Help Expedite Your Own Claims,

Use Self-Insured Claims Related Checklists

Frustrated with delays at the Department on pension requests, vocational rehabilitation determinations, etc, etc, etc?  The Department has developed a series of “checklists” that will help make certain you’re submitting all of the information necessary to get more timely decisions.  Go to the WSIA website at www.wsiassn.org and click the box on the home page that says “Claims Facilitation Checklists.”

SIEDRS Project Voluntary Participation Strongly Encouraged,

as July 1, 2008 Mandatory Participation Date Approaches

The Self-Insurance Electronic Data Reporting System (SIEDRS) project is proceeding as planned.  A number of organizations have already volunteered to participate effective the January 1, 2007 implementation date for voluntary submittal of data.  It is important to note that after June 29, 2007, there will be fewer technical support staff dedicated solely to the SIEDRS project.  You can prepare your system any time, and test when you are ready.  Mandatory participation will occur July 1, 2008, so it is very important that you budget and plan ahead to be in compliance.  This is particularly important for public entity self-insured employers that must budget and plan far ahead.  To get an enrollment package, contact the Department at SIEDRS@lni.wa.gov.  Note your name, email address, telephone number, and name of the self-insured employer or third party administrator that you represent.

DLI Self-Insured Claims Adjudicator Testing Dates Set,

WSIA to Provide Study Session/Review Course

The Department has announced the testing dates for the Claims Adjudicator certification test.  The test will be administered on March 2, June 11, September 20, and December 13, 2007.  As applications must be received no later than 45 days prior to the testing, it is too late to submit applications for the March 2nd date; BUT you can’t submit an application for the next testing until AFTER the March testing date.  When the time is right, the application is available online at http://www.lni.wa.gov/forms/pdf/207177af.pdf.  As with the December testing, WSIA will be providing a study session or review course the day before each test date for WSIA member employees only.  Holding the sessions the day before the test is being done to minimize impacts on those having to travel from out of state.  The scope of the study session or review course is being developed to help those taking the Certification test make the most of their time.  Please watch the WSIA website for more information as it becomes available.

New Mileage Per Diem Rates

Effective January 1, 2007

The Privately Owned Vehicle (POV) Mileage Rate increased to $0.485 per mile effective January 1, 2007.  Please make whatever changes you need to make in your systems to reflect the new rate.  This and all other current per diem rates are available at the Washington State Office of Financial Management’s website at http://www.ofm.wa.gov/policy/10.90a.pdf.

You Pay for It, Use It!          

DOSH Safety Materials Available for Your Use

The Department of Labor & Industries’ Division of Occupational Safety & Health has at least 27 downloadable safety videos, 75 industry fact sheets, 18 employee safety rule training kits, 85 online safety presentations, 52 construction industry toolbox talks, and over 2000 different safety, health, and risk management video titles for checkout in their safety library.  YOU pay for these services, so please take advantage of them.  You can find these materials at the DOSH webpage at the Department’s website at http://www.lni.wa.gov/safety/.

Requesting Self-Insured and

Requesting State Fund Claims Files

In response to changes in public disclosure law, the Department of Labor & Industries has changed the way they process and respond to requests for prior industrial insurance claims files.  You will need to submit TWO requests: one to Norm Voiles for information on self insured claims (faxed to 360-902-6900), and then requests for State Fund claims histories to Paula Clayton (faxed to 360-902-6970.)  If you have questions on the status of State Fund claims information requests, you can call 360-902-5656.  Most State Fund requests will be handled within 10 business days.

Updated Self-Insurance Section

Phone Contact Listing

Need an updated list of Self-Insurance section phone numbers?  Here’s the link to the latest and greatest list, http://www.lni.wa.gov/ClaimsIns/Files/SelfIns/SelfInsPhoneList.pdf, updated January 3, 2007.  Check back at the link periodically for updated information.

Division II Court of Appeals Decision

Upholds Birklid “Intentional Injury” Standards

On January 17th, 2007, in a rare victory for employers in the courts, the Court of Appeals Division II upheld the narrow exceptions in prior cases for injured workers to sue for employers causing “intentional injuries.”  In Brame et al v. Western State Hospital, the Court ruled that the hospital did not intentionally injure their employees.  You can find the reasoning in the full decision at http://www.courts.wa.gov/opinions/?fa=opinions.disp&filename=348179MAJ.

State Fund Performance Assessment

For Vocational Services

The Department is holding a number of stakeholder meetings in an effort to find a new method and system to assess vocational provider performance.  This became necessary because the old CACO scoring system was found to be arbitrary in a court decision.  While not directly affecting self-insurance, this will affect the vocational providers who provide services to self-insurers and may have an impact on the market for vocational services.  A number of meetings have been held around the state.  The last scheduled meeting is February 6th in Spokane, but the Department will be sending out a survey to stakeholders between February 20th and March 2nd.  If you have ideas you would like to share, please contact Janice Orcutt at prck235@lni.wa.gov or by phone at 360.902.4854, or Mary Reister at reiq235@lni.wa.gov or by phone at 360.902.6258.

New Provider Bulletins:

Autologous Chondrocyte Implantation & Bone Growth Stimulators

There are two new Provider Bulletins regarding changes to coverage policies.  PB 06-07 applies to Autologous Chondrocyte Implantation (ACI) and allows coverage for cartilaginous defects femoral condyle (medial, lateral or trochlear). PB 06-08 applies to Bone Growth Stimulators (BGS) coverage policy, and it removes the requirement that the patient have failed at least one surgical intervention prior to approval for ultrasound BGS.  This replaces PB 03-13.

You can find these Provider Bulletins at the Department’s website at http://www.lni.wa.gov/ClaimsIns/Providers/Billing/ProvBulletins/default.asp.

Department Caves into Device Manufacturers,

Backs Down on Rules Governing Intrathecal Pumps

The Department of Labor & Industries had proposed rules last year that would limit the use of intrathecal pumps, setting clear guidelines for their use as a treatment modality in workers’ compensation claims.  After much pressure from organized labor and the trial attorneys, the Department withdrew the proposed rule.  According to the November 15th, 2006 memo from Assistant Director for Insurance Services Bob Malooly, the Department’s “primary concern continues to be the safety and effectiveness for injured workers and victims of crime.  This proposed rulemaking is being withdrawn pending review of safety data from the manufacturers of this device and the federal Food and Drug Administration.”

Self-Insured Employer Notice of Denial (SIF-4)

Now Available Online

You can now access a fillable SIF-4 template online at the Department of Labor & Industries’ website at http://www.lni.wa.gov/Forms/pdf/207163af.pdf.  Please remember that while you can use the template, you cannot change or delete text, font size, layout or headings.  It must remain substantially similar, and must contain all legal language as provided by statute or rule.  You can find other forms at the Department’s website by going to the homepage, click on “Get a Form or Publication,” and search for forms using key words or the form number.

Electronic Filing of Claims Appeals

At the Board of Industrial Insurance Appeals

Did you know you can file your claims appeals electronically, online?  You can!  Go to the Board of Industrial Insurance Appeals website at www.biia.wa.gov and click on the E-filing logo.  Your appeal is submitted instantly, saving time and postage.  You are able to print a copy for your records, and a receipt showing that your submittal was received.  Give it a try!