AN ACT Relating to self-insured industrial insurance claims; amending RCW 51.52.130; and adding new sections to chapter 51.28 RCW.

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

Sec. 1. Section 51.52.130, chapter 23, Laws of 1961 as last amended by section 23, chapter 63, Laws of 1982 and RCW 51.52.130 are each amended to read as follows:

If, on appeal to the 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 by the court, 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 the decision and order of the board is reversed or modified and if the accident fund is affected by the litigation then the attorney's fee fixed by the court 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, if on appeal by the worker or beneficiary the decision and order of the board is reversed or modified resulting in additional benefits ((~~by the litigation~~)) to the worker or beneficiary that would be paid from the accident fund if the employer were not self-insured, then the attorney fees fixed by the court for services before the court, only, and the fees of medical and other witnesses and ((~~the~~)) other costs shall be payable directly by the self-insured employer. If on appeal by the self-insured employer the decision and order of the board is sustained in whole or part, resulting in affirmance of the worker's or beneficiary's entitlement to benefits, the attorneys' fees fixed by the court for services before the court, only, and the fees of medical and other witnesses and other costs shall be payable by the self-insured employer.

NEW SECTION. Sec. 2. (1) The self-insurer shall provide a copy of the employee's claim file at no cost within fifteen days of receipt of a request by the employee or the employee's representative. The self-insurer shall provide the entire contents of the claim file unless the request is for only a particular portion of the file.

(2) The self-insurer shall transmit notice to the department of any protest by an employee relating to the administration of an industrial injury claim under this chapter by the end of the next working day. Failure of a self-insurer to comply with this notification requirement shall subject the self- insurer to the penalty provisions of RCW 51.48.017.

(3) The self-insurer shall submit a medical report with the request for closure of a claim under this chapter.

NEW SECTION. Sec. 3. Self-insurers may require medical examinations of employees submitting a claim under this chapter only in the following circumstances:

(1) To determine medical causal relationship questions upon the filing of a claim;

(2) To determine issues relating to medical treatment of the claimant;

(3) To determine questions concerning permanent partial disability or benefits at the conclusion of the claim evaluation process.

Absent a change in the medical management of the claimant's condition, the self-insurer shall not require the claimant to undergo additional medical examinations during the pendency of the claim.

NEW SECTION. Sec. 4. The self-insurer shall allow or disallow a claim within sixty days from the date the claim is filed, or the claim shall be deemed allowed. A self-insurer may, for good cause, extend the deadline an additional thirty days, if written notice of the extension is provided to the employee within forty-five days from the date the claim is filed.

NEW SECTION. Sec. 5. In carrying out their responsibilities to administer fairly the industrial insurance laws of this state as authorized under this chapter, self-insurers shall not restrict the ability of employees submitting claims under this chapter to choose the physician who will provide their medical care.

NEW SECTION. Sec. 6. Any violation of sections 2 through 5 of this act or any rule adopted thereunder constitutes a violation of chapter 19.86 RCW.

NEW SECTION. Sec. 7. Sections 2 through 6 of this act are each added to chapter 51.28 RCW.