SENATE BILL REPORT

ESB 6740

BYSenator Matson

Regulating medical treatment under the industrial insurance retrospective rating program.

Senate Committee on Economic Development & Labor

Senate Hearing Date(s):January 30, 1990; February 2, 1990

Majority Report:     That Substitute Senate Bill No. 6740 be substituted therefor, and the substitute bill do pass.

     Signed by Senators Lee, Chairman; Anderson, Vice Chairman; McDonald, McMullen, Matson, Murray, Smitherman, West, Williams.

Senate Staff:David Cheal (786-7576)

                February 19, 1990

AS PASSED SENATE, FEBRUARY 13, 1990

BACKGROUND:

Insured workers who file a claim for benefits under industrial insurance may be required to submit to independent medical exams by the department or self-insurer.  Employers who insure through the state fund are not authorized to independently require a worker to submit to such an exam.

There is no limit on the number of such medical exams that a worker may be required to submit to.

Workers occasionally fail to appear at these scheduled medical exams resulting in expense to the department, the self-insurer, or the accident fund account of their employer.

Some employers who insure through the state fund participate in retrospective rating programs.  This program is available to members of trade associations who participate as a group.  Through an adjustment process, premiums are based on the actual loss experienced by participants.

SUMMARY:

Employer participants in retrospective rating programs are given the authority to require their employee-claimants to submit to medical examinations as provided by rules of the department.  These exams are limited to four times within any two calendar year period and twice within any four-month period with respect to the same injury, and may only be conducted by a department-approved physician.

If a worker fails to appear for a scheduled medical exam or treatment, vocational rehabilitation examination or training session, without good cause, the expense of that event shall be deducted from future benefits and credited to the retrospective rating program employers' accident fund account, or the self-insurer.  A worker does not "fail to appear" for these purposes if the worker arrives within fifteen minutes of the scheduled time and the exam is not begun within two hours of the scheduled time.

If a worker refuses to submit to a medical examination or generally refuses to cooperate without good cause, future benefits shall be suspended during the period of noncooperation.  Under current law, such suspension is discretionary with the department or the self-insurer upon approval of the department.

The department is required to reject all bills submitted by health care providers which do not conform to relevant rules and regulations promulgated by the department.  Under current law, this refusal to pay is discretionary.

Appropriation:  none

Revenue:   none

Fiscal Note:    requested

Senate Committee - Testified:   Clif Finch, Association of Washington Business (for); Bill Pickell, Washington Contract Loggers Association (for); Callie Wilson, Department of Labor and Industries (against); Doug Connell, Department of Labor and Industries (against); Shannon Williams, Medical Consultants N.W. (for)