BILL REQ. #: S-4639.1
State of Washington | 58th Legislature | 2004 Regular Session |
READ FIRST TIME 02/10/04.
AN ACT Relating to authorizing self-insurers to make claim decisions and actively participate in workers' compensation claims; amending RCW 51.04.020, 51.04.030, 51.04.040, 51.04.085, 51.08.040, 51.08.173, 51.14.110, 51.14.120, 51.14.130, 51.16.120, 51.24.030, 51.24.050, 51.24.060, 51.24.070, 51.24.080, 51.24.090, 51.28.010, 51.28.020, 51.28.030, 51.28.040, 51.28.055, 51.28.060, 51.28.070, 51.32.010, 51.32.040, 51.32.055, 51.32.060, 51.32.080, 51.32.095, 51.32.110, 51.32.130, 51.32.150, 51.32.160, 51.32.195, 51.32.210, 51.32.220, 51.32.225, 51.32.230, 51.32.240, 51.32.250, 51.36.010, 51.36.015, 51.36.020, 51.36.060, 51.36.070, 51.48.017, 51.48.040, 51.48.080, 51.52.050, 51.52.070, and 51.52.080; reenacting and amending RCW 51.52.060; adding new sections to chapter 51.14 RCW; repealing RCW 51.32.190; and providing an effective date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 51.04.020 and 2000 c 5 s 14 are each amended to read
as follows:
(1) The director shall:
(((1))) (a) Establish and adopt rules governing the administration
of this title and the periodic auditing of self-insured employers under
RCW 51.48.040 (4) and (5);
(((2))) (b) Ascertain and establish the amounts to be paid into and
out of the accident fund;
(((3))) (c) Regulate the proof of accident and extent thereof, the
proof of death and the proof of relationship and the extent of
dependency;
(((4))) (d) Supervise the medical, surgical, and hospital treatment
to the intent that it may be in all cases efficient and up to the
recognized standard of modern surgery;
(((5))) (e) Issue proper receipts for moneys received and
certificates for benefits accrued or accruing;
(((6))) (f) Investigate the cause of all serious injuries and
report to the governor from time to time any violations or laxity in
performance of protective statutes or regulations coming under the
observation of the department;
(((7))) (g) Compile statistics which will afford reliable
information upon which to base operations of all divisions under the
department;
(((8))) (h) Make an annual report to the governor of the workings
of the department;
(((9))) (i) Be empowered to enter into agreements with the
appropriate agencies of other states relating to conflicts of
jurisdiction where the contract of employment is in one state and
injuries are received in the other state, and insofar as permitted by
the Constitution and laws of the United States, to enter into similar
agreements with the provinces of Canada; and
(((10))) (j) Designate a medical director who is licensed under
chapter 18.57 or 18.71 RCW.
(2) Self-insured employers shall be vested with the powers and
duties necessary to process all aspects of industrial injury or
occupational disease claims of their injured workers without prior
approval or consent of the department subject to the provisions of this
title.
Sec. 2 RCW 51.04.030 and 1998 c 230 s 1 are each amended to read
as follows:
(1) The director shall supervise the providing of prompt and
efficient care and treatment, including care provided by physician
assistants governed by the provisions of chapters 18.57A and 18.71A
RCW, acting under a supervising physician, and including chiropractic
care, to workers injured during the course of their employment at the
least cost consistent with promptness and efficiency, without
discrimination or favoritism, and with as great uniformity as the
various and diverse surrounding circumstances and locations of
industries will permit and to that end shall, from time to time,
establish and adopt and supervise the administration of printed forms,
rules, ((regulations,)) and practices for the furnishing of such care
and treatment((: PROVIDED, That)). However, the medical coverage
decisions of the department do not constitute a "rule" as used in RCW
34.05.010(16), nor are such decisions subject to the rule-making
provisions of chapter 34.05 RCW except that criteria for establishing
medical coverage decisions shall be adopted by rule after consultation
with the workers' compensation advisory committee established in RCW
51.04.110((: PROVIDED FURTHER, That)). The department or self-insurer, as the case may be, may recommend to an injured worker
particular health care services and providers where specialized
treatment is indicated or where cost-effective payment levels or rates
are obtained by the department((: AND PROVIDED FURTHER, That)) or
self-insurer. The department may enter into contracts for goods and
services including, but not limited to, durable medical equipment so
long as statewide access to quality service is maintained for injured
workers.
(2) The director shall, in consultation with interested persons,
establish and, in his or her discretion, periodically change as may be
necessary, and make available a fee schedule of the maximum charges to
be made by any physician, surgeon, chiropractor, hospital, druggist,
physicians' assistants as defined in chapters 18.57A and 18.71A RCW,
acting under a supervising physician or other agency or person
rendering services to injured workers. The department shall coordinate
with other state purchasers of health care services to establish as
much consistency and uniformity in billing and coding practices as
possible, taking into account the unique requirements and differences
between programs. No service covered under this title, including
services provided to injured workers, whether aliens or other injured
workers, who are not residing in the United States at the time of
receiving the services, shall be charged or paid at a rate or rates
exceeding those specified in such fee schedule, and no contract
providing for greater fees shall be valid as to the excess. The
establishment of such a schedule, exclusive of conversion factors, does
not constitute "agency action" as used in RCW 34.05.010(3), nor does
such a fee schedule constitute a "rule" as used in RCW 34.05.010(16).
(3) The director or self-insurer, as the case may be, shall make a
record of the commencement of every disability and the termination
thereof and, when bills are rendered for the care and treatment of
injured workers, shall approve and pay those which conform to the
adopted rules, ((regulations,)) established fee schedules, and
practices of the director and may reject any bill or item thereof
incurred in violation of the principles laid down in this section or
the rules, regulations, or the established fee schedules and rules and
regulations adopted under it.
Sec. 3 RCW 51.04.040 and 1987 c 316 s 1 are each amended to read
as follows:
The director and ((his or her)) the director's authorized
assistants shall have power to issue subpoenas to enforce the
attendance and testimony of witnesses and the production and
examination of books, papers, photographs, tapes, and records before
the department or a self-insurer in connection with any claim made to
the department or a self-insurer, any billing submitted to the
department or a self-insurer, or the assessment or collection of
premiums. The director shall issue a subpoena on behalf of a self-insurer upon application demonstrating a reasonable basis for the
issuance of a subpoena. The superior court shall have the power to
enforce any such subpoena by proper proceedings.
Sec. 4 RCW 51.04.085 and 1977 ex.s. c 323 s 26 are each amended
to read as follows:
The department or the self-insurer, as the case may be, may, at any
time, on receipt of written authorization, transmit amounts payable to
a claimant, beneficiary, or any supplier of goods or services to the
account of such person in a bank or other financial institution
regulated by state or federal authority.
Sec. 5 RCW 51.08.040 and 1961 c 23 s 51.08.040 are each amended
to read as follows:
For purposes of this title, "department" means the department of
labor and industries, its director, and its director's appointees and
employees.
Sec. 6 RCW 51.08.173 and 1983 c 174 s 1 are each amended to read
as follows:
"Self-insurer" or "self-insured employer" means an employer or
group of employers which has been authorized under this title to carry
its own liability to its employees covered by this title and includes
their designated agents.
Sec. 7 RCW 51.14.110 and 1971 ex.s. c 289 s 35 are each amended
to read as follows:
Every self-insurer shall maintain a record of all payments of
compensation made under this title. In the event of an audit by the
department or protest by the injured worker, the self-insurer shall
furnish to the ((director)) department all information ((he)) it has in
((his)) its possession ((as to any disputed claim)), upon forms
approved by the ((director)) department.
Sec. 8 RCW 51.14.120 and 2001 c 152 s 1 are each amended to read
as follows:
(1) The self-insurer shall provide, when authorized under RCW
51.28.070, 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, and shall provide the physician performing an
examination with all relevant medical records from the worker's claim
file, but only to the extent required of the department under RCW
51.36.070. If the self-insured employer determines that release of the
claim file to an unrepresented worker in whole or in part((,)) may not
be in the worker's best interests, the employer must ((submit a request
for denial with)) issue an order under section 10 of this act that
includes an explanation ((along with a copy of that portion of the
claim file not previously provided within twenty days after the request
from)) to the worker. In the case of second or subsequent requests, a
reasonable charge for copying may be made. The self-insurer shall
provide the entire contents of the claim file unless the request is for
only a particular portion of the file. Any new material added to the
claim file after the initial request shall be provided under the same
terms and conditions as the initial request.
(2) The self-insurer shall transmit notice to the department of any
protest or appeal by an employee relating to the administration of an
industrial injury or occupational disease claim under this chapter
within five working days of receipt. The date that the protest or
appeal is received by the self-insurer shall be deemed to be the date
the protest is received by the department for the purpose of RCW
51.52.050.
(((3) The self-insurer shall submit a medical report with the
request for closure of a claim under this chapter.))
Sec. 9 RCW 51.14.130 and 1993 c 122 s 3 are each amended to read
as follows:
The self-insurer shall ((request allowance or denial of)) allow or
deny a claim within sixty days from the date that the claim is filed((.
If the self-insurer fails to act within sixty days, the department
shall promptly intervene and adjudicate the claim)) unless extended for
up to ninety days by notice to the worker for good cause.
NEW SECTION. Sec. 10 A new section is added to chapter 51.14 RCW
to read as follows:
(1) Self-insured employers shall issue orders encompassing their
claims decisions under the same circumstances and parameters and to the
same force and effect as orders issued by the department so long as
such orders conform to the requirements of RCW 51.52.050. This
includes but is not limited to allowance, denial and reopening of
claims, payment of monthly compensation, provision of medical care and
treatment, specification of conditions allowed, denied, or segregated
under the claim, closure of claims with or without award for permanent
disability, reduction, suspension, or denial of benefits pursuant to
RCW 51.32.110, and eligibility for vocational services pursuant to RCW
51.32.095.
(2) If a worker or beneficiary requests reconsideration or appeals
a self-insurer order, the department may reconsider the order under RCW
51.52.050, or may direct submission of further evidence under RCW
51.52.050 and 51.52.060. A subsequent order issued by the department
may be appealed by any aggrieved party.
Sec. 11 RCW 51.16.120 and 1984 c 63 s 1 are each amended to read
as follows:
(1) Whenever a worker has a previous bodily disability from any
previous injury or disease, whether known or unknown to the employer,
and shall suffer a further disability from injury or occupational
disease in employment covered by this title and become totally and
permanently disabled from the combined effects thereof or die when
death was substantially accelerated by the combined effects thereof,
then the experience record of an employer insured with the state fund
at the time of said further injury or disease shall be charged and a
self-insured employer shall pay directly into the reserve fund only the
accident cost which would have resulted solely from said further injury
or disease, had there been no preexisting disability, and which
accident cost shall be based upon an evaluation of the disability by
medical experts. The difference between the charge thus assessed to
such employer at the time of said further injury or disease and the
total cost of the pension reserve shall be assessed against the second
injury fund. The department shall pass upon the application of this
section in all state fund cases where benefits are paid for total
permanent disability or death and issue an order thereon appealable by
the employer. Pending outcome of such appeal the transfer or payment
shall be made as required by such order. In cases involving self-insurers, the department shall issue an order appealable by the
employer passing on the application of this section within sixty days
of a written request by the self-insurer. However, for good cause, the
department may once extend the time for making the determination for an
additional thirty days. If the department fails to issue an order
passing on the application of this section within the time frame
specified, this section applies. When this section applies, the
department shall reimburse the self-insurer from the second injury fund
all monthly compensation paid to the worker or beneficiary beginning
with the first date of permanent total disability or death of the
worker.
(2) The department shall, in cases of claims of workers sustaining
injuries or occupational diseases in the employ of state fund
employers, recompute the experience record of such employers when the
claims of workers injured in their employ have been found to qualify
for payments from the second injury fund after the regular time for
computation of such experience records and the department may make
appropriate adjustments in such cases including cash refunds or credits
to such employers.
(3) To encourage employment of injured workers who are not
reemployed by the employer at the time of injury, the department may
adopt rules providing for the reduction or elimination of premiums or
assessments from subsequent employers of such workers and may also
adopt rules for the reduction or elimination of charges against such
employers in the event of further injury to such workers in their
employ.
Sec. 12 RCW 51.24.030 and 1995 c 199 s 2 are each amended to read
as follows:
(1) If a third person, not in a worker's same employ, is or may
become liable to pay damages on account of a worker's injury for which
benefits and compensation are provided under this title, the injured
worker or beneficiary may elect to seek damages from the third person.
(2) In every action brought under this section, the plaintiff shall
give notice to the department or self-insurer, as the case may be, when
the action is filed. The department or self-insurer may file a notice
of statutory interest in recovery. When such notice has been filed by
the department or self-insurer, the parties shall thereafter serve
copies of all notices, motions, pleadings, and other process on the
department or self-insurer. The department or self-insurer may then
intervene as a party in the action to protect its statutory interest in
recovery.
(3) For the purposes of this chapter, "injury" shall include any
physical or mental condition, disease, ailment or loss, including
death, for which compensation and benefits are paid or payable under
this title.
(4) Damages recoverable by a worker or beneficiary pursuant to the
underinsured motorist coverage of an insurance policy shall be subject
to this chapter only if the owner of the policy is the employer of the
injured worker.
(5) For the purposes of this chapter, "recovery" includes all
damages except loss of consortium.
Sec. 13 RCW 51.24.050 and 1995 c 199 s 3 are each amended to read
as follows:
(1) An election not to proceed against the third person operates as
an assignment of the cause of action to the department or self-insurer,
as the case may be, which may prosecute or compromise the action in its
discretion in the name of the injured worker, beneficiary or legal
representative.
(2) If an injury to a worker results in the worker's death, the
department or self-insurer to which the cause of action has been
assigned may petition a court for the appointment of a special personal
representative for the limited purpose of maintaining an action under
this chapter and chapter 4.20 RCW.
(3) If a beneficiary is a minor child, an election not to proceed
against a third person on such beneficiary's cause of action may be
exercised by the beneficiary's legal custodian or guardian.
(4) Any recovery made by the department or self-insurer shall be
distributed as follows:
(a) The department or self-insurer, as the case may be, shall be
paid the expenses incurred in making the recovery including reasonable
costs of legal services;
(b) The injured worker or beneficiary shall be paid twenty-five
percent of the balance of the recovery made, which shall not be subject
to subsection (5) of this section: PROVIDED, That in the event of a
compromise and settlement by the parties, the injured worker or
beneficiary may agree to a sum less than twenty-five percent;
(c) The department and/
(d) The injured worker or beneficiary shall be paid any remaining
balance.
(5) Thereafter no payment shall be made to or on behalf of a worker
or beneficiary by the department ((and/)) or self-insurer, as the
case may be, for such injury until the amount of any further
compensation and benefits shall equal any such remaining balance.
Thereafter, such benefits shall be paid by the department ((and/)) or
self-insurer, as the case may be, to or on behalf of the worker or
beneficiary as though no recovery had been made from a third person.
(6) When the cause of action has been assigned to the self-insurer
and compensation and benefits have been paid and/
(a) The prosecution of such cause of action shall also be for the
benefit of the department to the extent of compensation and benefits
paid and payable from state funds;
(b) Any compromise or settlement of such cause of action which
results in less than the entitlement under this title is void unless
made with the written approval of the department;
(c) The department shall be reimbursed for compensation and
benefits paid from state funds;
(d) The department shall bear its proportionate share of the costs
and reasonable attorneys' fees incurred by the self-insurer in
obtaining the award or settlement; and
(e) Any remaining balance under subsection (4)(d) of this section
shall be applied, under subsection (5) of this section, to reduce the
obligations of the department and self-insurer to pay further
compensation and benefits in proportion to which the obligations of
each bear to the remaining entitlement of the worker or beneficiary.
Sec. 14 RCW 51.24.060 and 2001 c 146 s 9 are each amended to read
as follows:
(1) If the injured worker or beneficiary elects to seek damages
from the third person, any recovery made shall be distributed as
follows:
(a) The costs and reasonable attorneys' fees shall be paid
proportionately by the injured worker or beneficiary and the department
and/or self-insurer((: PROVIDED, That)), as the case may be. However,
the department and/or self-insurer may require court approval of costs
and attorneys' fees or may petition a court for determination of the
reasonableness of costs and attorneys' fees;
(b) The injured worker or beneficiary shall be paid twenty-five
percent of the balance of the award((: PROVIDED, That)). However, in
the event of a compromise and settlement by the parties, the injured
worker or beneficiary may agree to a sum less than twenty-five percent;
(c) The department and/or self-insurer shall be paid the balance of
the recovery made, but only to the extent necessary to reimburse the
department and/or self-insurer for benefits paid;
(i) The department and/or self-insurer shall bear its proportionate
share of the costs and reasonable attorneys' fees incurred by the
worker or beneficiary to the extent of the benefits paid under this
title((: PROVIDED, That)). However, the department's and/or self-insurer's proportionate share shall not exceed one hundred percent of
the costs and reasonable attorneys' fees;
(ii) The department's and/or self-insurer's proportionate share of
the costs and reasonable attorneys' fees shall be determined by
dividing the gross recovery amount into the benefits paid amount and
multiplying this percentage times the costs and reasonable attorneys'
fees incurred by the worker or beneficiary;
(iii) The department's and/or self-insurer's reimbursement share
shall be determined by subtracting their proportionate share of the
costs and reasonable attorneys' fees from the benefits paid amount;
(d) Any remaining balance shall be paid to the injured worker or
beneficiary; and
(e) Thereafter no payment shall be made to or on behalf of a worker
or beneficiary by the department and/or self-insurer for such injury
until the amount of any further compensation and benefits shall equal
any such remaining balance minus the department's and/or self-insurer's
proportionate share of the costs and reasonable attorneys' fees in
regards to the remaining balance. This proportionate share shall be
determined by dividing the gross recovery amount into the remaining
balance amount and multiplying this percentage times the costs and
reasonable attorneys' fees incurred by the worker or beneficiary.
Thereafter, such benefits shall be paid by the department and/or self-insurer to or on behalf of the worker or beneficiary as though no
recovery had been made from a third person.
(2) The recovery made shall be subject to a lien by the department
and/or self-insurer for its share under this section.
(3) The department or self-insurer, as the case may be, has sole
discretion to compromise the amount of its lien. In deciding whether
or to what extent to compromise its lien, the department or self-insurer shall consider at least the following:
(a) The likelihood of collection of the award or settlement as may
be affected by insurance coverage, solvency, or other factors relating
to the third person;
(b) Factual and legal issues of liability as between the injured
worker or beneficiary and the third person. Such issues include but
are not limited to possible contributory negligence and novel theories
of liability; and
(c) Problems of proof faced in obtaining the award or settlement.
(4) In an action under this section, the self-insurer may act on
behalf and for the benefit of the department to the extent of any
compensation and benefits paid or payable from state funds.
(5) It shall be the duty of the person to whom any recovery is paid
before distribution under this section to advise the department or
self-insurer, as the case may be, of the fact and amount of such
recovery, the costs and reasonable attorneys' fees associated with the
recovery, and to distribute the recovery in compliance with this
section.
(6) The distribution of any recovery made by award or settlement of
the third party action shall be confirmed by ((department)) order of
the department or self-insurer, as the case may be, served by
registered or certified mail, and shall be subject to chapter 51.52
RCW. In the event the order of distribution becomes final under
chapter 51.52 RCW, the ((director or the director's designee))
department or self-insurer, as the case may be, may file with the clerk
of any county within the state a warrant in the amount of the sum
representing the unpaid lien plus interest accruing from the date the
order became final. The clerk of the county in which the warrant is
filed shall immediately designate a superior court cause number for
such warrant and the clerk shall cause to be entered in the judgment
docket under the superior court cause number assigned to the warrant,
the name of such worker or beneficiary mentioned in the warrant, the
amount of the unpaid lien plus interest accrued and the date when the
warrant was filed. The amount of such warrant as docketed shall become
a lien upon the title to and interest in all real and personal property
of the injured worker or beneficiary against whom the warrant is
issued, the same as a judgment in a civil case docketed in the office
of such clerk. The sheriff shall then proceed in the same manner and
with like effect as prescribed by law with respect to execution or
other process issued against rights or property upon judgment in the
superior court. Such warrant so docketed shall be sufficient to
support the issuance of writs of garnishment in favor of the department
or self-insurer, as the case may be, in the manner provided by law in
the case of judgment, wholly or partially unsatisfied. The clerk of
the court shall be entitled to a filing fee under RCW 36.18.012(10),
which shall be added to the amount of the warrant. A copy of such
warrant shall be mailed to the injured worker or beneficiary within
three days of filing with the clerk.
(7) The ((director, or the director's designee,)) department or
self-insurer, as the case may be, may issue to any person, firm,
corporation, municipal corporation, political subdivision of the state,
public corporation, or agency of the state, a notice and order to
withhold and deliver property of any kind if he or she has reason to
believe that there is in the possession of such person, firm,
corporation, municipal corporation, political subdivision of the state,
public corporation, or agency of the state, property which is due,
owing, or belonging to any worker or beneficiary upon whom a warrant
has been served by the department or self-insurer for payments due to
the state fund or self-insurer. The notice and order to withhold and
deliver shall be served by the sheriff of the county or by the
sheriff's deputy; by certified mail, return receipt requested; or by
any authorized representatives of the ((director)) department or self-insurer. Any person, firm, corporation, municipal corporation,
political subdivision of the state, public corporation, or agency of
the state upon whom service has been made shall answer the notice
within twenty days exclusive of the day of service, under oath and in
writing, and shall make true answers to the matters inquired of in the
notice and order to withhold and deliver. In the event there is in the
possession of the party named and served with such notice and order,
any property which may be subject to the claim of the department or
self-insurer, such property shall be delivered forthwith to the
((director or the director's authorized representative)) department or
self-insurer, as the case may be, upon demand. If the party served and
named in the notice and order fails to answer the notice and order
within the time prescribed in this section, the court may, after the
time to answer such order has expired, render judgment by default
against the party named in the notice for the full amount claimed by
the director or self-insurer in the notice together with costs. In the
event that a notice to withhold and deliver is served upon an employer
and the property found to be subject thereto is wages, the employer may
assert in the answer to all exemptions provided for by chapter 6.27 RCW
to which the wage earner may be entitled.
Sec. 15 RCW 51.24.070 and 1984 c 218 s 6 are each amended to read
as follows:
(1) The department or self-insurer, as the case may be, may require
the injured worker or beneficiary to exercise the right of election
under this chapter by serving a written demand by registered mail,
certified mail, or personal service on the worker or beneficiary.
(2) Unless an election is made within sixty days of the receipt of
the demand, and unless an action is instituted or settled within the
time granted by the department or self-insurer, the injured worker or
beneficiary is deemed to have assigned the action to the department or
self-insurer, as the case may be. The department or self-insurer shall
allow the worker or beneficiary at least ninety days from the election
to institute or settle the action. When a beneficiary is a minor child
the demand shall be served upon the legal custodian or guardian of such
beneficiary.
(3) If an action which has been filed is not diligently prosecuted,
the department or self-insurer, as the case may be, may petition the
court in which the action is pending for an order assigning the cause
of action to the department or self-insurer. Upon a sufficient showing
of a lack of diligent prosecution the court in its discretion may issue
the order.
(4) If the department or self-insurer has taken an assignment of
the third party cause of action under subsection (2) of this section,
the injured worker or beneficiary may, at the discretion of the
department or self-insurer, exercise a right of reelection and assume
the cause of action subject to reimbursement of litigation expenses
incurred by the department or self-insurer.
Sec. 16 RCW 51.24.080 and 1977 ex.s. c 85 s 6 are each amended to
read as follows:
(1) If the injured worker or beneficiary elects to seek damages
from the third person, notice of the election must be given to the
department or self-insurer, as the case may be. The notice shall be by
registered mail, certified mail, or personal service. If an action is
filed by the injured worker or beneficiary, a copy of the complaint
must be sent by registered mail to the department or self-insurer, as
the case may be.
(2) A return showing service of the notice on the department or
self-insurer shall be filed with the court but shall not be part of the
record except as necessary to give notice to the defendant of the lien
imposed by RCW 51.24.060(2).
Sec. 17 RCW 51.24.090 and 1995 c 199 s 5 are each amended to read
as follows:
(1) Any compromise or settlement of the third party cause of action
by the injured worker or beneficiary which results in less than the
entitlement under this title is void unless made with the written
approval of the department or self-insurer((: PROVIDED, That)), as the
case may be. However, for the purposes of this chapter, "entitlement"
means benefits and compensation paid and estimated by the department or
self-insurer, as the case may be, to be paid in the future.
(2) If a compromise or settlement is void because of subsection (1)
of this section, the department or self-insurer, as the case may be,
may petition the court in which the action was filed for an order
assigning the cause of action to the department or self-insurer. If an
action has not been filed, the department or self-insurer may proceed
as provided in chapter 7.24 RCW.
Sec. 18 RCW 51.28.010 and 2001 c 231 s 1 are each amended to read
as follows:
(1) Whenever any accident occurs to any worker it shall be the duty
of such worker or someone in his or her behalf to forthwith report such
accident to his or her employer, superintendent, or supervisor in
charge of the work, and 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) Upon receipt of such notice of accident, the department or
self-insurer, as the case may be, 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. The notice must be
given on department forms.
Sec. 19 RCW 51.28.020 and 2001 c 231 s 2 are each amended to read
as follows:
(1)(((a))) Where a worker is entitled to compensation under this
title he or she shall file with the department or his or her self-insured employer, as the case may be, his or her application for such,
together with the certificate of the physician who attended him or her.
An application form developed by the department shall include a notice
specifying 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 listing the types of
providers authorized to provide these services.
(((b))) (2) The physician who attended the injured worker shall
inform the injured worker of his or her rights under this title and
lend all necessary assistance in making this application for
compensation and such proof of other matters as required by the rules
of the department without charge to the worker. The department shall
provide physicians with a manual which outlines the procedures to be
followed in applications for compensation involving occupational
diseases, and which describes claimants' rights and responsibilities
related to occupational disease claims.
(((2) If application for compensation is made to a self-insured
employer, he or she shall forthwith send a copy of the application to
the department.))
Sec. 20 RCW 51.28.030 and 1972 ex.s. c 43 s 17 are each amended
to read as follows:
Where death results from injury the parties entitled to
compensation under this title, or someone in their behalf, shall make
application for the same to the department or self-insurer as the case
may be, which application must be accompanied with proof of death and
proof of relationship showing the parties to be entitled to
compensation under this title, certificates of attending physician, if
any, and such proof as required by the rules of the department.
Upon receipt of notice of accident under RCW 51.28.010, the
director or self-insurer, as the case may be, shall immediately forward
to the party or parties required to make application for compensation
under this section, notification on department forms, in nontechnical
language, of their rights under this title.
Sec. 21 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 to the department
or self-insurer, as the case may be. Where the application has been
granted, 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. 22 RCW 51.28.055 and 2003 2nd sp.s. c 2 s 1 are each amended
to read as follows:
(1) Except as provided in subsection (2) 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 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. If the employer is self-insured, the physician
shall file the notice with the self-insurer. If the employer is a
state fund employer, the physician shall file the notice with the
department. The department or self-insurer 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 the date of death of the worker suffering from an occupational
disease.
(2)(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 the date of the worker's
last injurious exposure to occupational noise in employment covered
under this title or within one year of 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 be
allowed for medical aid benefits under chapter 51.36 RCW.
(3) The department may adopt rules to implement this section.
Sec. 23 RCW 51.28.060 and 1977 ex.s. c 350 s 35 are each amended
to read as follows:
A dependent shall at all times furnish the department or self-insurer, as the case may be, with proof satisfactory to the
((director)) department or self-insurer of the nature, amount and
extent of the contribution made by the deceased worker.
Proof of dependency by any beneficiary residing without the United
States shall be made before the nearest United States consul or
consular agency, under the seal of such consul or consular agent, and
the department or self-insurer may cause any warrant or warrants to
which such beneficiary is entitled to be transmitted to the beneficiary
through the nearest United States consul or consular agent.
Sec. 24 RCW 51.28.070 and 1990 c 209 s 2 are each amended to read
as follows:
Information contained in the claim files and records of injured
workers, under the provisions of this title, shall be deemed
confidential and shall not be open to public inspection (other than to
public employees in the performance of their official duties), but
representatives of a claimant, be it an individual or an organization,
may review a claim file or receive specific information therefrom upon
the presentation of the signed authorization of the claimant. A
claimant may review his or her claim file if the ((director))
department or self-insurer, as the case may be, determines, pursuant to
criteria adopted by rule, that the review is in the claimant's
interest. Employers or their duly authorized representatives may
review any files of their own injured workers in connection with any
pending claims. Physicians treating or examining workers claiming
benefits under this title, or physicians giving medical advice to the
department or self-insurer regarding any claim may, at the discretion
of the department or self-insurer, inspect the claim files and records
of injured workers, and other persons may make such inspection, at the
department's or self-insurer's discretion, when such persons are
rendering assistance to the department or self-insurer at any stage of
the proceedings on any matter pertaining to the administration of this
title.
Sec. 25 RCW 51.32.010 and 1977 ex.s. c 350 s 37 are each amended
to read as follows:
Each worker injured in the course of his or her employment, or his
or her family or dependents in case of death of the worker, shall
receive compensation in accordance with this chapter, and, except as in
this title otherwise provided, such payment shall be in lieu of any and
all rights of action whatsoever against any person whomsoever((:
PROVIDED, That)). However, if an injured worker, or the surviving
spouse of an injured worker shall not have the legal custody of a child
for, or on account of whom payments are required to be made under this
title, such payment or payments shall be made to the person or persons
having the legal custody of such child but only for the periods of time
after the department or self-insurer, as the case may be, has been
notified of the fact of such legal custody, and it shall be the duty of
any such person or persons receiving payments because of legal custody
of any child immediately to notify the department or self-insurer, as
the case may be, of any change in such legal custody.
Sec. 26 RCW 51.32.040 and 2003 c 379 s 27 are each amended to
read as follows:
(1) Except as provided in RCW 43.20B.720, 72.09.111, 74.20A.260,
and 51.32.380, no money paid or payable under this title shall, before
the issuance and delivery of the check or warrant, be assigned,
charged, or taken in execution, attached, garnished, or pass or be paid
to any other person by operation of law, any form of voluntary
assignment, or power of attorney. Any such assignment or charge is
void unless the transfer is to a financial institution at the request
of a worker or other beneficiary and made in accordance with RCW
51.32.045.
(2)(a) If any worker suffers (i) a permanent partial injury and
dies from some other cause than the accident which produced the injury
before he or she receives payment of the award for the permanent
partial injury or (ii) any other injury before he or she receives
payment of any monthly installment covering any period of time before
his or her death, the amount of the permanent partial disability award
or the monthly payment, or both, shall be paid to the surviving spouse
or the child or children if there is no surviving spouse. If there is
no surviving spouse and no child or children, the award or the amount
of the monthly payment shall be paid by the department or self-insurer,
as the case may be, and distributed consistent with the terms of the
decedent's will or, if the decedent dies intestate, consistent with the
terms of RCW 11.04.015.
(b) If any worker suffers an injury and dies from it before he or
she receives payment of any monthly installment covering time loss for
any period of time before his or her death, the amount of the monthly
payment shall be paid to the surviving spouse or the child or children
if there is no surviving spouse. If there is no surviving spouse and
no child or children, the amount of the monthly payment shall be paid
by the department or self-insurer, as the case may be, and distributed
consistent with the terms of the decedent's will or, if the decedent
dies intestate, consistent with the terms of RCW 11.04.015.
(c) Any application for compensation under this subsection (2)
shall be filed with the department or self-insuring employer, as the
case may be, within one year of the date of death. The department or
self-insurer may satisfy its responsibilities under this subsection (2)
by sending any payment due in the name of the decedent and to the last
known address of the decedent.
(3)(a) Any worker or beneficiary receiving benefits under this
title who is subsequently confined in, or who subsequently becomes
eligible for benefits under this title while confined in, any
institution under conviction and sentence shall have all payments of
the compensation canceled during the period of confinement. After
discharge from the institution, payment of benefits due afterward shall
be paid if the worker or beneficiary would, except for the provisions
of this subsection (3), otherwise be entitled to them.
(b) If any prisoner is injured in the course of his or her
employment while participating in a work or training release program
authorized by chapter 72.65 RCW and is subject to the provisions of
this title, he or she is entitled to payments under this title, subject
to the requirements of chapter 72.65 RCW, unless his or her
participation in the program has been canceled, or unless he or she is
returned to a state correctional institution, as defined in RCW
72.65.010(3), as a result of revocation of parole or new sentence.
(c) If the confined worker has any beneficiaries during the
confinement period during which benefits are canceled under (a) or (b)
of this subsection, they shall be paid directly the monthly benefits
which would have been paid to the worker for himself or herself and the
worker's beneficiaries had the worker not been confined.
(4) Any lump sum benefits to which a worker would otherwise be
entitled but for the provisions of this section shall be paid on a
monthly basis to his or her beneficiaries.
Sec. 27 RCW 51.32.055 and 1997 c 416 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. Claims shall be closed and 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 and stable, or the worker
has failed to continue to seek treatment recommended by the attending
physician and has failed to maintain contact with the department or the
self-insurer as the case may be.
(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
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.)) The department or the
self-insurer, as the case may be, may require that the worker present
himself or herself for a special medical examination by a physician or
physicians selected by the department or the self-insurer and 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.
(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 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,
(((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 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 must protest in writing to the
department of labor and industries, self-insurance section, within
sixty days of the date you received this order."
(8)(a) If a claim (i) is accepted by a self-insurer after June 30,
1990, and before August 1, 1997, (ii) involves only medical treatment,
(iii) does not involve payment of temporary disability compensation
under RCW 51.32.090, and (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 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."
(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.
Sec. 28 RCW 51.32.060 and 1993 c 521 s 2 are each amended to read
as follows:
(1) When the ((supervisor of industrial insurance shall))
department or the self-insurer, as the case may be, determines that
permanent total disability results from the injury, the worker shall
receive monthly during the period of such disability:
(a) If married at the time of injury, sixty-five percent of his or
her wages but not less than two hundred fifteen dollars per month.
(b) If married with one child at the time of injury, sixty-seven
percent of his or her wages but not less than two hundred fifty-two
dollars per month.
(c) If married with two children at the time of injury, sixty-nine
percent of his or her wages but not less than two hundred eighty-three
dollars.
(d) If married with three children at the time of injury,
seventy-one percent of his or her wages but not less than three hundred
six dollars per month.
(e) If married with four children at the time of injury,
seventy-three percent of his or her wages but not less than three
hundred twenty-nine dollars per month.
(f) If married with five or more children at the time of injury,
seventy-five percent of his or her wages but not less than three
hundred fifty-two dollars per month.
(g) If unmarried at the time of the injury, sixty percent of his or
her wages but not less than one hundred eighty-five dollars per month.
(h) If unmarried with one child at the time of injury, sixty-two
percent of his or her wages but not less than two hundred twenty-two
dollars per month.
(i) If unmarried with two children at the time of injury,
sixty-four percent of his or her wages but not less than two hundred
fifty-three dollars per month.
(j) If unmarried with three children at the time of injury,
sixty-six percent of his or her wages but not less than two hundred
seventy-six dollars per month.
(k) If unmarried with four children at the time of injury,
sixty-eight percent of his or her wages but not less than two hundred
ninety-nine dollars per month.
(l) If unmarried with five or more children at the time of injury,
seventy percent of his or her wages but not less than three hundred
twenty-two dollars per month.
(2) For any period of time where both husband and wife are entitled
to compensation as temporarily or totally disabled workers, only that
spouse having the higher wages of the two shall be entitled to claim
their child or children for compensation purposes.
(3) In case of permanent total disability, if the character of the
injury is such as to render the worker so physically helpless as to
require the hiring of the services of an attendant, the department
shall make monthly payments to such attendant for such services as long
as such requirement continues, but such payments shall not obtain or be
operative while the worker is receiving care under or pursuant to the
provisions of chapter 51.36 RCW and RCW 51.04.105.
(4) Should any further accident result in the permanent total
disability of an injured worker, he or she shall receive the pension to
which he or she would be entitled, notwithstanding the payment of a
lump sum for his or her prior injury.
(5) In no event shall the monthly payments provided in this section
exceed the applicable percentage of the average monthly wage in the
state as computed under the provisions of RCW 51.08.018 as follows:
AFTER | PERCENTAGE | ||
June 30, 1993 | 105% | ||
June 30, 1994 | 110% | ||
June 30, 1995 | 115% | ||
June 30, 1996 | 120% |
Sec. 29 RCW 51.32.080 and 1993 c 520 s 1 are each amended to read
as follows:
(1)(a) Until July 1, 1993, for the permanent partial disabilities
here specifically described, the injured worker shall receive
compensation as follows:
LOSS BY AMPUTATION | |
Of leg above the knee joint with short thigh stump (3" or less below the tuberosity of ischium) . . . . . . . . . . . . | $54,000.00 |
Of leg at or above knee joint with functional stump . . . . . . . . . . . . | 48,600.00 |
Of leg below knee joint . . . . . . . . . . . . | 43,200.00 |
Of leg at ankle (Syme) . . . . . . . . . . . . | 37,800.00 |
Of foot at mid-metatarsals . . . . . . . . . . . . | 18,900.00 |
Of great toe with resection of metatarsal bone . . . . . . . . . . . . | 11,340.00 |
Of great toe at metatarsophalangeal joint . . . . . . . . . . . . | 6,804.00 |
Of great toe at interphalangeal joint . . . . . . . . . . . . | 3,600.00 |
Of lesser toe (2nd to 5th) with resection of metatarsal bone . . . . . . . . . . . . | 4,140.00 |
Of lesser toe at metatarsophalangeal joint . . . . . . . . . . . . | 2,016.00 |
Of lesser toe at proximal interphalangeal joint . . . . . . . . . . . . | 1,494.00 |
Of lesser toe at distal interphalangeal joint . . . . . . . . . . . . | 378.00 |
Of arm at or above the deltoid insertion or by disarticulation at the shoulder . . . . . . . . . . . . | 54,000.00 |
Of arm at any point from below the deltoid insertion to below the elbow joint at the insertion of the biceps tendon . . . . . . . . . . . . | 51,300.00 |
Of arm at any point from below the elbow joint distal to the insertion of the biceps tendon to and including mid-metacarpal amputation of the hand . . . . . . . . . . . . | 48,600.00 |
Of all fingers except the thumb at metacarpophalangeal joints . . . . . . . . . . . . | 29,160.00 |
Of thumb at metacarpophalangeal joint or with resection of carpometacarpal bone . . . . . . . . . . . . | 19,440.00 |
Of thumb at interphalangeal joint . . . . . . . . . . . . | 9,720.00 |
Of index finger at metacarpophalangeal joint or with resection of metacarpal bone . . . . . . . . . . . . | 12,150.00 |
Of index finger at proximal interphalangeal joint . . . . . . . . . . . . | 9,720.00 |
Of index finger at distal interphalangeal joint . . . . . . . . . . . . | 5,346.00 |
Of middle finger at metacarpophalangeal joint or with resection of metacarpal bone . . . . . . . . . . . . | 9,720.00 |
Of middle finger at proximal interphalangeal joint . . . . . . . . . . . . | 7,776.00 |
Of middle finger at distal interphalangeal joint . . . . . . . . . . . . | 4,374.00 |
Of ring finger at metacarpophalangeal joint or with resection of metacarpal bone . . . . . . . . . . . . | 4,860.00 |
Of ring finger at proximal interphalangeal joint . . . . . . . . . . . . | 3,888.00 |
Of ring finger at distal interphalangeal joint . . . . . . . . . . . . | 2,430.00 |
Of little finger at metacarpophalangeal joint or with resection of metacarpal bone . . . . . . . . . . . . | 2,430.00 |
Of little finger at proximal interphalangeal joint . . . . . . . . . . . . | 1,944.00 |
Of little finger at distal interphalangeal joint . . . . . . . . . . . . | 972.00 |
MISCELLANEOUS | |
21,600.00 | |
18,000.00 | |
43,200.00 | |
7,200.00 |
Sec. 30 RCW 51.32.095 and 1999 c 110 s 1 are each amended to read
as follows:
(1) One of the primary purposes of this title is to enable the
injured worker to become employable at gainful employment. To this
end, the department or self-insurers, as the case may be, shall utilize
the services of individuals and organizations, public or private, whose
experience, training, and interests in vocational rehabilitation and
retraining qualify them to lend expert assistance ((to the supervisor
of industrial insurance)) in such programs of vocational rehabilitation
as may be reasonable to make the worker employable consistent with his
or her physical and mental status. ((Where, after evaluation and
recommendation by such individuals or organizations and prior to final
evaluation of the worker's permanent disability and in the sole opinion
of the supervisor or supervisor's designee, whether or not medical
treatment has been concluded, vocational rehabilitation is both
necessary and likely to enable the injured worker to become employable
at gainful employment, the supervisor or supervisor's designee may, in
his or her sole discretion, pay or, if the employer is a self-insurer,
direct the self-insurer to pay the cost as provided in subsection (3)
of this section.)) The department or self-insurer, as the case may be,
may pay the costs as provided in subsection (3) of this section if
vocational rehabilitation is both necessary and likely to enable the
injured worker to become employable at gainful employment. Such costs
may be approved before final evaluation of the worker's permanent
disability, whether or not medical treatment has been concluded.
(2) When in the ((sole)) discretion of the ((supervisor or the
supervisor's designee)) department or self-insurer, as the case may be,
vocational rehabilitation is both necessary and likely to make the
worker employable at gainful employment, then the following order of
priorities shall be used:
(a) Return to the previous job with the same employer;
(b) Modification of the previous job with the same employer
including transitional return to work;
(c) A new job with the same employer in keeping with any
limitations or restrictions;
(d) Modification of a new job with the same employer including
transitional return to work;
(e) Modification of the previous job with a new employer;
(f) A new job with a new employer or self-employment based upon
transferable skills;
(g) Modification of a new job with a new employer;
(h) A new job with a new employer or self-employment involving on-the-job training;
(i) Short-term retraining and job placement.
(3)(a) Except as provided in (b) of this subsection, costs for
vocational rehabilitation benefits allowed ((by the supervisor or
supervisor's designee)) under subsection (1) of this section may
include the cost of books, tuition, fees, supplies, equipment,
transportation, child or dependent care, and other necessary expenses
for any such worker in an amount not to exceed three thousand dollars
in any fifty-two week period ((except as authorized by RCW 51.60.060)),
and the cost of continuing the temporary total disability compensation
under RCW 51.32.090 while the worker is actively and successfully
undergoing a formal program of vocational rehabilitation.
(b) Beginning with vocational rehabilitation plans approved on or
after July 1, 1999, costs for vocational rehabilitation benefits
allowed ((by the supervisor or supervisor's designee)) under subsection
(1) of this section may include the cost of books, tuition, fees,
supplies, equipment, child or dependent care, and other necessary
expenses for any such worker in an amount not to exceed four thousand
dollars in any fifty-two week period ((except as authorized by RCW
51.60.060)), and the cost of transportation and continuing the
temporary total disability compensation under RCW 51.32.090 while the
worker is actively and successfully undergoing a formal program of
vocational rehabilitation.
(c) The expenses allowed under (a) or (b) of this subsection may
include training fees for on-the-job training and the cost of
furnishing tools and other equipment necessary for self-employment or
reemployment. However, compensation or payment of retraining with job
placement expenses under (a) or (b) of this subsection may not be
authorized for a period of more than fifty-two weeks, except that such
period may, in the sole discretion of the ((supervisor after his or her
review)) department or self-insurer, as the case may be, be extended
for an additional fifty-two weeks or portion thereof by written order
of the ((supervisor)) department or self-insurer, as the case may be.
(d) In cases where the worker is required to reside away from his
or her customary residence, the reasonable cost of board and lodging
shall also be paid.
(e) Costs paid under this subsection shall be chargeable to the
employer's cost experience or shall be paid by the self-insurer as the
case may be.
(4) In addition to the vocational rehabilitation expenditures
provided for under subsection (3) of this section, an additional five
thousand dollars may, upon authorization of the ((supervisor or the
supervisor's designee)) department or self-insurer, as the case may be,
be expended for: (a) Accommodations for an injured worker that are
medically necessary for the worker to participate in an approved
retraining plan; and (b) accommodations necessary to perform the
essential functions of an occupation in which an injured worker is
seeking employment, consistent with the retraining plan or the
recommendations of a vocational evaluation. The injured worker's
attending physician must verify the necessity of the modifications or
accommodations. The total expenditures authorized in this subsection
and the expenditures authorized under RCW 51.32.250 shall not exceed
five thousand dollars.
(5) The department shall establish criteria to monitor the quality
and effectiveness of rehabilitation services provided by the
individuals and organizations used under subsection (1) of this
section. The state fund shall make referrals for vocational
rehabilitation services based on these performance criteria.
(6) The department shall engage in, where feasible and cost-effective, a cooperative program with the state employment security
department to provide job placement services under this section.
(7) ((The benefits in this section shall be provided for the
injured workers of self-insured employers.)) Self-insurers shall
((report both benefits provided and benefits denied under this section
in the manner prescribed by the department by rule adopted under
chapter 34.05 RCW)) issue an order providing or denying benefits under
this section. The order shall state, in bold-faced type of at least
ten-point font, that such order becomes final within fifteen days from
the date the order is communicated to the parties unless a written
protest is filed with the director of the department of labor and
industries in Olympia. The self-insurer's order may not be appealed to
the board of industrial insurance appeals. If a worker timely protests
an order issued by a self-insured employer under this section, the
director may((, in his or her sole discretion and upon his or her own
initiative or at any time that a dispute arises under this section,))
promptly make such inquiries as circumstances require ((and)), take
such other action as he or she considers will properly determine the
matter and protect the rights of the parties, and determine whether, in
the director's sole discretion, vocational rehabilitation is both
necessary and likely to make the worker employable at gainful
employment. If the director does not make a determination reversing or
modifying a self-insured employer's order within thirty calendar days
of the worker's protest, the director shall be deemed to have exercised
his or her discretion and the self-insured employer's order shall be
deemed affirmed.
(8) Except as otherwise provided in this section, the benefits
provided for in this section are available to any otherwise eligible
worker regardless of the date of industrial injury. However, claims
shall not be reopened solely for vocational rehabilitation purposes.
Sec. 31 RCW 51.32.110 and 1997 c 325 s 3 are each amended to read
as follows:
(1) Any worker entitled to receive any benefits or claiming such
under this title shall, if requested by the department or self-insurer,
submit himself or herself for medical examination, at a time and from
time to time, at a place reasonably convenient for the worker and as
may be provided by the rules of the department. An injured worker,
whether an alien or other injured worker, who is not residing in the
United States at the time that a medical examination is requested may
be required to submit to an examination at any location in the United
States determined by the department or self-insurer.
(2) If the worker refuses to submit to medical examination, or
obstructs the same, or, if any injured worker shall persist in
unsanitary or injurious practices which tend to imperil or retard his
or her recovery, or shall refuse to submit to such medical or surgical
treatment as is reasonably essential to his or her recovery or refuse
or obstruct evaluation or examination for the purpose of vocational
rehabilitation or does not cooperate in reasonable efforts at such
rehabilitation, the department or the self-insurer ((upon approval by
the department)), as the case may be, with notice to the worker may
suspend any further action on any claim of such worker so long as such
refusal, obstruction, noncooperation, or practice continues and reduce,
suspend, or deny any compensation for such period((: PROVIDED, That)).
However, the department or the self-insurer shall not suspend any
further action on any claim of a worker or reduce, suspend, or deny any
compensation if a worker has good cause for refusing to submit to or to
obstruct any examination, evaluation, treatment, or practice requested
by the department or self-insurer or required under this section.
(3) If the worker necessarily incurs traveling expenses in
attending the examination pursuant to the request of the department or
the self-insurer, such traveling expenses shall be repaid to him or her
out of the accident fund upon proper voucher and audit or shall be
repaid by the self-insurer, as the case may be.
(4)(a) If the medical examination required by this section causes
the worker to be absent from his or her work without pay:
(i) In the case of a worker insured by the department, the worker
shall be paid compensation out of the accident fund in an amount equal
to his or her usual wages for the time lost from work while attending
the medical examination; or
(ii) In the case of a worker of a self-insurer, the self-insurer
shall pay the worker an amount equal to his or her usual wages for the
time lost from work while attending the medical examination.
(b) This subsection (4) shall apply prospectively to all claims
regardless of the date of injury.
Sec. 32 RCW 51.32.130 and 1961 c 23 s 51.32.130 are each amended
to read as follows:
In case of death or permanent total disability, the monthly payment
provided may be converted, in whole or in part, into a lump sum
payment, not in any case to exceed eight thousand five hundred dollars,
equal or proportionate, as the case may be, to the value of the annuity
then remaining, to be fixed and certified by the state insurance
commissioner, in which event the monthly payments shall cease in whole
or in part accordingly or proportionately. Such conversion may be made
only upon written application (in case of minor children the
application may be by either parent) to the department or self-insurer,
as the case may be, and shall rest in the discretion of the department
or self-insurer, as the case may be. Within the rule aforesaid the
amount and value of the lump sum payment may be agreed upon between the
department or self-insurer, as the case may be, and applicant. In the
event any payment shall be due to an alien residing in a foreign
country, the department or self-insurer, as the case may be, may settle
the same by making a lump sum payment in such amount as may be agreed
to by such alien, not to exceed fifty percent of the value of the
annuity then remaining.
((Nothing herein shall preclude)) The department ((from making, and
authority is hereby given it to)) or self-insurer, as the case may be,
may make, on its own motion, lump sum payments equal or proportionate,
as the case may be, to the value of the annuity then remaining, in full
satisfaction of claims due to dependents.
Sec. 33 RCW 51.32.150 and 1977 ex.s. c 323 s 18 are each amended
to read as follows:
If a beneficiary ((shall)) resides or moves out of the state, the
department or self-insurer, as the case may be, may, with the written
consent of the beneficiary, convert any monthly payments provided for
such cases into a lump sum payment (not in any case to exceed the value
of the annuity then remaining, to be fixed and certified by the state
insurance commissioner, but in no case to exceed the sum provided in
RCW 51.32.130 ((as now or hereafter amended))).
Sec. 34 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)) department or self-insurer, as the case
may be, may, upon the application of the beneficiary to the department
or self-insurer, as the case may be, made within seven years from the
date the first closing order becomes final, or at any time upon ((his
or her own)) the director's or self-insurer's motion, as the case may
be, 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)). However, the ((director)) department or
self-insurer, as the case may be, 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 state fund 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, or an order closing the claim when the worker has failed
to continue to seek treatment recommended by the attending physician
and has failed to maintain contact with the department or self-insurer,
as the case may be.
(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) If an order denying an 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, as the case
may be, such application shall be deemed granted. However, for good
cause, the department or self-insurer, as the case may be, may extend
the time for making the final determination on the application for an
additional sixty days.
(2) If a worker receiving a pension for total disability returns to
gainful employment for wages, the director or self-insurer, as the case
may be, 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)) or the self-insurer before the ((signing and
filing in the matter)) issuing of a written order for such readjustment
shall be grounds for such readjustment.
Sec. 35 RCW 51.32.195 and 1987 c 290 s 1 are each amended to read
as follows:
On any industrial injury claim where ((the)) a self-insured
((employer or injured worker has requested a determination by the
department)) employer's order has been protested, the self-insurer must
submit ((all medical reports and any other specified information not
previously submitted)) the claim file to the department. When the
department requests information from a self-insurer by certified mail,
the self-insurer shall submit all information in its possession
concerning a claim within ten working days from the date of receipt of
such certified notice.
Sec. 36 RCW 51.32.210 and 1977 ex.s. c 350 s 55 are each amended
to read as follows:
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 or self-insurer, as the case may
be. 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)) or self-insurer,
as the case may be, 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 or self-insurer, as the case may be, 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.
Sec. 37 RCW 51.32.220 and 1982 c 63 s 19 are each amended to read
as follows:
(1) For persons under the age of sixty-five receiving compensation
for temporary or permanent total disability pursuant to the provisions
of chapter 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)) or self-insurer's estimate, as the
case may be, 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) Any reduction under subsection (1) of this section shall be
effective the month following the month in which the department or
self-insurer, as the case may be, 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)). However, in the event of an overpayment of
benefits the department or self-insurer, as the case may be, 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, as the case may be, 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) 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,
as the case may be, or one-sixth of the total overpayment, whichever is
the lesser.
(4) No reduction may be made unless the worker receives notice of
the reduction prior to the month in which the reduction is made.
(5) 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) The ((director)) department or self-insurer, as the case may
be, 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) 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. 38 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 or self-insurer, as the case may be, 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), 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.
Sec. 39 RCW 51.32.230 and 1979 ex.s. c 151 s 2 are each amended
to read as follows:
Notwithstanding any other provisions of law, any overpayments
previously recovered under the provisions of RCW 51.32.220 ((as now or
hereafter amended)) shall be limited to six months' overpayments.
Where greater recovery has already been made, the director((, in his))
or the self-insurer, as the case may be, has the discretion((, may)) to
make restitution in those cases where an extraordinary hardship has
been created.
Sec. 40 RCW 51.32.240 and 2001 c 146 s 10 are each amended to
read as follows:
(1) Whenever any payment of benefits under this title is made
because of clerical error, mistake of identity, innocent
misrepresentation by or on behalf of the recipient thereof mistakenly
acted upon, or any other circumstance of a similar nature, all not
induced by fraud, the recipient thereof shall repay it and recoupment
may be made from any future payments due to the recipient on any claim
with the state fund or self-insurer, as the case may be. The
department or self-insurer, as the case may be, must make claim for
such repayment or recoupment within one year of the making of any such
payment or it will be deemed any claim therefor has been waived. The
((director)) department or self-insurer, as the case may be, 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 such timely
claim where the recovery would be against equity and good conscience.
(2) Whenever the department or self-insurer, as the case may be,
fails to pay benefits because of clerical error, mistake of identity,
or innocent misrepresentation, all not induced by recipient fraud, the
recipient may request an adjustment of benefits to be paid from the
state fund or by the self-insurer, as the case may be, subject to the
following:
(a) The recipient must request an adjustment in benefits within one
year from the date of the incorrect payment, whether the payment was
made by order or otherwise, or it will be deemed any claim therefore
has been waived.
(b) The recipient may not seek an adjustment of benefits because of
adjudicator error whether the payment was made by order or otherwise.
"Adjudicator error" includes the failure to consider information in the
claim file, failure to secure adequate information, or an error in
judgment.
(3) Whenever the department or self-insurer issues an order
rejecting a claim for benefits paid pursuant to RCW ((51.32.190 or))
51.32.210, after payment for temporary disability benefits has been
paid ((by a self-insurer pursuant to RCW 51.32.190(3) or by the
department pursuant to RCW 51.32.210)), the recipient thereof shall
repay such benefits and recoupment may be made from any future payments
due to the recipient on any claim with the state fund or self-insurer,
as the case may be. The ((director)) department or self-insurer, as
the case may be, under rules adopted in accordance with the procedures
provided in the administrative procedure act, chapter 34.05 RCW, may
exercise discretion to waive, in whole or in part, the amount of any
such payments where the recovery would be against equity and good
conscience.
(4) Whenever any payment of benefits under this title has been made
pursuant to an adjudication by the department or self-insurer or by
order of the board or any court and timely appeal therefrom has been
made where the final decision is that any such payment was made
pursuant to an erroneous adjudication, the recipient thereof shall
repay it and recoupment may be made from any future payments due to the
recipient on any claim with the state fund or self-insurer, as the case
may be. The ((director)) department or self-insurer, as the case may
be, 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 such payments where the recovery would be against equity and
good conscience.
(5) Whenever any payment of benefits under this title has been
induced by fraud the recipient thereof shall repay any such payment
together with a penalty of fifty percent of the total of any such
payments and the amount of such total sum may be recouped from any
future payments due to the recipient on any claim with the state fund
or self-insurer against whom the fraud was committed, as the case may
be, and the amount of such penalty shall be placed in the supplemental
pension fund. Such repayment or recoupment must be demanded or ordered
within three years of the discovery of the fraud.
(6) The worker, beneficiary, or other person affected thereby shall
have the right to contest an order assessing an overpayment pursuant to
this section in the same manner and to the same extent as provided
under RCW 51.52.050 and 51.52.060. In the event such an order becomes
final under chapter 51.52 RCW and notwithstanding the provisions of
subsections (1) through (5) of this section, the ((director, director's
designee,)) department or self-insurer, as the case may be, may file
with the clerk in any county within the state a warrant in the amount
of the sum representing the unpaid overpayment and/or penalty plus
interest accruing from the date the order became final. The clerk of
the county in which the warrant is filed shall immediately designate a
superior court cause number for such warrant and the clerk shall cause
to be entered in the judgment docket under the superior court cause
number assigned to the warrant, the name of the worker, beneficiary, or
other person mentioned in the warrant, the amount of the unpaid
overpayment and/or penalty plus interest accrued, and the date the
warrant was filed. The amount of the warrant as docketed shall become
a lien upon the title to and interest in all real and personal property
of the worker, beneficiary, or other person against whom the warrant is
issued, the same as a judgment in a civil case docketed in the office
of such clerk. The sheriff shall then proceed in the same manner and
with like effect as prescribed by law with respect to execution or
other process issued against rights or property upon judgment in the
superior court. Such warrant so docketed shall be sufficient to
support the issuance of writs of garnishment in favor of the department
or self-insurer, as the case may be, in the manner provided by law in
the case of judgment, wholly or partially unsatisfied. The clerk of
the court shall be entitled to a filing fee under RCW 36.18.012(10),
which shall be added to the amount of the warrant. A copy of such
warrant shall be mailed to the worker, beneficiary, or other person
within three days of filing with the clerk.
The ((director, director's designee,)) department or self-insurer,
as the case may be, may issue to any person, firm, corporation,
municipal corporation, political subdivision of the state, public
corporation, or agency of the state, a notice to withhold and deliver
property of any kind if there is reason to believe that there is in the
possession of such person, firm, corporation, municipal corporation,
political subdivision of the state, public corporation, or agency of
the state, property that is due, owing, or belonging to any worker,
beneficiary, or other person upon whom a warrant has been served for
payments due the department or self-insurer. The notice and order to
withhold and deliver shall be served by certified mail accompanied by
an affidavit of service by mailing or served by the sheriff of the
county, or by the sheriff's deputy, or by any authorized representative
of the ((director, director's designee,)) department or self-insurer.
Any person, firm, corporation, municipal corporation, political
subdivision of the state, public corporation, or agency of the state
upon whom service has been made shall answer the notice within twenty
days exclusive of the day of service, under oath and in writing, and
shall make true answers to the matters inquired or in the notice and
order to withhold and deliver. In the event there is in the possession
of the party named and served with such notice and order, any property
that may be subject to the claim of the department or self-insurer,
such property shall be delivered forthwith to the ((director, the
director's authorized representative,)) department or self-insurer upon
demand. If the party served and named in the notice and order fails to
answer the notice and order within the time prescribed in this section,
the court may, after the time to answer such order has expired, render
judgment by default against the party named in the notice for the full
amount, plus costs, claimed by the ((director, director's designee,))
department or self-insurer in the notice. In the event that a notice
to withhold and deliver is served upon an employer and the property
found to be subject thereto is wages, the employer may assert in the
answer all exemptions provided for by chapter 6.27 RCW to which the
wage earner may be entitled.
This subsection shall only apply to orders assessing an overpayment
which are issued on or after July 28, 1991: PROVIDED, That this
subsection shall apply retroactively to all orders assessing an
overpayment resulting from fraud, civil or criminal.
(7) Orders assessing an overpayment which are issued on or after
July 28, 1991, shall include a conspicuous notice of the collection
methods available to the department or self-insurer.
Sec. 41 RCW 51.32.250 and 1988 c 161 s 10 are each amended to
read as follows:
Modification of the injured worker's previous job or modification
of a new job is recognized as a desirable method of returning the
injured worker to gainful employment. In order to assist employers in
meeting the costs of job modification, and to encourage employers to
modify jobs to accommodate retaining or hiring workers with
disabilities resulting from work-related injury, the ((supervisor or
the supervisor's designee)) department, in ((his or her)) its
discretion, may pay job modification costs in an amount not to exceed
five thousand dollars per worker per job modification. This payment is
intended to be a cooperative participation with the employer and funds
shall be taken from the appropriate account within the second injury
fund.
The benefits provided for in this section are available to any
otherwise eligible worker regardless of the date of industrial injury.
Sec. 42 RCW 51.36.010 and 1986 c 58 s 6 are each amended to read
as follows:
Upon the occurrence of any injury to a worker entitled to
compensation under the provisions of this title, he or she shall
receive proper and necessary medical and surgical services at the hands
of a physician of his or her own choice, if conveniently located, and
proper and necessary hospital care and services during the period of
his or her disability from such injury, but the same shall be limited
in point of duration as follows:
In the case of permanent partial disability, 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 not to extend beyond the time when monthly
allowances to him or her shall cease; in case of temporary disability
not to extend beyond the time when monthly allowances to him or her
shall cease((: PROVIDED, That)). However, 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))
department or self-insurer, as the case may be, to be necessary to his
or her more complete recovery; in case of a permanent total disability
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)) department or self-insurer, as the case may be, solely in
((his or her)) its 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)) department or
self-insurer, as the case may be, 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)) department or self-insurer, as the case may be, issued in
advance of the continuation shall be necessary.
The ((supervisor of industrial insurance, the supervisor's
designee,)) department or a self-insurer, as the case may be, in ((his
or her)) its 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.
Sec. 43 RCW 51.36.015 and 1994 c 94 s 1 are each amended to read
as follows:
Subject to the other provisions of this title, the health services
that are available to an injured worker under RCW 51.36.010 include
chiropractic care and evaluation. For the purposes of assisting the
department or self-insurer in making claims determinations, an injured
worker may be required by the department or self-insurer, as the case
may be, to undergo examination by a chiropractor licensed under chapter
18.25 RCW.
Sec. 44 RCW 51.36.020 and 1999 c 395 s 1 are each amended to read
as follows:
(1) When the injury to any worker is so serious as to require his
or her being taken from the place of injury to a place of treatment,
his or her employer shall, at the expense of the medical aid fund, or
self-insurer, as the case may be, furnish transportation to the nearest
place of proper treatment.
(2) Every worker whose injury results in the loss of one or more
limbs or eyes shall be provided with proper artificial substitutes and
every worker, who suffers an injury to an eye producing an error of
refraction, shall be once provided proper and properly equipped lenses
to correct such error of refraction and his or her disability rating
shall be based upon the loss of sight before correction.
(3) Every worker whose accident results in damage to or destruction
of an artificial limb, eye, or tooth, shall have same repaired or
replaced.
(4) Every worker whose hearing aid or eyeglasses or lenses are
damaged, destroyed, or lost as a result of an industrial accident shall
have the same restored or replaced. The department or self-insurer, as
the case may be, shall be liable only for the cost of restoring damaged
hearing aids or eyeglasses to their condition at the time of the
accident.
(5) All mechanical appliances necessary in the treatment of an
injured worker, such as braces, belts, casts, and crutches, shall be
provided and all mechanical appliances required as permanent equipment
after treatment has been completed shall continue to be provided or
replaced without regard to the date of injury or date treatment was
completed, notwithstanding any other provision of law.
(6) A worker, whose injury is of such short duration as to bring
him or her within the time limit provisions of RCW 51.32.090, shall
nevertheless receive during the omitted period medical, surgical, and
hospital care and service and transportation under the provisions of
this chapter.
(7) Whenever in the sole discretion of the ((supervisor))
department or self-insurer, as the case may be, it is reasonable and
necessary to provide residence modifications necessary to meet the
needs and requirements of the worker who has sustained catastrophic
injury, the department or self-insurer may ((be ordered to)) pay an
amount not to exceed the state's average annual wage for one year as
determined under RCW 50.04.355((, as now existing or hereafter
amended,)) toward the cost of such modifications or construction. Such
payment shall only be made for the construction or modification of a
residence in which the injured worker resides. Only one residence of
any worker may be modified or constructed under this subsection,
although ((the supervisor may order)) there may be more than one
payment for any one home, up to the maximum amount permitted by this
section.
(8)(a) Whenever in the sole discretion of the ((supervisor))
department or self-insurer, as the case may be, it is reasonable and
necessary to modify a motor vehicle owned by a worker who has become an
amputee or becomes paralyzed because of an industrial injury, the
((supervisor may order)) department or self-insurer may pay up to fifty
percent of the state's average annual wage for one year, as determined
under RCW 50.04.355, ((to be paid by the department or self-insurer))
toward the costs thereof.
(b) In the sole discretion of the ((supervisor)) department or
self-insurer, as the case may be, after ((his or her)) its review, the
amount paid under this subsection may be increased by no more than four
thousand dollars by written order ((of the supervisor)).
(9) The benefits provided by subsections (7) and (8) of this
section are available to any otherwise eligible worker regardless of
the date of industrial injury.
Sec. 45 RCW 51.36.060 and 1991 c 89 s 3 are each amended to read
as follows:
Physicians examining or attending injured workers under this title
shall comply with rules and regulations adopted by the director, and
shall make such reports as may be requested by the department or self-insurer upon the condition or treatment of any such worker, or upon any
other matters concerning such workers in their care. Except under RCW
49.17.210 and 49.17.250, all medical information in the possession or
control of any person and relevant to the particular injury in the
opinion of the department or self-insurer pertaining to any worker
whose injury or occupational disease is the basis of a claim under this
title shall be made available at any stage of the proceedings to the
employer, the claimant's representative, and the department upon
request, and no person shall incur any legal liability by reason of
releasing such information.
Sec. 46 RCW 51.36.070 and 2001 c 152 s 2 are each amended to read
as follows:
Whenever the ((director)) department or the self-insurer, as the
case may be, deems it necessary in order to resolve any medical issue,
a worker shall submit to examination by a physician or physicians
selected by the ((director)) department or self-insurer, with the
rendition of a report to the person ordering the examination. The
department or self-insurer shall provide the physician performing an
examination with all relevant medical records from the worker's claim
file. ((The director, in his or her discretion, may charge)) The cost
of such examination ((or examinations to the self-insurer or to the
medical aid fund as the case may be)) shall be borne by the self-
insurer in a self-insured claim. The cost of said examination shall
include payment to the worker of reasonable expenses connected
therewith.
Sec. 47 RCW 51.48.017 and 1985 c 347 s 3 are each amended to read
as follows:
(1) If a self-insurer unreasonably delays or refuses to ((pay))
provide benefits to the worker as they become due ((there shall be paid
by the self-insurer upon order of the director)), but not after an
order closing the claim has become final by operation of law, the
department may order the self-insured employer to pay an additional
amount equal to five hundred dollars or twenty-five percent of the
amount then due, whichever is greater, which shall accrue for the
benefit of the claimant and shall be paid to him with the benefits
which may be assessed under this title. ((The director shall issue an
order determining whether there was an unreasonable delay or refusal to
pay benefits within thirty days upon the request of the claimant. Such
an order))
(2) The department may summarily deny a request for penalties if on
its face it is deemed frivolous, in all other cases the department
shall require the self-insured employer to file a written, substantive
response. In such event, the self-insured employer shall have twenty
working days to provide relevant documents to the department and
respond to the request for penalties by the claimant. The department
shall issue an order determining whether there was an unreasonable
delay or refusal to pay benefits within sixty days after receipt of the
documents requested from the self-insurer. Failure of the department
to review the request and issue a timely order shall result in the
issuance of an order denying the request for penalties. Any order
under this section shall conform to the requirements of RCW 51.52.050.
Sec. 48 RCW 51.48.040 and 2003 c 53 s 282 are each amended to
read as follows:
(1) The books, records and payrolls of the employer pertinent to
the administration of this title shall always be open to inspection by
the department or its traveling auditor, agent or assistant, for the
purpose of ascertaining the correctness of the payroll, the persons
employed, and such other information as may be necessary for the
department and its management under this title.
(2) Refusal on the part of the employer to submit his or her books,
records and payrolls for such inspection to the department, or any
assistant presenting written authority from the director, shall subject
the offending employer to a penalty determined by the director but not
to exceed two hundred fifty dollars for each offense and the individual
who personally gives such refusal is guilty of a misdemeanor.
(3) Any employer who fails to allow adequate inspection in
accordance with the requirements of this section is subject to having
its certificate of coverage revoked by order of the department and is
forever barred from questioning in any proceeding in front of the board
of industrial insurance appeals or any court, the correctness of any
assessment by the department based on any period for which such records
have not been produced for inspection.
(4) Claims processing practices of self-insured employers are
subject to audit by the department. Supporting documentation and
records shall be maintained in accordance with RCW 51.14.110.
(5) Audits of self-insured employers by the department shall be
conducted as necessary to determine compliance with this title and
rules adopted by the department to carry out the purposes of this
title, but shall not disturb any prior final orders issued in good
faith by the self-insured employer that have become final by operation
of law.
Sec. 49 RCW 51.48.080 and 1985 c 347 s 7 are each amended to read
as follows:
(1) Every person, firm or corporation who violates or fails to
obey, observe or comply with any rule of the department ((promulgated))
adopted under authority of this title, shall be subject to a penalty of
not to exceed five hundred dollars.
(2) The department may impose penalties against a self-insured
employer when it determines by audit pursuant to RCW 51.48.040 that the
self-insured employer has:
(a) Failed to pay or provide benefits to a worker or on a worker's
behalf on a timely basis;
(b) Paid its injured workers monetary benefits in incorrect
amounts;
(c) Failed to issue allowance or rejection orders on a timely
basis;
(d) Failed to issue orders closing a claim within sixty days after
the attending physician has found an injured worker to be fixed and
stable and a permanent disability level has been established by a
preponderance of the medical evidence.
(3) Self-insured employer audits discovering claims processing and
clerical errors not involving violations set forth in subsection (2)(a)
through (d) of this section are not subject to assessment of penalties.
(4) The department shall adopt a schedule of penalties that will
take into account the severity and number of violations.
(5) Orders imposing penalties for violations described in this
section shall conform to the requirements of RCW 51.52.050.
Sec. 50 RCW 51.52.050 and 1987 c 151 s 1 are each amended to read
as follows:
(1) Except as provided in RCW 51.32.095, whenever the department or
self-insurer has made any order, decision, or award, it shall promptly
serve the worker, beneficiary, employer, or other person affected
thereby, with a copy thereof by mail, which shall be addressed to such
person at his or her last known address as shown by the records of the
department or self-insurer, as the case may be. The copy, in case the
same is a final order, decision, or award, shall bear on the same side
of the same page on which is found the amount of the award, a
statement, set in black faced type of at least ten point body or size,
that such final order, decision, or award shall become final within
sixty days from the date the order is communicated to the parties
unless a written request for reconsideration is filed with the
department of labor and industries, Olympia, and in cases involving a
self-insurer with the self-insurer, or an appeal is filed with the
board of industrial insurance appeals, Olympia((: 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) Except as provided in RCW 51.32.095, whenever the department or
self-insurer 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. 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.
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) Except as provided in RCW 51.32.095, if the department is
requested to reconsider an order issued by a self-insurer, the
department must issue an order affirming, modifying, reversing, or
remanding the order within sixty days of receipt of the request.
However, for good cause, the department may once extend the time for
issuing an order for an additional thirty days. The self-insurer's
order shall be affirmed if it is supported by substantial evidence in
the claim file. If the department fails to issue an order within the
time frames specified in this section, the self-insurer's order is
deemed affirmed, subject to appeal. Upon receipt of a request for
reconsideration, the department shall notify all parties of the date
the department received the request and the date upon which the self-insurer's order will be deemed affirmed if the department fails to take
action. The notice shall also inform the parties that any appeal
pursuant to RCW 51.52.060 must be filed within sixty days from the date
the order is deemed affirmed. If such appeal is filed, the department
may not direct submission of further evidence under RCW 51.52.060.
Sec. 51 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:
(1)(a) Except as otherwise specifically provided in this section,
a worker, beneficiary, employer, health services provider, or other
person aggrieved by an order, decision, or award of the department or
self-insurer must, before he or she appeals to the courts, file with
the board and the director, by mail or personally, and in cases
involving a self-insurer, with the self-insurer, within sixty days from
the day on which a copy of the order, decision, or award was
communicated to such person, a notice of appeal to the board. However,
a health services provider or other person aggrieved by a department
order or decision making demand, whether with or without penalty,
solely for repayment of sums paid to a provider of medical, dental,
vocational, or other health services rendered to an industrially
injured worker must, before he or she appeals to the courts, file with
the board and the director, by mail or personally, within twenty days
from the day on which a copy of the order or decision was communicated
to the health services provider upon whom the department order or
decision was served, a notice of appeal to the board.
(b) Failure to file a notice of appeal with ((both)) the board
((and)), the department, and the self-insurer, if applicable, shall not
be grounds for denying the appeal if the notice of appeal is filed with
((either)) the board ((or)), the department, or the self-insurer. If
the notice of appeal does not demonstrate, on its face, that it was
sent to the department, the board, and the self-insurer, if applicable,
the recipient shall forward a copy of the notice to the other parties
not served.
(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.
Sec. 52 RCW 51.52.070 and 1977 ex.s. c 350 s 77 are each amended
to read as follows:
The notice of appeal to the board shall set forth in full detail
the grounds upon which the person appealing considers such order,
decision, or award is unjust or unlawful, and shall include every issue
to be considered by the board, and it must contain a detailed statement
of facts upon which such worker, beneficiary, employer, or other person
relies in support thereof. The worker, beneficiary, employer, or other
person shall be deemed to have waived all objections or irregularities
concerning the matter on which such appeal is taken other than those
specifically set forth in such notice of appeal or appearing in the
records of the department or self-insurer. The department or self-insurer shall promptly transmit its original record, or a legible copy
thereof produced by mechanical, photographic, or electronic means, in
such matter to the board.
Sec. 53 RCW 51.52.080 and 1971 ex.s. c 289 s 69 are each amended
to read as follows:
If the notice of appeal raises no issue or issues of fact and the
board finds that the department or self-insurer properly and lawfully
decided all matters raised by such appeal it may, without further
hearing, deny the same and confirm the ((department's)) decision or
award, or if the ((department's)) record sustains the contention of the
person appealing to the board, it may, without further hearing, allow
the relief asked in such appeal; otherwise, it shall grant the appeal.
NEW SECTION. Sec. 54 A new section is added to chapter 51.14 RCW
to read as follows:
For purposes of this title, "department or self-insurer, as the
case may be," means the department in claims insured by the state fund,
and the self-insurer in claims self-insured by the employer.
NEW SECTION. Sec. 55 RCW 51.32.190 (Self-insurers -- Notice of
denial of claim, reasons -- Procedure -- Powers and duties of director) and
1996 c 58 s 2, 1982 1st ex.s. c 20 s 3, 1977 ex.s. c 350 s 54, 1972
ex.s. c 43 s 25, & 1971 ex.s. c 289 s 47 are each repealed.
NEW SECTION. Sec. 56 This act takes effect January 1, 2005.