SENATE BILL REPORT

SB 5608

BYSenators Rasmussen and Vognild

Establishing procedures regarding self-insured industrial insurance claims.

Senate Committee on Economic Development & Labor

Senate Hearing Date(s):February 15, 1989

Senate Staff:David Cheal (786-7576)

AS OF FEBRUARY 14, 1989

BACKGROUND:

When the Department of Labor and Industries or a self-insurer issues an order regarding a workers' compensation claim, either of the affected parties may appeal to the Board of Industrial Insurance Appeals.  Following the board's decision either party may appeal to superior court.  If the injured worker prevails in an appeal to superior court either as the appellant or respondent, the court must award a reasonable attorney's fee.

In an appeal involving a self-insured employer, where the employer appeals and the worker prevails, the worker is to be awarded attorney's fees.  However, it is unclear whether that same right exists if the worker is the appellant.

There is no explicit requirement for self-insurers to promptly supply copies of the employee's claim file upon request by the employee.  There is also no explicit duty on the part of self-insurers to inform the department of protests by claimants relating to the self-insured employer's administration of a claim.

Self-insurers may require claimants to submit to medical examinations without any limitation, unless the department intervenes in the event of a protest by a claimant.

Although benefits must be paid promptly following the submission of an apparently valid claim, there is no limitation as to when a self-insured employer must decide whether to allow or disallow a claim.

SUMMARY:

Claimants' rights to attorneys' fees when they appeal a Board of Industrial Insurance Appeals order to superior court is clarified.

Self-insurers are required to provide the employee's claim file to the employee or employee's representative at no cost within 15 days of the request.  Self-insurers are required to transmit any claimant protest of the handling of their claim to the Department of Labor and Industries by the end of the next working day following the protest.  Self-insurers are required to submit a medical report with a request to close a claim.

Claimants can only be required by self-insurers to submit to medical examinations in certain circumstances:  (1) to determine medical causal relationship questions, (2) to determine issues of medical treatment, and (3) to determine the rating for permanent partial disability awards or to close a claim.  These are the only times when an examination may be required except when there is a change of medical management of a claimant's condition.

Self-insurers must allow or disallow a claim within 60 days from the date the claim is filed or the claim shall be allowed.  This deadline may be extended an additional 30 days for good cause.

Self-insurers are prohibited from restricting the ability of claimants to choose physicians who will provide medical care relating to the claim.

Violations of the provisions of the bill by self-insurers constitute a violation of the Consumer Protection Act.

Appropriation:    none

Revenue:    none

Fiscal Note:      available