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.
