CERTIFICATION OF ENROLLMENT

 

                   SUBSTITUTE HOUSE BILL 1607

 

 

                   Chapter 416, Laws of 1997

 

 

 

 

                        55th Legislature

                      1997 Regular Session

 

 

DETERMINATION OF PARTIAL PERMANENT DISABILITY BENEFITS BY INDUSTRIAL INSURANCE SELF-INSURERS

 

 

 

                    EFFECTIVE DATE:  7/27/97

Passed by the House April 21, 1997

  Yeas 60   Nays 38

 

 

 

             CLYDE BALLARD

Speaker of the

      House of Representatives

 

Passed by the Senate April 10, 1997

  Yeas 27   Nays 21

             CERTIFICATE

 

I, Timothy A. Martin, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is SUBSTITUTE HOUSE BILL 1607  as passed by the House of Representatives and the Senate on the dates hereon set forth.

 

 

 

               BRAD OWEN

President of the Senate

          TIMOTHY A. MARTIN

                          Chief Clerk

 

 

Approved May 19, 1997 Place Style On Codes above, and Style Off Codes below.   

                                FILED          

 

 

             May 19, 1997 - 7:25 p.m.

 

 

 

              GARY LOCKE

Governor of the State of Washington

                   Secretary of State

                  State of Washington


          _______________________________________________

 

                    SUBSTITUTE HOUSE BILL 1607

          _______________________________________________

 

             Passed Legislature - 1997 Regular Session

 

                     AS AMENDED BY THE SENATE

                                

State of Washington      55th Legislature     1997 Regular Session

 

By House Committee on Commerce & Labor (originally sponsored by Representatives McMorris, Thompson, Dyer, Sheldon, Boldt, Honeyford, Lisk, Clements, Mulliken and Mielke)

 

Read first time 03/05/97.

  Providing for industrial insurance self-insurers to determine benefits for permanent disability.   


    AN ACT Relating to determination of benefits for permanent partial disability by industrial insurance self-insurers; amending RCW 51.32.055; and creating a new section.

 

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

 

    Sec. 1.  RCW 51.32.055 and 1994 c 97 s 1 are each amended to read as follows:

    (1) One purpose of this title is to restore the injured worker as 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, except as otherwise authorized in subsection (9) of this section, only after the injured worker's condition becomes fixed.

    (2) All determinations of permanent disabilities shall be made by the department, except as otherwise authorized in subsection (9) of this section.  Either the worker, employer, or self-insurer may make a request or the inquiry may be initiated by the director or, as authorized in subsection (9) of this section, by the self-insurer on ((his or her)) the director or the self-insurer's own motion.  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, if the self-insurer has made a request to the department, in the possession of or under the control of the self-insurer shall be forwarded to the director with the request.

    (3) A request for determination of permanent disability shall be examined by the department or, if authorized in subsection (9) of this section, the self-insurer, and the department shall issue an order ((shall issue)) in accordance with RCW 51.52.050 or, in the case of a self-insured employer, the self-insurer may:  (a) Enter a written order, communicated to the worker and the department self-insurance section in accordance with subsection (9) of this section, or (b) request the department to issue an order in accordance with RCW 51.52.050.

    (4) The department or, in cases authorized in subsection (9) of this section, the self-insurer 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 or, in cases authorized in subsection (9) of this section, the self-insurer may require that the worker present himself or herself for a personal interview.  The costs of 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 the medical bureau in a manner to be determined by the department.

    (6) Where a dispute arises from the handling of any claim before the condition of the injured worker 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 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) If a claim (i) is accepted by a self-insurer after June 30, 1986, and before August 1, 1997, (ii) 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, (iii) at the time medical treatment is concluded does not involve permanent disability, (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, whether at the worker's previous job or at a job that has comparable wages and benefits, the claim 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 under this subsection (7) by self-insurers ((after June 30, 1986,)) 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 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)) must protest in writing to the department of labor and industries, self-insurance section, within sixty days of the date you received this order."  ((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 does not limit in any way the application of RCW 51.32.240.))

    (8)(a) If a claim (((a))) (i) is accepted by a self-insurer after June 30, 1990, (((b))) and before August 1, 1997, (ii) involves only medical treatment, (((c))) (iii) does not involve payment of temporary disability compensation under RCW 51.32.090, and (((d))) (iv) at the time medical treatment is concluded does not involve permanent disability, the claim 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.  Upon closure of a claim, the self-insurer 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)) must 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."  ((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.))

    (b) All determinations of permanent disability for claims accepted under this subsection (8) by self-insurers shall be made by the self-insured section of the department under subsections (1) through (4) of this section.

    (9)(a) If a claim:  (i) Is accepted by a self-insurer after July 31, 1997; (ii)(A) involves only medical treatment, or medical treatment and the payment of temporary disability compensation under RCW 51.32.090, and a determination of permanent partial disability, if applicable, has been made by the self-insurer as authorized in this subsection; or (B) involves only the payment of temporary disability compensation under RCW 51.32.090 and a determination of permanent partial disability, if applicable, has been made by the self-insurer as authorized in this subsection; (iii) is one with respect to which the department has not intervened under subsection (6) of this section; and (iv) concerns an injured worker who has returned to work with the self-insured employer of record, whether at the worker's previous job or at a job that has comparable wages and benefits, the claim 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) If a physician submits a report to the self-insurer that concludes that the worker's condition is fixed and stable and supports payment of a permanent partial disability award, and if within fourteen days from the date the self-insurer mailed the report to the attending or treating physician, the worker's attending or treating physician disagrees in writing that the worker's condition is fixed and stable, the self-insurer must get a supplemental medical opinion from a provider on the department's approved examiner's list before closing the claim.  In the alternative, the self-insurer may forward the claim to the department, which must review the claim and enter a final order as provided for in RCW 51.52.050.

    (c) Upon closure of a claim under this subsection (9), 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 such medical benefits and temporary disability compensation as provided to date and with such award for permanent partial disability, if any, as set forth below, and with the condition that 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, temporary disability compensation provided, or permanent partial disability that has been awarded, you must protest in writing to the Department of Labor and Industries, Self-Insurance Section, within sixty days of the date you received this order.  If you do not protest this order to the department, this order will become final."

    (d) All determinations of permanent partial disability for claims accepted by self-insurers under this subsection (9) may be made by the self-insurer or the self-insurer may request a determination by the self-insured section of the department.  All determinations shall be made under subsections (1) through (4) of this section.

    (10) If the department receives a protest of an order issued by a self-insurer under subsections (7) through (9) of this section, the self-insurer's closure order must be held in abeyance.  The department shall review the claim closure action and enter a further determinative order as provided for in RCW 51.52.050.  If no protest is timely filed, the closing order issued by the self-insurer shall become final and shall have the same force and effect as a department order that has become final under RCW 51.52.050.

    (11) If within two years of claim closure under subsections (7) through (9) of this section, 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 subsection (11) does not limit in any way the application of RCW 51.32.240.

    (12) For the purposes of this section, "comparable wages and benefits" means wages and benefits that are at least ninety-five percent of the wages and benefits received by the worker at the time of injury.

 

    NEW SECTION.  Sec. 2.  The department of labor and industries shall review the permanent partial disability claims closure activity by self-insured employers authorized under RCW 51.32.055(9) through at least June 30, 1999.  The department must also review the claims closure activity by the self-insured section of the department for the same period.  The review of these activities must include the number and types of claims closed, protested, reconsidered, and appealed, and the results of such activities, including the results of injured worker satisfaction surveys conducted by the department.  The department must report on its review to the appropriate committees of the legislature no later than January 1, 2000.


    Passed the House April 21, 1997.

    Passed the Senate April 10, 1997.

Approved by the Governor May 19, 1997.

    Filed in Office of Secretary of State May 19, 1997.