S-0738.1 _______________________________________________
SENATE BILL 5599
_______________________________________________
State of Washington 53rd Legislature 1993 Regular Session
By Senators Moore, Newhouse, Vognild, Anderson, Amondson, Prince, Prentice and Winsley
Read first time 02/04/93. Referred to Committee on Labor & Commerce.
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)),
(iii) at the time medical treatment is concluded ((do)) does
not involve permanent disability, ((if the claim)) and (iv) is
one with respect to which the department has not intervened under subsection
(6) of this section, and the injured worker has returned to work with the
self-insured employer of record, ((such)) 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.
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