked or assumed 160 hours per month –Complete and accurate time records of all hours worked, whether paid or not

 Personal Services Labor Contracts  RCW and RCW  Independent contractor providing essentially personal labor for employer is a worker  Must meet ALL six parts of test described in RCW to be exempt

Department Web Site  RCWs, WACs, Forms, Publications, Self- Insurance information  lni.wa.gov/ClaimsIns/Insurance/SelfInsure/  At lni.wa.gov web site, click on Business Links, then Self-Insurance