BILL REQ. #: H-4103.1
| State of Washington | 58th Legislature | 2004 Regular Session |
Read first time 01/22/2004. Referred to Committee on Commerce & Labor.
AN ACT Relating to improving the competitiveness of Washington's industrial insurance system; amending RCW 51.04.110, 51.16.035, 51.28.010, 51.28.055, 51.28.040, 51.32.160, 51.04.060, 51.32.220, 51.32.225, 51.36.110, 51.36.010, 51.44.010, 51.44.020, 28B.20.458, 51.32.210, 41.06.380, 51.52.050, 51.52.132, 51.52.120, and 51.52.130; reenacting and amending RCW 43.84.092 and 51.52.060; adding new sections to chapter 51.32 RCW; adding a new section to chapter 51.36 RCW; adding a new section to chapter 51.04 RCW; adding a new chapter to Title 51 RCW; creating new sections; repealing RCW 51.16.042; prescribing penalties; providing effective dates; providing an expiration date; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 51.04.110 and 1982 c 109 s 2 are each amended to read
as follows:Three representing subject workers,
three representing subject employers, one representing self-insurers,
one representing workers of self-insurers, and two ex officio members,
without a vote, one of whom shall be the chairman))
(a) Three members representing workers of state fund employers;
(b) One member representing workers of self-insurers;
(c) Three members representing state fund employers;
(d) One member representing self-insurers; and
(e) Two ex officio members, without a vote, one of whom shall be
the chair of the board of industrial appeals and the other the
representative of the department. The member representing the
department shall be ((chairman. This committee shall conduct a
continuing study of any aspects of workers' compensation as the
committee shall determine require their consideration. The committee
shall report its findings to the department or the board of industrial
insurance appeals for such action as deemed appropriate)) the chair.
(2) The members of the committee shall be appointed for a term of
three years commencing on July 1, 1971 and the terms of the members
representing the workers and employers shall be staggered so that the
director shall designate one member from each such group initially
appointed whose term shall expire on June 30, 1972 and one member from
each such group whose term shall expire on June 30, 1973.
(3) The members shall serve without compensation, but shall be
entitled to travel expenses as provided in RCW 43.03.050 and 43.03.060
as now existing or hereafter amended. The committee may hire such
experts, if any, as it shall require to discharge its duties, and may
utilize such personnel and facilities of the department and board of
industrial insurance appeals as it shall need without charge. All
expenses of this committee shall be paid ((by the department)) from
funds appropriated from the medical aid fund to the department.
Sec. 201 RCW 51.16.035 and 1999 c 7 s 8 are each amended to read
as follows:
(a) Shall classify all occupations or industries in accordance with
their degree of hazard and fix therefor basic rates of premium which
shall be the lowest necessary to maintain actuarial solvency of the
accident and medical aid funds in accordance with recognized insurance
principles((. The department));
(b) Shall formulate and adopt rules ((and regulations)) governing
the method of premium calculation and collection and providing for a
rating system consistent with this title and with recognized principles
of workers' compensation insurance which shall be designed to stimulate
and encourage accident prevention and to facilitate premium
collection((. The department)). The basis for premium payment shall
be total employer payroll as provided in RCW 51.16.060, except that the
department may adopt by rule a basis other than payroll for a specific
industry when warranted by industry circumstances; and
(c) May annually, or at such other times as it deems necessary to
maintain solvency of the funds, readjust rates in accordance with the
rating system to become effective on such dates as the department may
designate.
(2) In providing a retrospective rating plan under RCW 51.18.010,
the department may consider each individual retrospective rating group
as a single employing entity for purposes of dividends or premium
discounts.
Sec. 301 RCW 51.28.010 and 2001 c 231 s 1 are each amended to
read as follows:shall be)) is the duty of ((such)) the worker or
someone ((in)) on his or her behalf to ((forthwith)) report ((such))
the accident to his or her employer, superintendent, or supervisor in
charge of the work((, and)) within fourteen days after the accident.
A claim for an injury due to an accident that was not timely reported
may be allowed only for medical aid benefits under chapter 51.36 RCW.
(2) When an employer receives a notice of an accident as required
under subsection (1) of this section, it is the duty of the employer to
at once report such accident and the injury resulting therefrom to the
department pursuant to RCW 51.28.025 where the worker has received
treatment from a physician, has been hospitalized, disabled from work,
or has died as the apparent result of such accident and injury.
(((2))) (3) Upon receipt of ((such)) the notice of accident
required under RCW 51.28.025, the department shall immediately forward
to the worker or his or her beneficiaries or dependents notification,
in nontechnical language, of their rights under this title. The notice
must specify the worker's right to receive health services from a
physician of the worker's choice under RCW 51.36.010, including
chiropractic services under RCW 51.36.015, and must list the types of
providers authorized to provide these services.
Sec. 302 RCW 51.28.055 and 2003 2nd sp.s. c 2 s 1 are each
amended to read as follows:
(2) Except as provided in subsection (((2))) (3) of this section
for claims filed for occupational hearing loss, claims for occupational
disease or infection to be valid and compensable must be filed within
two years following the date the physician notifies the worker ((had
written notice from a physician: (a))) of the existence of his or her
occupational disease((, and (b) that a claim for disability benefits
may be filed. The notice shall also contain a statement that the
worker has two years from the date of the notice to file a claim. The
physician shall file the notice with the department. The department
shall send a copy to the worker and to the self-insurer if the worker's
employer is self-insured)). However, a claim is valid if it is filed
within two years ((from)) after the date of death of the worker
suffering from an occupational disease.
(((2))) (3)(a) Except as provided in (b) of this subsection, to be
valid and compensable, claims for hearing loss due to occupational
noise exposure must be filed within two years ((of)) after the date of
the worker's last injurious exposure to occupational noise in
employment covered under this title or within one year ((of)) after
September 10, 2003, whichever is later.
(b) A claim for hearing loss due to occupational noise exposure
that is not timely filed under (a) of this subsection ((can only)) may
be allowed only for medical aid benefits under chapter 51.36 RCW.
(((3))) (4) The department may adopt rules to implement this
section.
Sec. 303 RCW 51.28.040 and 1977 ex.s. c 199 s 1 are each amended
to read as follows:
((If change of circumstances warrants an increase or rearrangement
of compensation, like application shall be made therefor.)) Where the
worker's application to reopen a claim has been granted under RCW
51.32.160, compensation and other benefits, if in order, shall be
allowed for periods of time up to sixty days prior to the receipt of
such application.
Sec. 304 RCW 51.32.160 and 1995 c 253 s 2 are each amended to
read as follows:
(1)(a) If aggravation, diminution, or termination of disability
takes place, the director may, upon the application of the beneficiary,
made within seven years from the date the first closing order becomes
final, or at any time upon his or her own motion, readjust the rate of
compensation in accordance with the rules in this section provided for
the same, or in a proper case terminate the payment: PROVIDED, That
the director may, upon application of the worker made at any time,
provide proper and necessary medical and surgical services as
authorized under RCW 51.36.010. The department shall promptly mail a
copy of the application to the employer at the employer's last known
address as shown by the records of the department.
(b) "Closing order" as used in this section means an order based on
factors which include medical recommendation, advice, or examination.
(c) Applications for benefits where the claim has been closed
without medical recommendation, advice, or examination are not subject
to the seven year limitation of this section. The preceding sentence
shall not apply to any closing order issued prior to July 1, 1981.
First closing orders issued between July 1, 1981, and July 1, 1985,
shall, for the purposes of this section only, be deemed issued on July
1, 1985. The time limitation of this section shall be ten years in
claims involving loss of vision or function of the eyes.
(d)(i) With respect to an application to reopen a claim filed on or
after July 1, 1988, but before the effective date of this section, if
an order denying ((an)) the application to reopen ((filed on or after
July 1, 1988,)) is not issued within ninety days of receipt of such
application by the self-insured employer or the department, such
application shall be deemed granted. ((However,))
(ii) With respect to an application to reopen a claim filed on or
after the effective date of this section:
(A) The self-insured employer or department, as applicable, must
notify the worker by mail at the worker's last known address as shown
by department records that the application has been received.
(B) If an order denying or granting the application is not issued
within ninety days of mailing notice to the worker of receipt of the
application, such application shall be deemed granted.
(iii) For good cause, the department or self-insurer may extend the
time for making the final determination on the application filed under
(d)(i) or (ii) of this subsection for an additional sixty days.
(2) If a worker receiving a pension for total disability returns to
gainful employment for wages, the director may suspend or terminate the
rate of compensation established for the disability without producing
medical evidence that shows that a diminution of the disability has
occurred.
(3) No act done or ordered to be done by the director, or the
department prior to the signing and filing in the matter of a written
order for such readjustment shall be grounds for such readjustment.
(4) This section does not apply to any claim subject to a final
settlement agreement under section 305 of this act which provides that
the claim is not subject to reopening under this section.
NEW SECTION. Sec. 305 A new section is added to chapter 51.32
RCW to read as follows:
(i) Bind the parties with regard to any or all aspects of a claim,
including but not limited to allowance or rejection of a claim,
monetary payment, provision of medical treatment, claim closure, and
claim reopening under RCW 51.32.160; and
(ii) Not subject any employer who is not a signatory to the
agreement to any responsibility or burden under any claim.
(b) A final settlement agreement entered into under this section
must be signed by the employer and the worker and must clearly state
that the parties agree to the terms of the final settlement agreement.
In a state fund claim, the employer or the worker must file the final
settlement agreement with the director. Unless the worker or the
employer revokes consent to the agreement, except as provided in
subsection (2) or (3) of this section: (i) The final settlement
agreement in a state fund case becomes final and binding fourteen days
after the agreement is filed with the director; and (ii) in a self-insured case, the final settlement agreement becomes final and binding
fourteen days after the agreement is signed.
(c) A self-insured employer and a worker may enter into a final
settlement agreement. The agreement must be signed by the employer and
the worker.
(d) A final settlement agreement that has become final and binding
as provided in this section is binding on the department and on all
parties to the agreement as to its terms and the injuries and
occupational diseases to which the final settlement applies. A final
settlement agreement that has become final and binding is not subject
to appeal.
(2)(a) A worker or an employer in a state fund case may revoke
consent to the final settlement agreement by providing written notice
to the other party and the director within fourteen days of the date
the agreement is filed with the director.
(b) A worker or an employer in a self-insured case may revoke
consent to the final settlement agreement by providing written notice
to the other party within fourteen days of signing the settlement
agreement. Unless subsection (3) of this section applies, if no party
revokes the agreement as specified in this subsection, the self-insurer
must forward the agreement to the department to provide notice to the
department of the binding terms of the agreement and for placement of
the agreement in the applicable claim files.
(3)(a) If a worker is not represented by legal counsel at the time
of signing a final settlement agreement, the department or the self-
insurer, as the case may be, must forward a copy of the signed
settlement agreement to the board of industrial insurance appeals with
a request for a conference with a settlement officer. Unless the
worker or the employer requests a later date, the settlement officer
must convene a conference within fourteen days of receipt of the
request for the limited purpose of receiving the final settlement
agreement of the parties, explaining the benefits generally available
under this title, and explaining that a final settlement agreement may
alter the benefits payable on a claim. In no event may a settlement
officer render legal advice to any party.
(b) The settlement officer may reject a settlement agreement only
if the agreement constitutes a gross miscarriage of justice. Within
seven days after the conference, the settlement officer shall issue a
conference report accepting or rejecting the final settlement
agreement. If the settlement agreement is rejected, no further
proceedings with regard to the settlement agreement may take place, and
the settlement agreement is null and void.
(c) If the settlement officer accepts the agreement and no party
revokes the agreement as specified in subsection (2) of this section or
(d) of this subsection, the agreement becomes final and binding. If
the case involves a self-insurer, the self-insurer shall forward the
final and binding agreement to the department to provide notice to the
department of the binding terms of the agreement and for placement of
the agreement in the applicable claim files.
(d) In cases requiring a conference under this subsection:
(i) The worker or the employer in a state fund case may revoke
consent to the agreement by providing written notice to the other party
and the department within fourteen days after the conference with the
settlement officer.
(ii) If the case involves a self-insurer, the worker or the
employer may revoke consent to the agreement by providing written
notice to the other party within fourteen days after the conference
with the settlement officer.
(4) To the extent the worker is entitled to temporary total
disability or permanent total disability benefits while a final
settlement agreement is being negotiated, or during the revocation
period of an agreement, such benefits shall be paid until the agreement
becomes final.
(5)(a) If the parties have provided in a final settlement agreement
that a claim or claims are not subject to reopening pursuant to RCW
51.32.160, any application to reopen the claim or claims is of no force
or effect and must be denied.
(b)(i) If a worker subject to a final settlement agreement
subsequently files a new claim under this title, or an application
under RCW 51.32.160 to reopen a claim that is not covered by the
settlement agreement, for an injury or occupational disease involving
the same or similar diagnosis in the same region of the body or the
same or similar mental health diagnosis as the claim or claims covered
by the final settlement agreement, any monthly compensation or
permanent disability compensation payable to the worker under the
subsequent or reopened claim shall be reduced by the monetary
compensation paid to the worker under the final settlement agreement.
(ii) Proper and necessary medical treatment under RCW 51.36.010, if
indicated, shall be provided to the worker in a new claim or a reopened
claim not covered by the final settlement agreement notwithstanding the
existence of a prior final settlement agreement in another claim or
claims of the worker involving the same or similar diagnosis in the
same region of the body or the same or similar mental health diagnosis.
(c) A final settlement agreement in any claim may be used as a
defense by any employer if a worker subject to a final settlement
agreement files a subsequent new claim or an application to reopen a
claim for the same or similar diagnosis in the same region of the body
or the same or similar mental health diagnosis.
(d) As used in this subsection, "same or similar diagnosis in the
same region of the body or the same or similar mental health diagnosis"
shall be broadly construed to prevent excessive or duplicative benefits
to the worker or abuse by the worker in filing multiple or repetitious
claims for benefits.
Sec. 306 RCW 51.04.060 and 1977 ex.s. c 350 s 3 are each amended
to read as follows:
No employer or worker shall exempt himself or herself from the
burden or waive the benefits of this title by any contract, agreement,
rule or regulation, and any such contract, agreement, rule or
regulation shall be pro tanto void. However, this section does not
prohibit final settlement agreements authorized under section 305 of
this act.
Sec. 401 RCW 51.32.220 and 1982 c 63 s 19 are each amended to
read as follows:51.32 RCW)), such compensation shall be reduced by an amount equal to
the benefits payable under the federal old-age, survivors, and
disability insurance act as now or hereafter amended not to exceed the
amount of the reduction established pursuant to 42 USC 424a. However,
such reduction shall not apply when the combined compensation provided
pursuant to chapter 51.32 RCW and the federal old-age, survivors and
disability insurance act is less than the total benefits to which the
federal reduction would apply, pursuant to 42 USC 424a. Where any
person described in this section refuses to authorize the release of
information concerning the amount of benefits payable under said
federal act the department's estimate of said amount shall be deemed to
be correct unless and until the actual amount is established and no
adjustment shall be made for any period of time covered by any such
refusal.
(2) For persons who are the age of sixty-five or over receiving
compensation for temporary or permanent total disability under this
chapter on or after July 1, 2004, such compensation must be reduced by
an amount equal to the benefits payable under the disability provisions
of the federal old-age, survivors, and disability insurance act not to
exceed the amount of the reduction established pursuant to 42 U.S.C.
424a. However, the reduction does not apply when the combined
compensation provided under this chapter and the federal old-age,
survivors, and disability insurance act is less than the total benefits
to which the federal reduction would apply, pursuant to 42 U.S.C. 424a.
When a person described in this section refuses to authorize the
release of information concerning the amount of benefits payable under
the federal act, the department's estimate of the amount is deemed to
be correct unless and until the actual amount is established and no
adjustment shall be made for any period of time covered by any such
refusal.
(3) Any reduction under subsection (1) or (2) of this section shall
be effective the month following the month in which the department or
self-insurer is notified by the federal social security administration
that the person is receiving disability benefits under the federal old-age, survivors and disability insurance act: PROVIDED, That in the
event of an overpayment of benefits the department or self-insurer may
not recover more than the overpayments for the six months immediately
preceding the date the department or self-insurer notifies the worker
that an overpayment has occurred: PROVIDED FURTHER, That upon
determining that there has been an overpayment, the department or self-insurer shall immediately notify the person who received the
overpayment that he or she shall be required to make repayment pursuant
to this section and RCW 51.32.230.
(((3))) (4) Recovery of any overpayment must be taken from future
temporary or permanent total disability benefits or permanent partial
disability benefits provided by this title. In the case of temporary
or permanent total disability benefits, the recovery shall not exceed
twenty-five percent of the monthly amount due from the department or
self-insurer or one-sixth of the total overpayment, whichever is the
lesser.
(((4))) (5) No reduction may be made unless the worker receives
notice of the reduction prior to the month in which the reduction is
made.
(((5))) (6) In no event shall the reduction reduce total benefits
to less than the greater amount the worker may be entitled to under
this title or the federal old-age, survivors and disability insurance
act.
(((6))) (7) The director or self-insurer, pursuant to rules adopted
in accordance with the procedures provided in the administrative
procedure act, chapter 34.05 RCW, may exercise his discretion to waive,
in whole or in part, the amount of any overpayment where the recovery
would be against equity and good conscience.
(((7))) (8) The amendment in subsection (1) of this section by
chapter 63, Laws of 1982 raising the age limit during which the
reduction shall be made from age sixty-two to age sixty-five shall
apply with respect to workers whose effective entitlement to total
disability compensation begins after January 1, 1983.
Sec. 402 RCW 51.32.225 and 1986 c 59 s 5 are each amended to read
as follows:
(1) For persons receiving compensation for temporary or permanent
total disability under this title, the compensation shall be reduced by
the department to allow an offset for social security retirement
benefits payable under the federal social security, old age survivors,
and disability insurance act, 42 U.S.C. This reduction shall not apply
to any worker who is receiving permanent total disability benefits
prior to July 1, 1986.
(2) Reductions for social security retirement benefits under this
section shall comply with the procedures in RCW 51.32.220 (1) through
(((6))) (7), except those that relate to computation, and with any
other procedures established by the department to administer this
section.
(3) Any reduction in compensation made under chapter 58, Laws of
1986, shall be made before the reduction established in this section.
NEW SECTION. Sec. 501
(1) "Complaint" means any dissatisfaction expressed by an injured
worker concerning a workers' compensation managed care arrangement.
(2) "Grievance" means a written complaint, other than an
application for benefits, filed by the injured worker pursuant to the
requirements of the managed care arrangement, expressing
dissatisfaction with the refusal of the workers' compensation managed
care arrangement to provide health care or dissatisfaction with the
health care provided.
(3) "Health care coordinator" means a primary care provider within
a provider network who is responsible for managing the health care of
an injured worker, including determining other health care providers
and health care facilities to which the injured worker will be referred
for evaluation or treatment. A health care coordinator must be a
physician licensed under chapter 18.71 RCW, an osteopathic physician
licensed under chapter 18.57 RCW, a chiropractor licensed under chapter
18.25 RCW, or a podiatric physician licensed under chapter 18.22 RCW.
(4) "Practice parameters and protocols" means the practice
parameters and protocols of treatment adopted by the United States
agency for healthcare research and quality in effect on January 1,
2003, and any other practice parameters or protocols of treatment
applicable under this title that the director adopts by rule or policy.
(5) "Provider network" means a comprehensive panel of health care
providers and health care facilities who have contracted directly or
indirectly with a self-insurer or the department in accordance with
this chapter to provide proper and necessary medical, surgical, and
hospital care and services to injured workers as required under chapter
51.36 RCW.
(6) "Service area" means the department-approved geographic area
within which the self-insured employer or department is authorized to
offer a workers' compensation managed care arrangement.
(7) "Workers' compensation managed care arrangement" means an
arrangement under which a health care provider as defined in RCW
48.43.005, a health care facility as defined in RCW 48.43.005, a group
of health care providers, a health carrier regulated under chapter
48.20 or 48.21 RCW, a health care service contractor registered under
chapter 48.44 RCW, or a health maintenance organization registered
under chapter 48.46 RCW has entered into a written agreement directly
or indirectly with a self-insured employer or the department to provide
and to manage proper and necessary medical, surgical, and hospital care
and services to injured workers in accordance with this title.
NEW SECTION. Sec. 502
(2)(a) The department shall authorize a self-insured employer to
offer or use a workers' compensation managed care arrangement after:
(i) The self-insurer files a completed application along with the
payment of a one thousand dollar application fee;
(ii) The department is satisfied that the self-insurer has the
ability to provide quality of care consistent with the prevailing
professional standards of care; and
(iii) The self-insurer and its workers' compensation managed care
arrangement otherwise meet the requirements of this chapter.
(b) No self-insurer may offer or use a managed care arrangement in
this state without department authorization required by this section.
The authorization, unless sooner suspended or revoked, automatically
expires two years after the date of issuance unless renewed by the
self-insurer. The authorization shall be renewed upon application for
renewal and payment of a renewal fee of one thousand dollars, provided
that the self-insurer is in compliance with this section and any rules
adopted hereunder. An application for renewal of the authorization
shall be made ninety days before expiration of the authorization on
forms provided by the department. The renewal application shall not
require the resubmission of any documents previously filed with the
department if such documents have remained valid and unchanged since
their original filing.
NEW SECTION. Sec. 503
(2) A self-insurer must file a proposed managed care plan of
operation with the department in a format prescribed by the department.
The plan of operation must contain evidence that all covered services
are available and accessible, including a demonstration that:
(a) The covered services can be provided with reasonable promptness
with respect to geographic location, hours of operation, and after-hour
care. The hours of operation must reflect usual practice in the local
area. Geographic availability must reflect the usual travel times with
the community;
(b) Unless the department determines that insufficient numbers of
providers are available, the number of providers in the workers'
compensation managed care arrangement service area is sufficient, with
respect to current and expected workers to be serviced by the
arrangement, either:
(i) By delivery of all required health care services; or
(ii) Through the ability to make appropriate referrals within the
provider network;
(c) Written agreements are entered into with providers describing
specific responsibilities and prohibiting providers from billing or
otherwise seeking reimbursement from or recourse against any injured
worker for covered services; and
(d) Emergency care is available twenty-four hours a day and seven
days a week.
(3) The proposed managed care plan of operation must include:
(a) A statement or map providing a clear description of the service
area;
(b) A description of the grievance procedure to be used;
(c) A description of the quality assurance program that assures
that the health care services provided to workers shall be rendered
under reasonable standards of quality of care consistent with the
prevailing standards of medical practice in the medical community. The
program shall include, but not be limited to:
(i) A written statement of goals and objectives that stresses
health and return-to-work outcomes as the principal criteria for the
evaluation of the quality of care rendered to injured workers;
(ii) A written statement describing how methodology has been
incorporated into an ongoing system for monitoring of care that is
individual care oriented and, when implemented, can provide
interpretation and analysis of patterns of care rendered to individual
patients by individual providers;
(iii) Written procedures for taking appropriate remedial action
whenever, as determined under the quality assurance program,
inappropriate or substandard services have been provided or services
that should have been furnished have not been provided;
(iv) A written plan, that includes ongoing review, for providing
review of physicians and other licensed health care providers;
(v) Appropriate financial incentives to reduce service costs and
utilization without sacrificing the quality of service;
(vi) Adequate methods of peer review and utilization review. The
utilization review process shall include a health care facility's
precertification mechanism, including, but not limited to, all elective
admissions and nonemergency surgeries and adherence to practice
parameters and protocols established under this chapter;
(vii) Provisions for resolution of disputes arising between a
health care provider and a self-insurer regarding reimbursements and
utilization review;
(viii) Availability of process for aggressive health care
coordination, as well as a program involving cooperative efforts by the
workers, the employer, and the workers' compensation managed care
arrangement to promote early return to work for injured workers;
(ix) A provision for the selection of a primary care provider by
the employee from among primary providers in the provider network; and
(x) The written information proposed to be used by the self-insurer
to comply with (e) of this subsection;
(d) Written procedures to provide the self-insurer with timely
medical records and information including, but not limited to, work
status, work restrictions, date of maximum medical improvement,
permanent impairment ratings, and other information as required,
including information demonstrating compliance with the practice
parameters and protocols of treatment established under this chapter;
(e) Evidence that appropriate health care providers and
administrative staff of the self-insurer's workers' compensation
managed care arrangement have received training and education on the
provisions of this chapter; the administrative rules that govern the
provision of proper and necessary medical, surgical, and hospital care
and services to injured workers; and the practice parameters and
protocols of treatment established under this chapter;
(f) Written procedures and methods to prevent inappropriate or
excessive treatment that are in accordance with the practice parameters
and protocols of treatment established under this chapter;
(g) Written procedures and methods for the management of an injured
worker's health care by a health care coordinator including:
(i) The mechanism for assuring that covered employees receive all
initial covered services from a primary care provider participating in
the provider network, except for emergency care;
(ii) The mechanism for assuring that all continuing covered
services be received from the same primary care provider participating
in the provider network that provided the initial covered services,
except when services from another provider are authorized by the health
care coordinator pursuant to (g)(iv) of this subsection;
(iii) The policies and procedures for allowing an employee to
change to another provider within the provider network as the
authorized treating physician during the course of treatment for a
work-related injury in accordance with rules adopted under RCW
51.36.010;
(iv) The process for assuring that all referrals authorized by a
health care coordinator, in accordance with the practice parameters and
protocols of treatment established under this chapter, are made to the
participating network providers, unless proper and necessary medical,
surgical, and hospital care and services are not available and
accessible to the injured worker in the provider network; and
(v) Assignment of a health care coordinator licensed under chapter
18.71 RCW to manage care by physicians licensed under chapter 18.71
RCW, a health care coordinator licensed under chapter 18.57 RCW to
manage care by osteopathic physicians licensed under chapter 18.57 RCW,
a health care coordinator licensed under chapter 18.25 RCW to manage
care by chiropractors licensed under chapter 18.25 RCW, on an injured
worker's request for care by any of the listed providers; and
(h) A description of the use of workers' compensation practice
parameters and protocols of treatment for health care services.
(4) A self-insured employer must file any proposed changes to the
plan of operation, except for changes in the list of health care
providers, with the department before implementing the changes. The
changes are considered approved forty-five days after filing unless
specifically disapproved by the department within the forty-five day
period.
NEW SECTION. Sec. 504 (1) Before the department may offer or use
a workers' compensation managed care arrangement in this state, the
department must develop a managed care plan of operation that meets the
requirements of the plan of operation required under section 503 of
this act, and must provide a period of at least thirty days for public
review and comment before implementing the plan or any changes to the
plan, except for changes to the list of health care providers.
(2) The department must develop a plan under which retrospective
rating plan employers and retrospective rating plan groups would be
authorized to contract for workers' compensation managed care
arrangements. The proposal must include the requirements that the
retrospective rating plan employer or group must meet to qualify for a
workers' compensation managed care arrangement and the responsibilities
and rights of both employers and employees under the arrangement. The
plan must be developed within one year after the effective date of this
section and, thereafter, must be implemented through the adoption of
rules.
NEW SECTION. Sec. 505
(1) A description, including address and telephone number, of the
network providers, including primary care physicians, specialty
physicians, hospitals, and other health care providers;
(2) A description of the coverage for emergency and urgently needed
care provided within and outside the service area;
(3) A description of limitations on referrals; and
(4) A description of the grievance process.
NEW SECTION. Sec. 506
(2) The grievance procedures must be described in writing and
provided to the affected workers and health care providers.
(3) At the time that the workers' compensation managed care
arrangement is implemented, the self-insurer or the department, as the
case may be, must provide detailed information to workers and health
care providers describing the manner in which a grievance may be filed
with the self-insured employer or department.
(4) Grievances must be considered in a timely manner and must be
transmitted to appropriate decision makers who have the authority to
investigate the issues fully and take corrective action.
(5) If a grievance is found to be valid, corrective action must be
taken promptly.
(6) All concerned parties must be notified of the results of a
grievance.
NEW SECTION. Sec. 507
(2) When a self-insurer or the department enters into a managed
care arrangement under this chapter, the employees who are covered by
the provision of such arrangement shall be deemed to have received all
the benefits to which they are entitled pursuant to chapter 51.36 RCW.
In addition, the employer and the department shall be deemed to have
complied completely with the requirements of such provisions. The
provisions governing managed care arrangements shall govern exclusively
unless specifically stated otherwise in this title.
NEW SECTION. Sec. 508
(a) The self-insurer or its managed care contractor is in
substantial violation of its contracts;
(b) The self-insurer or its managed care contractor is unable to
fulfill its obligations under outstanding managed care arrangement
contracts;
(c) The self-insurer or managed care contractor knowingly uses a
provider who is furnishing or has furnished health care services
without having an existing license or other authority to practice or
furnish health care services in this state;
(d) The self-insurer no longer meets the requirements for
authorization as originally issued; or
(e) The self-insurer has violated any provision of this chapter or
rule or order of the director adopted under this chapter.
(2) Revocation of a self-insurer's authorization under this chapter
shall be for a period of two years. After two years, the self-insurer
may apply for a new authorization by complying with all requirements
applicable to first-time applicants.
(3) Suspension of a self-insurer's authority to offer a workers'
compensation managed care arrangement shall be for a period, not to
exceed one year, as is fixed by the director. The director shall, in
his or her order suspending the authority of a self-insurer to offer
workers' compensation managed care, specify the period during which the
suspension is to be in effect and the conditions, if any, that must be
met by the self-insurer before reinstatement of its authority. The
order of suspension is subject to rescission or modification by further
order of the director before the expiration of the suspension period.
Reinstatement shall not be made unless requested by the self-insurer.
However, the director shall not grant reinstatement if he or she finds
that the circumstances for which the suspension occurred still exist or
are likely to recur.
(4) Upon expiration of the suspension period, the self-insurer's
authorization shall automatically be reinstated unless the director
finds before the expiration that the causes of the suspension have not
been rectified or that the self-insurer is otherwise not in compliance
with the requirements of this chapter. If not so automatically
reinstated, the authorization shall be deemed to have expired as of the
end of the suspension period.
(5) If the director finds that one or more grounds exist for the
revocation or suspension of an authorization issued under this section,
the director may, in lieu of such revocation or suspension, impose a
fine upon the self-insurer as follows:
(a) With respect to a nonwillful violation, the fine may not exceed
two thousand five hundred dollars for each such violation. A fine may
not exceed an aggregate amount of ten thousand dollars for all
nonwillful violations arising out of the same action; or
(b) With respect to a knowing and willful violation, the fine may
not exceed twenty thousand dollars for each such violation. A fine may
not exceed an aggregate amount of one hundred thousand dollars for all
knowing and willful violations arising out of the same action.
NEW SECTION. Sec. 509
(1) Procedures for authorization and examination of workers'
compensation managed care arrangements by the department;
(2) Requirements and procedures for authorization of workers'
compensation arrangement provider networks and procedures for the
department to grant exceptions from accessibility of services;
(3) Requirements and procedures for case management, utilization
management, and peer review;
(4) Requirements and procedures for quality assurance and medical
records;
(5) Requirements and procedures for dispute resolution in
conformance with this chapter;
(6) Requirements and procedures for employee and provider
education; and
(7) Requirements and procedures for reporting data regarding
grievances, return-to-work outcomes, and provider networks.
Sec. 510 RCW 51.36.110 and 1994 c 154 s 312 are each amended to
read as follows:
(1) The director of the department of labor and industries or the
director's authorized representative shall have the authority to:
(((1))) (a) Conduct audits and investigations of providers of
medical, chiropractic, dental, vocational, and other health services
furnished to industrially injured workers pursuant to Title 51 RCW to
determine whether providers are: (i) Complying with this title and the
rules adopted under this title; (ii) engaging in overutilization; (iii)
engaging in improper billing practices; and (iv) adhering to practice
parameters and protocols of treatment established under this title. In
the conduct of such audits or investigations, the director or the
director's authorized representatives may examine all records, or
portions thereof, including patient records, for which services were
rendered by a health services provider and reimbursed by the
department, notwithstanding the provisions of any other statute which
may make or purport to make such records privileged or confidential:
PROVIDED, That no original patient records shall be removed from the
premises of the health services provider, and that the disclosure of
any records or information obtained under authority of this section by
the department of labor and industries is prohibited and constitutes a
violation of RCW 42.52.050, unless such disclosure is directly
connected to the official duties of the department: AND PROVIDED
FURTHER, That the disclosure of patient information as required under
this section shall not subject any physician or other health services
provider to any liability for breach of any confidential relationships
between the provider and the patient: AND PROVIDED FURTHER, That the
director or the director's authorized representative shall destroy all
copies of patient medical records in their possession upon completion
of the audit, investigation, or proceedings;
(((2))) (b) Approve or deny applications to participate as a
provider of services furnished to industrially injured workers pursuant
to Title 51 RCW; and
(((3))) (c) Terminate or suspend eligibility to participate as a
provider of services furnished to industrially injured workers pursuant
to Title 51 RCW.
(2)(a) If the department finds that a health services provider has
improperly billed, overutilized, or failed to comply with rules adopted
under this title, including but not limited to practice parameters and
protocols established under this title, it must notify the provider of
its findings and may determine that the health services provider may
not receive payment from the department or self-insured employer, as
the case may be, or may impose penalties as provided in RCW 51.48.080.
(b) If a health services provider has received payment from the
department or self-insured employer for services that were improperly
billed, that constitute overutilization, or that were outside the
practice parameters or protocols established under this title, the
provider must repay those amounts to the department or self-insurer, as
the case may be. The department may assess a penalty of up to five
hundred dollars for each overpayment that is not refunded within thirty
days after notification of overpayment by the department.
(c) For the purposes of this subsection, "overutilization" means
providing an inappropriate health service or level of service to an
injured worker, including but not limited to providing treatment in
excess of established practice parameters and protocols of treatment
established under this title.
NEW SECTION. Sec. 511 A new section is added to chapter 51.36
RCW to read as follows:
(1)(a) Abnormal anatomical findings alone, in the absence of
objective relevant medical findings, shall not be an indicator of
injury or illness, a justification for the provision of curative or
rehabilitative medical care or the assignment of restrictions, or a
foundation for limitations.
(b) At all times during evaluation and treatment, the health
services provider shall act on the premise that returning to work is an
integral part of the treatment plan. The goal of removing all
restrictions and limitations as early as appropriate shall be part of
the treatment plan on a continuous basis. The assignment of
restrictions and limitations shall be reviewed with each patient
examination and upon receipt of new information, such as progress
reports from physical therapists and other health services providers.
Consideration shall be given to upgrading or removing the restrictions
and limitations with each patient examination, based upon the presence
or absence of objective relevant medical findings.
(c) Reasonable proper and necessary medical care of injured
employees shall in all situations:
(i) Use a high intensity, short duration treatment approach that
focuses on early activation and restoration of function whenever
possible.
(ii) Include reassessment of the treatment plans, regimes,
therapies, prescriptions, and functional limitations or restrictions
prescribed by the provider every thirty days.
(iii) Be focused on treatment of the individual employee's specific
clinical dysfunction or status and shall not be based upon nondescript
diagnostic labels.
(2) All treatment shall be inherently scientifically logical and
the evaluation or treatment procedure must match the documented
physiologic and clinical problem. Treatment shall match the type,
intensity, and duration of service required by the problem identified.
Sec. 512 RCW 51.36.010 and 1986 c 58 s 6 are each amended to read
as follows:, but the same shall be limited in point
of duration as follows:)).
(a) The duration of medical and surgical services is limited as
provided in this subsection:
(i) In the case of permanent partial disability, services may not
((to)) extend beyond the date when compensation shall be awarded him or
her, except when the worker returned to work before permanent partial
disability award is made, in such case services may not ((to)) extend
beyond the time when monthly allowances to him or her shall cease;
(ii) In case of temporary disability services may not ((to)) extend
beyond the time when monthly allowances to him or her shall cease:
PROVIDED, That after any injured worker has returned to his or her work
his or her medical and surgical treatment may be continued if, and so
long as, such continuation is deemed necessary by the supervisor of
industrial insurance to be necessary to his or her more complete
recovery;
(iii) In case of a permanent total disability services may not
((to)) extend beyond the date on which a lump sum settlement is made
with him or her or he or she is placed upon the permanent pension roll:
PROVIDED, HOWEVER, That the supervisor of industrial insurance, solely
in his or her discretion, may authorize continued medical and surgical
treatment for conditions previously accepted by the department when
such medical and surgical treatment is deemed necessary by the
supervisor of industrial insurance to protect such worker's life or
provide for the administration of medical and therapeutic measures
including payment of prescription medications, but not including those
controlled substances currently scheduled by the state board of
pharmacy as Schedule I, II, III, or IV substances under chapter 69.50
RCW, which are necessary to alleviate continuing pain which results
from the industrial injury. In order to authorize such continued
treatment the written order of the supervisor of industrial insurance
issued in advance of the continuation shall be necessary.
(b) The choice of attending physician is limited as provided in
this subsection:
(i) If an injured worker is covered through a workers' compensation
managed care arrangement as provided in chapter 51.-- RCW (sections 501
through 509 of this act), the worker must select a primary care
provider from among the primary care providers in the provider network
as prescribed in the managed care contract; and
(ii) A physician who is not an attending physician may not: (A)
Authorize payment of temporary disability compensation; or (B) make
ratings regarding the worker's impairment for the purpose of evaluating
the worker's disability unless requested by the department or the
employer.
(2) The supervisor of industrial insurance, the supervisor's
designee, or a self-insurer, in his or her sole discretion, may
authorize inoculation or other immunological treatment in cases in
which a work-related activity has resulted in probable exposure of the
worker to a potential infectious occupational disease. Authorization
of such treatment does not bind the department or self-insurer in any
adjudication of a claim by the same worker or the worker's beneficiary
for an occupational disease.
NEW SECTION. Sec. 513 A new section is added to chapter 51.32
RCW to read as follows:
(a) Schedule medical examinations and consultations under RCW
51.36.070, using only providers from the department's approved provider
list; and
(b) Initiate vocational and other rehabilitation services under RCW
51.32.095, using only providers from the department's approved provider
list. Vocational and other rehabilitation services may include job
placement services, vocational rehabilitation plans, or other accepted
services.
(2) Within one hundred twenty days after the effective date of this
section, the department shall adopt rules to implement the specific
requirements of this section, including the following:
(a) The rules may require notification to the department before the
employer or retrospective rating plan group exercises authority under
this section, but the rules must minimize the department's need to
respond and must ensure that a failure to respond or a delay in
response by the department does not impede the timely administration of
the claim.
(b) The rules may not require that: (i) A medical examination be
performed by the worker's attending physician or other treating
provider; or (ii) a consultation referral be requested from the
worker's attending physician or other treating provider before
scheduling a provider for a medical examination.
(c) The rules must establish qualifications for authorized claims
administrators and require an authorized claims administrator to
demonstrate, in a manner satisfactory to the department, a thorough
knowledge of the industrial insurance laws, and an expertise in
processing claims as authorized under this section. The rules must
also establish procedures for approval and disapproval of authorized
claims administrators. This section does not permit the department to
establish requirements for authorized claims administrators that exceed
the requirements for state fund claims administrators.
(3) This section applies to all claims regardless of the date of
injury.
(4) For purposes of this section, "authorized claims administrator"
means a person who is approved by the department as meeting the
qualifications established by rule under subsection (2)(c) of this
section.
Sec. 601 RCW 51.44.010 and 1961 c 23 s 51.44.010 are each amended
to read as follows:.))" for the benefit of employers and employees subject to this
title. All receipts from premiums owed under RCW 51.16.060 must be
deposited in the accident fund. Expenditures from the accident fund
may be used only for the payment of compensation, vocational
rehabilitation, death benefits, funeral expenses, like benefits for
loss sustained on account of injury, disease, or death provided for by
this title, administration of this title, and debt service for capital
improvements related to the state fund, and may not be used for any
other purpose. Only the director or the director's designee may
authorize expenditures from the accident fund for such benefits.
Consistent with RCW 43.88.180, money in the accident fund may be spent
for the administration of this title and debt service for capital
improvements related to the state fund only after appropriation.
(2) The legislature declares that it is in the best interest of the
state, the employers and employees subject to Title 51 RCW, and the
owners and holders of the bonds issued by the state for capital
improvements related to the state fund to specify and thereby limit the
purposes for which expenditures from the accident fund may be used. It
is the intent of the legislature in this section to specify and thereby
limit the purposes for which expenditures from the accident fund may be
used. The legislature does not intend to diminish in any way the
current obligations of the state or diminish in any way the rights of
owners and holders of the bonds issued by the state for capital
improvements related to the state fund.
Sec. 602 RCW 51.44.020 and 1961 c 23 s 51.44.020 are each amended
to read as follows:.))" for the benefit of employers and employees subject to this
title. All receipts from premiums owed under RCW 51.16.060 must be
deposited in the medical aid fund. Expenditures from the medical aid
fund may be used only for the payment of medical aid and like benefits
for loss sustained on account of injury, disease, or death provided for
by this title, administration of this title, and debt service for
capital improvements related to the state fund, and may not be used for
any other purpose. Only the director or the director's designee may
authorize expenditures from the medical aid fund for such benefits.
Consistent with RCW 43.88.180, money in the medical aid fund may be
spent for the administration of this title and debt service for capital
improvements related to the state fund only after appropriation.
(2) The legislature declares that it is in the best interest of the
state, the employers and employees subject to Title 51 RCW, and the
owners and holders of the bonds issued by the state for capital
improvements related to the state fund to specify and thereby limit the
purposes for which expenditures from the medical aid fund may be used.
It is the intent of the legislature in this section to specify and
thereby limit the purposes for which expenditures from the medical aid
fund may be used. The legislature does not intend to diminish in any
way the current obligations of the state or diminish in any way the
rights of owners and holders of the bonds issued by the state for
capital improvements related to the state fund.
Sec. 603 RCW 43.84.092 and 2003 c 361 s 602, 2003 c 324 s 1, 2003
c 150 s 2, and 2003 c 48 s 2 are each reenacted and amended to read as
follows:
(1) All earnings of investments of surplus balances in the state
treasury shall be deposited to the treasury income account, which
account is hereby established in the state treasury.
(2) The treasury income account shall be utilized to pay or receive
funds associated with federal programs as required by the federal cash
management improvement act of 1990. The treasury income account is
subject in all respects to chapter 43.88 RCW, but no appropriation is
required for refunds or allocations of interest earnings required by
the cash management improvement act. Refunds of interest to the
federal treasury required under the cash management improvement act
fall under RCW 43.88.180 and shall not require appropriation. The
office of financial management shall determine the amounts due to or
from the federal government pursuant to the cash management improvement
act. The office of financial management may direct transfers of funds
between accounts as deemed necessary to implement the provisions of the
cash management improvement act, and this subsection. Refunds or
allocations shall occur prior to the distributions of earnings set
forth in subsection (4) of this section.
(3) Except for the provisions of RCW 43.84.160, the treasury income
account may be utilized for the payment of purchased banking services
on behalf of treasury funds including, but not limited to, depository,
safekeeping, and disbursement functions for the state treasury and
affected state agencies. The treasury income account is subject in all
respects to chapter 43.88 RCW, but no appropriation is required for
payments to financial institutions. Payments shall occur prior to
distribution of earnings set forth in subsection (4) of this section.
(4) Monthly, the state treasurer shall distribute the earnings
credited to the treasury income account. The state treasurer shall
credit the general fund with all the earnings credited to the treasury
income account except:
(a) The following accounts and funds shall receive their
proportionate share of earnings based upon each account's and fund's
average daily balance for the period: The accident account, the
accident reserve account, the capitol building construction account,
the Cedar River channel construction and operation account, the Central
Washington University capital projects account, the charitable,
educational, penal and reformatory institutions account, the common
school construction fund, the county criminal justice assistance
account, the county sales and use tax equalization account, the data
processing building construction account, the deferred compensation
administrative account, the deferred compensation principal account,
the department of retirement systems expense account, the drinking
water assistance account, the drinking water assistance administrative
account, the drinking water assistance repayment account, the Eastern
Washington University capital projects account, the education
construction fund, the election account, the emergency reserve fund,
The Evergreen State College capital projects account, the federal
forest revolving account, the health services account, the public
health services account, the health system capacity account, the
personal health services account, the state higher education
construction account, the higher education construction account, the
highway infrastructure account, the industrial insurance premium refund
account, the judges' retirement account, the judicial retirement
administrative account, the judicial retirement principal account, the
local leasehold excise tax account, the local real estate excise tax
account, the local sales and use tax account, the medical aid account,
the mobile home park relocation fund, the multimodal transportation
account, the municipal criminal justice assistance account, the
municipal sales and use tax equalization account, the natural resources
deposit account, the oyster reserve land account, the perpetual
surveillance and maintenance account, the public employees' retirement
system plan 1 account, the public employees' retirement system combined
plan 2 and plan 3 account, the public facilities construction loan
revolving account beginning July 1, 2004, the public health
supplemental account, the public works assistance account, the Puyallup
tribal settlement account, the regional transportation investment
district account, the resource management cost account, the second
injury account, the self-insurers' insolvency trust account, the site
closure account, the special wildlife account, the state employees'
insurance account, the state employees' insurance reserve account, the
state investment board expense account, the state investment board
commingled trust fund accounts, the supplemental pension account, the
Tacoma Narrows toll bridge account, the teachers' retirement system
plan 1 account, the teachers' retirement system combined plan 2 and
plan 3 account, the tobacco prevention and control account, the tobacco
settlement account, the transportation infrastructure account, the
tuition recovery trust fund, the University of Washington bond
retirement fund, the University of Washington building account, the
volunteer fire fighters' and reserve officers' relief and pension
principal fund, the volunteer fire fighters' and reserve officers'
administrative fund, the Washington fruit express account, the
Washington judicial retirement system account, the Washington law
enforcement officers' and fire fighters' system plan 1 retirement
account, the Washington law enforcement officers' and fire fighters'
system plan 2 retirement account, the Washington school employees'
retirement system combined plan 2 and 3 account, the Washington state
health insurance pool account, the Washington state patrol retirement
account, the Washington State University building account, the
Washington State University bond retirement fund, the water pollution
control revolving fund, and the Western Washington University capital
projects account. Earnings derived from investing balances of the
agricultural permanent fund, the normal school permanent fund, the
permanent common school fund, the scientific permanent fund, and the
state university permanent fund shall be allocated to their respective
beneficiary accounts. All earnings to be distributed under this
subsection (4)(a) shall first be reduced by the allocation to the state
treasurer's service fund pursuant to RCW 43.08.190.
(b) The following accounts and funds shall receive eighty percent
of their proportionate share of earnings based upon each account's or
fund's average daily balance for the period: The aeronautics account,
the aircraft search and rescue account, the county arterial
preservation account, the department of licensing services account, the
essential rail assistance account, the ferry bond retirement fund, the
grade crossing protective fund, the high capacity transportation
account, the highway bond retirement fund, the highway safety account,
the motor vehicle fund, the motorcycle safety education account, the
pilotage account, the public transportation systems account, the Puget
Sound capital construction account, the Puget Sound ferry operations
account, the recreational vehicle account, the rural arterial trust
account, the safety and education account, the special category C
account, the state patrol highway account, the transportation 2003
account (nickel account), the transportation equipment fund, the
transportation fund, the transportation improvement account, the
transportation improvement board bond retirement account, and the urban
arterial trust account.
(5) In conformance with Article II, section 37 of the state
Constitution, no treasury accounts or funds shall be allocated earnings
without the specific affirmative directive of this section.
Sec. 604 RCW 28B.20.458 and 1969 ex.s. c 223 s 28B.20.458 are
each amended to read as follows:
The University of Washington may accept and administer loans,
grants, funds, or gifts, conditional or otherwise, in furtherance of
the objects and purposes of RCW 28B.20.450 through 28B.20.458, from the
federal government and from other sources public or private. ((For the
purpose of securing payment from the accident fund and medical aid fund
as funds are required, vouchers shall be presented to the department of
labor and industries.))
NEW SECTION. Sec. 605 RCW 51.16.042 (Occupational and
environmental research facility) and 1977 ex.s. c 350 s 25, 1971 ex.s.
c 289 s 84, & 1963 c 151 s 2 are each repealed.
Sec. 701 RCW 51.32.210 and 1977 ex.s. c 350 s 55 are each amended
to read as follows:
(1) Claims of injured workers of employers who have secured the
payment of compensation by insuring with the department shall be
promptly acted upon by the department. The department must enter an
order allowing or denying a claim within ninety days from the date that
the claim is filed with the department.
(2) Where temporary disability compensation is payable, the first
payment thereof shall be mailed within fourteen days after receipt of
the claim at the department's offices in Olympia and shall continue at
regular semimonthly intervals. The payment of this or any other
benefits under this title, prior to the entry of an order by the
department in accordance with RCW 51.52.050 as now or hereafter
amended, shall be not considered a binding determination of the
obligations of the department under this title. The acceptance of
compensation by the worker or his or her beneficiaries prior to such
order shall likewise not be considered a binding determination of their
rights under this title.
NEW SECTION. Sec. 702 A new section is added to chapter 51.32
RCW to read as follows:
The department may purchase services by contract from individuals,
nonprofit organizations, or businesses to provide services with respect
to any aspect of managing industrial insurance claims filed with the
state fund under this title.
Sec. 703 RCW 41.06.380 and 2003 c 363 s 104 are each amended to
read as follows:
(((1))) Nothing contained in this chapter ((shall)) prohibits:
(1) Any department, as defined in RCW 41.06.020, from purchasing
services by contract with individuals or business entities if such
services were regularly purchased by valid contract by such department
prior to April 23, 1979: PROVIDED, That no such contract may be
executed or renewed if it would have the effect of terminating
classified employees or classified employee positions existing at the
time of the execution or renewal of the contract.
(2) ((Nothing contained in this chapter prohibits)) The department
of transportation from purchasing construction services or construction
engineering services, as those terms are defined in RCW 47.28.241, by
contract from qualified private businesses as specified in RCW
47.28.251(2).
(3) The department of labor and industries from purchasing services
by contract from individuals, nonprofit organizations, or business
entities to provide services with respect to any aspect of managing
industrial insurance claims filed with the state fund under Title 51
RCW.
Sec. 801 RCW 51.52.050 and 1987 c 151 s 1 are each amended to
read as follows:: PROVIDED,
That)). However, a department order or decision making demand, whether
with or without penalty, for repayment of sums paid to a provider of
medical, dental, vocational, or other health services rendered to an
industrially injured worker, shall state that such order or decision
shall become final within twenty days from the date the order or
decision is communicated to the parties unless a written request for
reconsideration is filed with the department of labor and industries,
Olympia, or an appeal is filed with the board of industrial insurance
appeals, Olympia.
(2)(a) Except as provided in section 305 of this act, whenever the
department has taken any action or made any decision relating to any
phase of the administration of this title the worker, beneficiary,
employer, or other person aggrieved thereby may request reconsideration
of the department((,)) or may appeal to the board. If an employer
requests reconsideration of a department order in favor of an injured
worker, temporary total disability compensation or medical aid benefits
granted to the worker by the order under reconsideration are suspended
while the reconsideration is pending.
(b) In an appeal before the board, the appellant shall have the
burden of proceeding with the evidence to establish a prima facie case
for the relief sought in such appeal((: PROVIDED, That)). However, in
an appeal from an order of the department that alleges fraud, the
department or self-insured employer shall initially introduce all
evidence in its case in chief.
(c) Any ((such)) person aggrieved by the decision and order of the
board may thereafter appeal to the superior court, as prescribed in
this chapter.
(3) When a provider files with the board an appeal from an order
terminating the provider's authority to provide services related to the
treatment of industrially injured workers, the department may petition
the board for an order immediately suspending the provider's
eligibility to participate as a provider of services to industrially
injured workers under this title pending the final disposition of the
appeal by the board. The board shall grant the petition if it
determines that there is good cause to believe that workers covered
under this title may suffer serious physical or mental harm if the
petition is not granted. The board shall expedite the hearing of the
department's petition under this subsection.
Sec. 802 RCW 51.52.060 and 1995 c 253 s 1 and 1995 c 199 s 7 are
each reenacted and amended to read as follows:
(b) Failure to file a notice of appeal with both the board and the
department shall not be grounds for denying the appeal if the notice of
appeal is filed with either the board or the department.
(2) Within ten days of the date on which an appeal has been granted
by the board, the board shall notify the other interested parties to
the appeal of the receipt of the appeal and shall forward a copy of the
notice of appeal to the other interested parties. Within twenty days
of the receipt of such notice of the board, the worker or the employer
may file with the board a cross-appeal from the order of the department
from which the original appeal was taken.
(3) If within the time limited for filing a notice of appeal to the
board from an order, decision, or award of the department, the
department directs the submission of further evidence or the
investigation of any further fact, the time for filing the notice of
appeal shall not commence to run until the person has been advised in
writing of the final decision of the department in the matter. In the
event the department directs the submission of further evidence or the
investigation of any further fact, as provided in this section, the
department shall render a final order, decision, or award within ninety
days from the date further submission of evidence or investigation of
further fact is ordered ((which time period may be extended by the
department for good cause stated in writing to all interested parties
for an additional ninety days)).
(4) The department, either within the time limited for appeal, or
within thirty days after receiving a notice of appeal, may:
(a) Modify, reverse, or change any order, decision, or award; or
(b)(i) Except as provided in (b)(ii) of this subsection, hold an
order, decision, or award in abeyance for a period of ninety days
((which time period may be extended by the department for good cause
stated in writing to all interested parties for an additional ninety
days pending further investigation in light of the allegations of the
notice of appeal)); or
(ii) Hold an order, decision, or award issued under RCW 51.32.160
in abeyance for a period not to exceed ninety days from the date of
receipt of an application under RCW 51.32.160. ((The department may
extend the ninety-day time period for an additional sixty days for good
cause.))
For purposes of this subsection, good cause includes delay that
results from conduct of the claimant that is subject to sanction under
RCW 51.32.110.
The board shall deny the appeal upon the issuance of an order under
(b)(i) or (ii) of this subsection holding an earlier order, decision,
or award in abeyance, without prejudice to the appellant's right to
appeal from any subsequent determinative order issued by the
department.
This subsection (4)(b) does not apply to applications deemed
granted under RCW 51.32.160.
(5) An employer shall have the right to appeal an application
deemed granted under RCW 51.32.160 on the same basis as any other
application adjudicated pursuant to that section.
(6) ((A provision of this section shall not be deemed to change,
alter, or modify the practice or procedure of the department for the
payment of awards pending appeal.)) If an employer appeals to the
board a department order granting temporary total disability
compensation or medical aid benefits to a worker, the payment of
compensation or medical aid benefits granted to the worker by the order
under appeal are suspended while the appeal is pending before the
board.
Sec. 803 RCW 51.52.132 and 1965 ex.s. c 63 s 2 are each amended
to read as follows:Where the department, the board or
the court, pursuant to RCW 51.52.120 or 51.52.130 fixes the attorney's
fee, it shall be)) (1) It is unlawful for an attorney engaged in the
representation of any worker or beneficiary to charge or receive any
fee for services rendered in connection with securing benefits under
this title in excess of ((that)) the lesser of:
(a) Twenty percent of the compensation awarded under chapter 51.32
RCW; or
(b) The amount fixed by the department, board, or the court under
RCW 51.52.120.
(2) Any person who violates any provision of this section ((shall
be)):
(a) Is guilty of a misdemeanor; and
(b) From the date of conviction under (a) of this subsection, may
not engage in the representation for a fee of a worker or beneficiary
in connection with securing benefits under this title.
Sec. 804 RCW 51.52.120 and 2003 c 53 s 285 are each amended to
read as follows:It shall be unlawful for an
attorney engaged in the representation of any worker or beneficiary to
charge for services in the department any fee in excess of a reasonable
fee, of not more than thirty percent of the increase in the award
secured by the attorney's services. Such reasonable fee shall be fixed
by)) For services rendered before the department in connection with
securing benefits under this title, the director or the director's
designee shall fix a reasonable fee, subject to RCW 51.52.132, for
services performed by an attorney for ((such)) a worker or beneficiary,
if written application therefor is made by the attorney, worker, or
beneficiary within one year from the date the final decision and order
of the department is communicated to the party making the application.
(2)(a) If, on appeal to the board, the order, decision, or award of
the department is reversed or modified and additional relief is granted
to a worker or beneficiary, or in cases where a party other than the
worker or beneficiary is the appealing party and the worker's or
beneficiary's right to relief is sustained by the board, the board
shall fix a reasonable fee, subject to RCW 51.52.132, for the services
of ((his or her)) the worker's or beneficiary's attorney in proceedings
before the board if written application therefor is made by the
attorney, worker, or beneficiary within one year from the date the
final decision and order of the board is communicated to the party
making the application.
(b) In fixing the ((amount of such attorney's)) fee, the board
shall take into consideration the fee ((allowed)), if any, fixed by the
director or the director's designee, for the attorney's services before
the department, and the board may review the fee fixed by the director
or the director's designee.
(3)(a) If, on appeal to the superior or appellate court from the
decision and order of the board, the decision and order is reversed or
modified and additional relief is granted to a worker or beneficiary,
or in cases where a party other than the worker or beneficiary is the
appealing party and the worker's or beneficiary's right to relief is
sustained, the court shall fix a reasonable fee, subject to RCW
51.52.132, for the services before the court of the worker's or
beneficiary's attorney.
(b) In fixing the fee, the court shall take into consideration the
fee or fees, if any, fixed by the director or the director's designee
or the board for the attorney's services before the department and the
board under subsections (1) and (2) of this section.
(4) Any attorney's fee ((set)) fixed by the ((department)) director
or the director's designee or the board may be reviewed by the superior
court upon application of such attorney, worker, or beneficiary. The
department or self-insured employer, as the case may be, shall be
served a copy of the application and shall be entitled to appear and
take part in the proceedings. ((Where the board, pursuant to this
section, fixes the attorney's fee, it shall be unlawful for an attorney
to charge or receive any fee for services before the board in excess of
that fee fixed by the board.))
(3) Any person who violates this section is guilty of a
misdemeanor.
Sec. 805 RCW 51.52.130 and 1993 c 122 s 1 are each amended to
read as follows:If, on
appeal to the superior or appellate court from the decision and order
of the board, said decision and order is reversed or modified and
additional relief is granted to a worker or beneficiary, or in cases
where a party other than the worker or beneficiary is the appealing
party and the worker's or beneficiary's right to relief is sustained,
a reasonable fee for the services of the worker's or beneficiary's
attorney shall be fixed by the court. In fixing the fee the court
shall take into consideration the fee or fees, if any, fixed by the
director and the board for such attorney's services before the
department and the board. If the court finds that the fee fixed by the
director or by the board is inadequate for services performed before
the department or board, or if the director or the board has fixed no
fee for such services, then the court shall fix a fee for the
attorney's services before the department, or the board, as the case
may be, in addition to the fee fixed for the services in the court.))
If, in a worker or beneficiary appeal to the superior or appellate
court from the decision and order of the board, the decision and order
of the board is reversed or modified and if the accident fund or
medical aid fund is affected by the litigation, or if in an appeal by
the department or employer the worker or beneficiary's right to relief
is sustained, or in an appeal by a worker involving a state fund
employer with twenty-five employees or less, in which the department
does not appear and defend, and the board order in favor of the
employer is sustained, the attorney's fee permitted under RCW 51.52.132
and fixed by the court under RCW 51.52.120, for services before the
court only, and the fees of medical and other witnesses and the costs
shall be payable out of the administrative fund of the department. In
the case of self-insured employers, the attorney's fee((s)) permitted
under RCW 51.52.132 and fixed by the court under RCW 51.52.120, for
services before the court only, and the fees of medical and other
witnesses and the costs shall be payable directly by the self-insured
employer.
NEW SECTION. Sec. 901 A new section is added to chapter 51.04
RCW to read as follows:
NEW SECTION. Sec. 902
NEW SECTION. Sec. 903 Sections 501 through 509 of this act
constitute a new chapter in Title
NEW SECTION. Sec. 904
NEW SECTION. Sec. 905
NEW SECTION. Sec. 906 Section 703 of this act expires July 1,
2005.
NEW SECTION. Sec. 907