Board of Industrial Insurance Appeals'

Proposed Rule Changes for 2007

The Board of Industrial Insurance Appeals has proposed a few rules changes for consideration at the end of this year.  We've already solicited your response on the change regarding claims that have been stuck in mediation for over 180 days (you support having them moved to hearing), but there are some other changes up for consideration.  There are proposed changes concerning: the conduct of mediation conferences; expansion of what constitutes public records; inclusion of "willful misrepresentation" evidence at hearings; what is considered part of the "record" at the BIIA; and concerning the payment of attorney fees.  You can find these proposed rules at the BIIA website.  If you have comments or concerns, please submit them to BIIA Executive Secretary Dave Theedy at theedy@biia.wa.gov as soon as possible.  Please be sure to copy WSIA on the email.

Everything Old is New Again:

Reinstatement of Billing Code for PCE's with New APF's

Due to rollout of the Activity Prescription Form, the IME Physical Capacities billing code 1105M was reactivated effective November 1, 2007, on the L&I Medical Aid Fee Schedule. The code replaces 1048M and is only billable when a physical capacities exam is requested by the insurer.  The fee, as of 11/1/2007, is $29.18.  Please make a note of it in your bill payment systems.

Department Considering Establishing

A Separate Massage Therapy Fee Schedule

In an effort to stem the rapidly growing costs of massage therapy (now costing the State Fund nearly $7 million a year), the Department is considering establishment of a separate massage therapy fee schedule under the Medical Aid Rules & Fee Schedules.  Currently, massage therapy is billed at the same rate as physical therapy.  There are limitations on pre-authorized visits for massage therapy under the current rules.  These won't be changed.  We'll let you know as more information becomes available.

First a Provider Bulletin, Now Rules

on Linear Analog Hearing Aid Replacement

Back in September the Department issued Provider Bulletin 07-07 concerning the replacement of linear analog hearing aids, and when to do so.  Apparently the Provider Bulletin wasn't enough, so the Department is going to be adopting rules to effectuate this change to "ensure uniform compliance."    The proposed rule language can be found at http://www.lni.wa.gov/rules/AO07/41/0741Proposal.pdf.  The new rule will take effect January 18, 2008.  A linear analog hearing aid issued by the insurer may be replaced with a non-linear digital or analog hearing aid when the worker's linear analog hearing aid is inoperable or the worker is experiencing an inability to hear, and when the insurer has given prior authorization to replace the hearing aid.  PB 07-07, as with all current Provider Bulletins, can be found at http://www.lni.wa.gov/ClaimsIns/Providers/Billing/ProvBulletins/.  According to the Department, older Provider Bulletins have either been incorporated into the WAC's or eliminated entirely.

Department Issues New Management Update

Concerning Interpreter and Translation Services to Workers

The Department has issued a new Management Update concerning Interpreter and Translation Services to workers.  The Management Update comes on the heels of a recent court decision that said that the Department and self-insurers are not obligated to pay for those services when it comes to the worker's communication with their attorney, or with the Board of Industrial Insurance Appeals or the courts.  To read the full Management Update, click here.

Updated Self-Insurance Section

Phone Contact Listing ... Including Team Assignments

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 September 4, 2007.  Note that the list now includes which adjudicator and which consultant work on which claims Team.  Check back at this link periodically for updated information.

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.

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/.

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!

as of 11/29/2007