2SHB 3139 -
By Representative Condotta
FAILED 02/19/2008
Strike everything after the enacting clause and insert the following:
"Sec. 1 RCW 51.32.240 and 2004 c 243 s 7 are each amended to read
as follows:
(1)(a) 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 willful misrepresentation, 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.
(b) Except as provided in subsections (3), (4), and (5) of this
section, the department may only assess an overpayment of benefits
because of adjudicator error when the order upon which the overpayment
is based is not yet final as provided in RCW 51.52.050 and 51.52.060.
"Adjudicator error" includes the failure to consider information in the
claim file, failure to secure adequate information, or an error in
judgment.
(c) The director, 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 fails to pay benefits
because of clerical error, mistake of identity, or innocent
misrepresentation, all not induced by recipient willful
misrepresentation, 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 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. Adjustments due to adjudicator error are addressed
by the filing of a written request for reconsideration with the
department of labor and industries or an appeal with the board of
industrial insurance appeals within sixty days from the date the order
is communicated as provided in RCW 51.52.050. "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 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, 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 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)) whether
state fund or self-insured. The director, 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, however, if the director waives in
whole or in part any such payments due to a self-insured employer, the
employer shall be reimbursed the amount waived from the employer
overpayment reimbursement fund. The department shall collect
information regarding self-insured claim overpayments resulting from
final decisions of the board of industrial insurance appeals and the
courts, and at a self-insurer's request, recoup such overpayments on
behalf of the self-insurer from any open, new, or reopened state fund
or self-insured claims. The department shall forward the amounts
collected to the self-insured employer to whom the payment is owed.
The department may provide information as needed to any self-insurers
from whom payments may be collected on behalf of the department or
another self-insurer. Notwithstanding RCW 51.32.040, any self-insurer
requested by the department to forward payments to the department
pursuant to this subsection shall pay the department directly. The
department shall credit the amounts recovered to the appropriate fund,
or forward amounts collected to the appropriate self-insurer, as the
case may be. If a self-insurer is not fully reimbursed within eighteen
months of the final decision of the board or court order through the
collection process pursuant to this subsection and by means of
processes pursuant to subsection (6) of this section, the self-insurer
shall be reimbursed for the remainder of the amount due from the
employer overpayment reimbursement fund. The fund shall also reimburse
the self-insured employer its reasonable attorney fees in pursuing
payment under this subsection or subsection (6) of this section.
(5)(a) Whenever any payment of benefits under this title has been
induced by willful misrepresentation 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 willful misrepresentation
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 willful misrepresentation.
(b) For purposes of this subsection (5), it is willful
misrepresentation for a person to obtain payments or other benefits
under this title in an amount greater than that to which the person
otherwise would be entitled. Willful misrepresentation includes:
(i) Willful false statement; or
(ii) Willful misrepresentation, omission, or concealment of any
material fact.
(c) For purposes of this subsection (5), "willful" means a
conscious or deliberate false statement, misrepresentation, omission,
or concealment of a material fact with the specific intent of
obtaining, continuing, or increasing benefits under this title.
(d) For purposes of this subsection (5), failure to disclose a
work-type activity must be willful in order for a misrepresentation to
have occurred.
(e) For purposes of this subsection (5), a material fact is one
which would result in additional, increased, or continued benefits,
including but not limited to facts about physical restrictions, or
work-type activities which either result in wages or income or would be
reasonably expected to do so. Wages or income include the receipt of
any goods or services. For a work-type activity to be reasonably
expected to result in wages or income, a pattern of repeated activity
must exist. For those activities that would reasonably be expected to
result in wages or produce income, but for which actual wage or income
information cannot be reasonably determined, the department shall
impute wages pursuant to RCW 51.08.178(4).
(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, or self-insurer 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 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, or self-insurer 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, 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, 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, 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. 2 RCW 51.52.050 and 2004 c 243 s 8 are each amended to read
as follows:
(1) Whenever the department 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. 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, 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)(a) Whenever the department 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)).
(b) An employer appeal of a department order shall operate as a
stay of the order except:
(i) An employer appeal of an order awarding temporary total
disability benefits shall not operate as a stay of temporary total
disability benefits, and such temporary total disability benefits shall
be paid no later than fifteen days after the board grants the appeal,
unless an employer moves for a stay of the department's order within
fifteen days after the board grants the appeal. Any employer may move
for a stay of the order, in whole or in part. The board shall review
the department's file as it existed as of the date of the order on
appeal, and issue a written order granting or denying the stay within
fifteen days of receipt of the motion. The board shall grant the
motion if the department's file demonstrates the issues on appeal are
debatable or if the hardship to the moving party if the stay were not
granted is greater than the hardship to the nonmoving party if the stay
were granted. If the board denies the motion for stay, the board shall
reconsider the motion one hundred eighty days after issuance of the
order denying the stay if a proposed decision and order on the merits
of the appeal has not been issued. If the board denies a motion to
stay payment of benefits, the board shall refer the appeal for
scheduling of hearings and shall not place the case in mediation
pursuant to RCW 51.52.095, unless requested and agreed by the parties.
Notwithstanding the denial of a stay, temporary total disability
benefits shall be terminated if changed circumstances indicate the
worker is not totally disabled. If the self-insured employer prevails
in the appeal on the merits, any benefits paid may be recouped pursuant
to RCW 51.32.240.
(ii) If a self-insured employer appeals a department order only
setting the basis or rate of monthly compensation to a worker, the
appeal shall not be a stay of benefits not in dispute. The appeal
shall operate as a stay of payment of benefits in dispute, and such
benefits shall not be paid unless so ordered after the appeal on the
merits has been finally determined, or unless agreed by the parties.
(c) In an appeal from an order of the department that alleges
willful misrepresentation, 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.
Sec. 3 RCW 51.52.090 and 1971 ex.s. c 289 s 70 are each amended
to read as follows:
If the appeal is not denied within thirty days after the notice is
filed with the board, the appeal shall be deemed to have been
granted((: PROVIDED, That the board may extend the time within which
it may act upon such appeal, not exceeding thirty days)).
NEW SECTION. Sec. 4 A new section is added to chapter 51.32 RCW
to read as follows:
(1) Except as provided in subsection (2) of this section, each
employer shall retain from the earnings of each worker that amount as
shall be fixed from time to time by the director, the basis for
measuring said amount to be determined by the director. The money so
retained shall be remitted to the department in such manner and at such
intervals as the department directs and shall be placed in the employer
overpayment reimbursement fund. However, the state apprenticeship
council shall pay the entire amount into the employer overpayment
reimbursement fund for registered apprentices or trainees during their
participation in supplemental and related instruction classes. The
moneys so collected shall be used exclusively for reimbursement to the
accident fund, medical aid fund, reserve fund, and to self-insured
employers for benefits overpaid to injured workers during the pendency
of board or court appeals in which the department or self-insured
employer prevails, and shall be no more than necessary to make such
payments on a current basis.
(2) None of the amount assessed for the employer overpayment
reimbursement fund under RCW 51.16.210 may be retained from the
earnings of workers covered under RCW 51.16.210.
NEW SECTION. Sec. 5 A new section is added to chapter 51.44 RCW
to read as follows:
The employer overpayment reimbursement fund is created in the
custody of the state treasurer. Expenditures from the account may be
used only for reimbursing the accident fund, medical aid fund, reserve
fund, and self-insured employers for benefits overpaid to injured
workers during the pendency of board or court appeals in which the
department or self-insured employer prevails. Only the director or the
director's designee may authorize expenditures from the account. The
account is subject to allotment procedures under chapter 43.88 RCW, but
an appropriation is not required for expenditures.
NEW SECTION. Sec. 6 This act applies to orders issued on or
after the effective date of this act."
Correct the title.
EFFECT: Creates an employer overpayment reimbursement fund, from
workers' earnings, to reimburse self-insured employers and the state
fund for overpayments of benefits resulting from employer appeals.
Provides for payments from the fund for overpayments if a self-insured
employer is not reimbursed within 18 months through the process
established in current law or through the collection of overpayments
from other claims (as established in the Second Substitute Bill), as
well as attorneys' fees. Makes changes in the process for collection
of overpayments from other claims. Provides that if the director of
the Department of Labor and Industries waives the recovery of
overpayments due a self-insurer, the employer must also be reimbursed
from the fund.
Modifies payments of benefits on appeal procedures and standard.
Provides that an employer appeal operates as a stay, unless the appeal
is for temporary total disability benefits, in which case benefits must
be paid unless a stay is granted. Shortens the time to issue orders on
stay motions from 25 to 15 days. Changes the burden of proof on a stay
motion from more likely than not to prevail to that the issues on
appeal are debatable or if the hardship to the moving party is greater
than the hardship to the nonmoving party. Provides that if a stay is
granted, the Board of Industrial Insurance Appeals (Board) must
reconsider the stay within 180 days if a proposed decision on the
underlying appeal has not yet been issued. Provides that if the Board
denies a stay, the case is not placed in mediation unless agreed to by
the parties. Provides that temporary total disability benefits must be
terminated if changed circumstances indicate the worker is not totally
disabled. Strikes provision providing for payment of permanent partial
disability awards of amounts not in dispute.
Allows recoupment from health service providers and eliminates
provision providing for recoupment of overpayments from health
insurance entities.