AN ACT Relating to
self-insured employers; and amending RCW 51.32.055.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF
WASHINGTON:
Sec. 1. RCW 51.32.055 and 1988 c
161 s 13 are each amended to read as follows:
(1) One purpose of this
title is to restore the injured worker as ((near)) nearly as
possible to the condition of self-support as an able-bodied worker. Benefits
for permanent disability shall be determined under the director's supervision
only after the injured worker's condition becomes fixed.
(2) All determinations
of permanent disabilities shall be made by the department. Either the worker,
employer, or self-insurer may make a request or ((such)) the
inquiry may be initiated by the director on his or her own motion. ((Such))
Determinations shall be required in every instance where permanent
disability is likely to be present. All medical reports and other pertinent
information in the possession of or under the control of the employer or
self-insurer shall be forwarded to the director with ((such)) the
request((s)).
(3) A request for
determination of permanent disability shall be examined by the department and
an order shall issue in accordance with RCW 51.52.050.
(4) The department may
require that the worker present himself or herself for a special medical
examination by a physician((,)) or physicians((,)) selected by
the department, and the department may require that the worker present himself
or herself for a personal interview. ((In such event)) The costs
of ((such)) the examination or interview, including payment of
any reasonable travel expenses, shall be paid by the department or self-insurer,
as the case may be.
(5) The director may
establish a medical bureau within the department to perform medical
examinations under this section. Physicians hired or retained for this purpose
shall be grounded in industrial medicine and in the assessment of industrial
physical impairment. Self-insurers shall bear a proportionate share of the
cost of ((such)) the medical bureau in a manner to be determined
by the department.
(6) Where a
dispute arises from the handling of any claim((s prior to)) before
the condition of the injured worker ((becoming)) becomes fixed,
the worker, employer, or self-insurer may request the department to resolve the
dispute or the director may initiate an inquiry on his or her own motion. In
((such)) these cases, the department shall proceed as
provided in this section and an order shall issue in accordance with RCW
51.52.050.
(7)(a) ((In the case
of)) If a claim((s)) (i) is accepted by a
self-insurer((s)) after June 30, 1986, ((and before July 1, 1990,
which)) (ii) involves only medical treatment and ((/or))
the payment of temporary disability compensation under RCW 51.32.090 ((and
which)) or only the payment of temporary disability compensation under
RCW 51.32.090, (iii) at the time medical treatment is concluded ((do))
does not involve permanent disability, ((if the claim)) (iv)
is one with respect to which the department has not intervened under subsection
(6) of this section, and (v) the injured worker has returned to work
with the self-insured employer of record((, such)) at the worker's
previous job or at a job that has comparable wages and benefits, the
claim((s)) may be closed by the self-insurer, subject to reporting of
claims to the department in a manner prescribed by department rules adopted
under chapter 34.05 RCW.
(b) All determinations
of permanent disability for claims accepted by self-insurers after June 30,
1986, ((and before July 1, 1990,)) shall be made by the self-insured
section of the department under subsections (1) through (4) of this section.
(c) Upon closure of a
claim((s)) under (a) of this subsection, the self-insurer shall
enter a written order, communicated to the worker and the department
self-insurance section, which contains the following statement clearly set
forth in bold face type: "This order constitutes notification that your
claim is being closed with medical benefits and temporary disability
compensation only as provided, and with the condition you have returned to work
with the self-insured employer. If for any reason you disagree with the
conditions or duration of your return to work or the medical benefits or the
temporary disability compensation that has been provided, you may protest in
writing to the department of labor and industries, self-insurance section,
within sixty days of the date you received this order." ((In the event))
If the department receives such a protest, the self-insurer's
closure order shall be held in abeyance. The department shall review the claim
closure action and enter a determinative order as provided for in RCW
51.52.050.
(d) If within two years
of claim closure the department determines that the self-insurer has made
payment of benefits because of clerical error, mistake of identity, or innocent
misrepresentation((,)) or the department discovers a violation of the
conditions of claim closure, the department may require the self-insurer to
correct the benefits paid or payable. This paragraph ((shall)) does
not limit in any way the application of RCW 51.32.240.
(8) ((In
the case of)) If a claim((s)) (a) is accepted by a
self-insurer((s)) after June 30, 1990, ((which)) (b)
involves only medical treatment ((and which do)), (c) does
not involve payment of temporary disability compensation under RCW 51.32.090,
and ((which)) (d) at the time medical treatment is concluded ((do))
does not involve permanent disability, ((such)) the
claim((s)) may be closed by the self-insurer((s)), subject
to reporting of claims to the department in a manner prescribed by department
rules ((promulgated pursuant to)) adopted under chapter 34.05
RCW. Upon ((such)) closure of a claim, the self-insurer((s))
shall enter a written order, communicated to the worker, which contains the
following statement clearly set forth in bold-face type: "This order
constitutes notification that your claim is being closed with medical benefits
only, as provided. If for any reason you disagree with this closure, you may
protest in writing to the Department of Labor and Industries, Olympia, within
60 days of the date you received this order. The department will then review
your claim and enter a further determinative order." ((In the event))
If the department receives such a protest, it shall review the
claim and enter a further determinative order as provided for in RCW 51.52.050.
