Don’t Leave Yourself Exposed: Request Wage Orders!
Based on conversations with the Self-Insurance Section at the Department, only about 25% of claims closure requests include a request for a Wage Orders. Remember, all it takes is another bad court decision to leave your old claims exposed to the same problems we encountered with the Cockle decision. With the Gallo decision due out some time this year, it’s possible we’ll see our next claims administration crisis within months. We strongly encourage you to request wage orders on your claims!

Better Communication of Orders: Strongly Suggested
There appears to have been a rash of claims with the injured worker denying they received the closing order. Regardless of whether you actually sent the order, this is resulting in delays and creating problems in the payment and termination of benefits, and on appeal to the Board of Industrial Insurance Appeals. The potential answers? Answer #1: Call repeatedly and note in the file if the worker said they received the order or not (otherwise note attempts to reach them.) or Answer #2: Send closing orders via certified return receipt mail. Yes, this is annoying and has a cost, but it is far less costly than an extra week or more of time loss while you resend another order that isn’t “received.” Don’t get taken advantage of! Protect yourself by using these tips.

And We Have a Winner: Gregoire Appoints Gary K. Weeks DLI Director
On April 5, 2005 Governor Christine Gregoire appointed Gary K. Weeks the new Director of the Department of Labor & Industries. Mr. Weeks takes the place of Paul Trause, who moved back to the Employment Security Department. Judy Schurke had been acting Director for the past few months. Gary Weeks has been Director of the Oregon Department of Human Services, the largest state agency in Oregon. Before that he was Director of Governmental Operations, a position that serves as the operations manager for all of state government. From 1991 to 1993, Weeks was the Director of the Oregon Department of Consumer and Business Services – covering worker’s compensation and safety compliance activities. Mr. Weeks will be attending the WSIA Annual Conference in Yakima and will be presenting on Thursday, June 2nd with Self-Insurance Program Manager Jean Vanek. You won’t want to miss this presentation!

Self-Insurance Contact List: At a DLI Website Near You
Effective January 2005, the Self-Insurance Section phone contact list is posted at the Department’s Web site. The latest version is dated February 15, 2005. You can find it at http://www.lni.wa.gov/ClaimsIns/Files/SelfIns/SelfInsPhoneList.pdf.

Reminder: Mileage Reimbursement Rate Went Up January 1st
In case you missed it, effective January 1, 2005, the mileage reimbursement rate went up to $.405 per mile. Please make the change in your systems.

New Social Security Legislation: Stop the Offset at Age 62
SHB 1732 passed the legislature and was signed into law by Governor Gregoire. The legislation will require employers to pay for the benefit reimbursement sought by the Social Security Administration (SSA) through their audits of Social Security recipients that had a prior workers’ compensation claim.

Washington State has an offset provision, but Congress passed a federal law in 1981 that put a “moratorium” on new states adopting laws to take an offset (when the retirement age was 62.) Apparently the SSA is now claiming that the moratorium also applied to those states with an offset, but that the offset could not be taken past age 62. Consequently, the SSA is attempting to go back and get money from the injured workers for the period from age 62 to the current retirement age. This is unfair to the injured worker, and the legislation was intended to fix that problem – at the employer’s expense.

So, for a period of time you will be seeing requests for reimbursement to the SSA. These reimbursements can be substantial. However, that’s not the end of the story. If you are continuing to take an offset past age 62, stop! Otherwise you’re opening yourself up to future indemnity costs during future SSA recipient audits. We strongly encourage you to stop taking the offset past age 62. Your organization will be much happier in the long run.

Compliance Activity: Self-Insurer Fined
Skanska USA Building Inc. (a self-insured employer) has been placed on notice of “corrective action” by The Department of Labor and Industries. The Department stated that Skanska will lose its certificate to self-insure if it doesn’t improve the way it manages workers’ compensation insurance claims. In addition there are questions regarding a recent audit that found the company underpaid injured workers who did file claims. The $136,264 fine is the largest ever levied against a self-insured employer. Skanska is working to correct any deficiencies in its handling of claims. They have also exercised their legal rights by protesting the audit findings. They are working with the Department by supplying records that support their contention that some of the audit findings are wrong.

Chiropractors Do An End-Run: Self-Insurers Told to “Pay Your Bills”
Chiropractors, rather than doing the usual frontal legislative assault to get self-insured employers to pay for excessive or unauthorized treatment, got clever this year – they pushed for and got an additional FTE added to the Department’s budget to audit self-insured employers and force them to pay their medical treatment bills. This position will enforce payment for all providers to self-insurers, not just chiropractors.

WISHA Advisory Committee: Homepage Added to Department Web site
In case you missed it, the WISHA Advisory Committee has its own page on the Department’s website. You can get the latest on their safety focus for the year, as well as minutes from their meetings. The page can be found at http://www.lni.wa.gov/Safety/Topics/AdvComm/default.asp. If you have issues you would like addressed at the Committee meetings, we encourage you to contact WSIA’s Safety Liaison Scott LaBar of ESD #112 at scott.labar@esd112.org or by phone at 360-750-7504, and he will make sure that WISHA hears about them.

Thar She Blows: ORCA Coming to Self-Insurance
For those who have been following our Self-Insured Electronic Data Reporting System (SIEDRS) efforts, you may or may not be aware of a project by the Department of Labor & Industries that has been in the process for a number of years. ORCA, the Online Reporting & Client Access project, was developed to address the concerns of State Fund employers and employees about access to basic claims information, without having to go through the maze of telephone voice messaging and non-response common to the State Fund. For the State Fund, ORCA has two main pieces: electronic notes and data on individual claims; and an electronic copy of all scanned documents received by the Department.

We did not originally want to participate in this project, seeing it as a mid-way step to achieving the data collection we wanted. However, with the elimination of the microfiche process, it only made sense for the scanning of self-insured documents to fit into a similar system. In the 2005-07 biennium, approximately $1 million will be charged to self-insured employers in one-time costs to develop the system. The value will be that you will be able to access the document information over the internet, and confirm the receipt of the documents necessary for the Department to take action on your claims. This should help with Department responsiveness to your inquiries and more prompt claims resolution.

JLARC Strikes Again: Vocational Rehab Follow-up to 1998 Audit
As if we hadn’t heard the last from JLARC (Joint Legislative Audit & Review Committee) regarding the 1998 audit (and 2003 follow-up) of the Department of Labor & Industries, here comes something else: a follow-up on vocational rehabilitation issues. The overall finding of the report is that “JLARC finds that L&I is not in compliance with the statutory requirement to make referrals to vocational rehabilitation providers on the basis of quality and effectiveness. The factors that L&I uses to measure provider performance are better measures of efficiency than quality and effectiveness, and the performance scoring methodology may actually create a disincentive for quality and effectiveness.” The report can be found online at http://www1.leg.wa.gov/JLARC/Audit+and+Study+Reports/2005/05-1.htm. [Please be aware that this report was scanned poorly, and must be printed out at only one or two pages at a time because of the size of the file.]

Employment Changes: Bob Dixon, David Dennis, Don Scoville Retire
Another generation of workers’ compensation, risk management, and safety professionals has or is on the brink of retirement. That seems to be the latest happenings within the workers’ compensation community in the last six months.

First, David Dennis with Longview Fibre Company retired in January 2005. David served over 20 years in the industry, and was a strong advocate on behalf of self-insured employers and improving the workers’ compensation system. His feedback and input on legislative issues in particular will be missed.

Next, Robert Dixon of ConAgra Foods (Lamb-Weston) also retired early this year. Bob worked in workers’ compensation and safety for over 20 years, and was WSIA’s early warning system to claims issues and problems that cropped up at the claims management level. He helped provide a context to complex workers’ compensation issues, and kept us apprise of changes made by the Department that never seemed to be formally announced.

Lastly, Don Scoville has announced that he will retire in August 2005. Don has been the director of the Puget Sound Workers’ Compensation Trust for ESD #121 since 1992, overseeing the management of claims for over 50,000 school employees. Prior to working for ESD #121, Don was the assistant director of risk management services, and then claims administration program manager at the Department of Labor & Industries. His first job in the industry was as director of health, safety and security at Tacoma Boat Building Company. In addition to his job, Don Scoville served as Vice-President for Legislation and President of WSIA, and served four years on the Insolvency Trust Fund Board.

Combined, all three of these individuals brought nearly 75 years of experience to our community. While the knowledge and experience of all three of these people will be sorely missed, we want to wish David, Bob and Don good luck and best wishes in their future endeavors.

Proposed Self-Insurance Rule Changes: Still Not Adopted
The stakeholder committee reviewing the draft rule changes for self-insurance, originally submitted back in July 2002, completed its work on August 31st, 2004, and the rules are STILL not adopted! The rules cover everything from qualifications for self-insurance, elimination of the 90 EAR for vocational rehabilitation, and claim adjudicator certification requirements. On the last topic, we will continue working with the Department’s Self-Insurance Section on a more comprehensive educational setup, with the goal of moving to a continuing education program (rather than re-certification.) The formal rule making process will probably occur in July 2005, with a hoped for implementation of October 2005 – some three years after they were initially proposed. Additionally, the NEXT round of proposed self-insured rule changes are supposed to take place in August! These will include provisions governing educational requirements and insolvency related financial issues. Watch your email and newsletters for hearings and time to submit comments!

Provider Bulletins: The Number Seems Endless
The Department of Labor & Industries has issued a number of Provider Bulletins over the past few months. Topics covering: interpretive services payment and utilization; payment to work hardening providers; nursing home/transitional care coverage and payment; authorization and payment of chronic pain management programs; an expansion of the universe related to the spinal chord stimulator study; and a number of coverage decisions are included. If you haven’t already received the Bulletins by mail, you can find them online at http://www.lni.wa.gov/ClaimsIns/Providers/Billing/ProvBulletins/default.asp.

In particular, please take note of Provider Bulletin 05-04 regarding Interpretive Services. As defined by the Department, except for legal purposes, provision of interpretive services is REQUIRED to comply with both state (RCW 51.04.030(1)) and federal law (Title VI of the Civil Rights Act of 1964.) Based on the Department’s evaluation, this is not a discretionary service, and you should be paying for these services.