1911-S

AN ACT Relating to expanding authority for retrospective rating plans; and adding a new section to chapter 51.16 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. A new section is added to chapter 51.16 RCW to read as follows:

(1) The department shall offer a retrospective rating plan to qualified employers and groups of employers. The plan shall be available on a voluntary basis for the period of one coverage period and may be renewed at the end of the year. The retrospective rating plan shall be consistent with recognized insurance principles and shall be administered according to rules, scales, tables, formulas, schedules, and factors adopted by the department. Rules adopted under this section should encourage the broadest possible participation by employers and groups consistent with insurance principles.

(2) In addition to those general powers and rights deemed appropriate by the department, retrospective rating plan employers and groups who administer their plans with an authorized claims administrator shall have the authority to assist the department in the processing of claims after January 1, 1996. The authority shall include implementation of administrative functions that are necessary to the timely management of a claim. The department shall adopt rules detailing such authority, which shall be comprehensive and include, but not be limited to, the following:

(a) Authorization to schedule medical examinations and consultations, provided that only qualified persons from the department list may be selected. The department shall strictly enforce penalties under RCW 51.32.110 for refusals to submit to medical examinations scheduled by retrospective rating plan employers or groups, obstruction of the same, or other prohibited actions set out in RCW 51.32.110.

(b) Authorization to initiate any rehabilitation services and select providers from the department list of qualified persons or, consistent with department utilization guidelines, use department providers. The time limitation on the expenditure of three thousand dollars in any fifty-two week period established in RCW 51.32.095 shall not apply to the provision of vocational rehabilitation approved by a retrospective rating plan employer or group, and the supervisor of industrial insurance may at any time, in the supervisor's sole discretion, authorize the expenditure of a sum not to exceed six thousand dollars for the costs of vocational rehabilitation. At the request of the retrospective rating plan employer or group, the supervisor may also waive department timelines to facilitate prompt intervention. If consistent with the discretion of the supervisor and department rules regarding vocational rehabilitation services, when both the employer or group and the worker sign an agreement for vocational rehabilitation services, the agreement is deemed approved. Vocational rehabilitation services may include job placement services, skill enhancement services, vocational rehabilitation plans, or other accepted services.

(3) Retrospective rating plan employers and groups who administer their plans with an authorized claims administrator shall have the authority to close claims as authorized in this subsection. If a claim accepted by the department after January 1, 1996, (a) involves only medical treatment and the payment of temporary disability compensation under RCW 51.32.090, or only the payment of temporary disability compensation under RCW 51.32.090, (b) at the time medical treatment is concluded, does not involve permanent disability, (c) is one with respect to which the department has not intervened under subsection (4) of this section, and (d) concerns an injured worker who has returned to work with the retrospective rating plan employer or group at the worker's previous job or at a job that has comparable wages and benefits, the claim may be closed by the retrospective rating plan employer or group, subject to reporting of claims to the department in a manner prescribed by department rules adopted under chapter 34.05 RCW. No later than at the time of closure for such claims, the retrospective rating plan employer or group shall forward notification to the worker, in nontechnical language, of the worker's rights under this title.

(4) If a dispute arises from the handling of any claim under this section before the condition of the injured worker becomes fixed, the injured worker, or retrospective rating plan employer or group, may request the department to intervene and assume all responsibilities for the claim and its processing.

(5) Exercise of any authority authorized by this section may require prior notification to the department, but rules adopted under this section shall minimize the department's need to respond and ensure that a failure to respond or delay in response by the department does not impede the timely administration of the claim. Standard charges incurred by the retrospective rating plan employer or group in the exercise of authority authorized by this section, other than management costs, shall continue to be charged against the claim. A retrospective rating plan employer or group may exceed department medical fee or other fee schedules but shall be required to pay any difference.

(6) The department shall conduct a study of all retrospective rating plan employers or groups who exercise the authority authorized under subsections (2) and (3) of this section and report to the legislature by December 1, 1998. The study plan shall be approved by the workers' compensation advisory committee and shall include examination of injured worker outcomes, worker complaints, litigation rates, and employer claims management problems with the department. The study shall focus specifically on return-to-work and long-term wage replacement outcomes for workers of the employers in the study compared with workers of state fund employers in similar risk classifications.

(7) For purposes of this section, "authorized claims administrator" means a person who meets department qualifications under chapter 51.14 RCW to manage industrial insurance claims.

(8) If, and only if, the outcome of the study under subsection (6) of this section demonstrates that, as a whole, retrospective rating plan employers or groups who exercise the authority authorized under subsections (2) and (3) of this section are not achieving better overall injured worker outcomes than their state fund counterparts, this section shall expire on July 1, 1999.