E2SHB 3139 -
By Committee on Labor, Commerce, Research & Development
NOT ADOPTED 03/07/2008
Strike everything after the enacting clause and insert the following:
"Sec. 1 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 order by the department awarding benefits shall become
effective and benefits due on the date issued. Subject to (b)(i) and
(ii) of this subsection, if the department order is appealed the order
shall not be stayed pending a final decision on the merits unless
ordered by the board. Upon issuance of the order granting the appeal,
the board will provide the worker with notice concerning the potential
of an overpayment of benefits paid pending the outcome of the appeal
and the requirements for interest on unpaid benefits pursuant to RCW
51.52.135. A worker may request that benefits cease pending appeal at
any time following the employer's motion for stay or the board's order
granting appeal. The request must be submitted in writing to the
employer, the board, and the department. Any employer may move for a
stay of the order on appeal, in whole or in part. The motion must be
filed within fifteen days of the order granting appeal. The board
shall conduct an expedited review of the claim file provided by the
department as it existed on the date of the department order. The
board shall issue a final decision within twenty-five days of the
filing of the motion for stay or the order granting appeal, whichever
is later. The board's final decision may be appealed to superior court
in accordance with RCW 51.52.110. The board shall grant a motion to
stay if the moving party demonstrates that it is more likely than not
to prevail on the facts as they existed at the time of the order on
appeal. The board shall not consider the likelihood of recoupment of
benefits as a basis to grant or deny a motion to stay.
(i) If upon reconsideration requested by a worker or medical
provider, the department has ordered an increase in a permanent partial
disability award from the amount reflected in an earlier order, the
award reflected in the earlier order shall not be stayed pending a
final decision on the merits. However, the increase is stayed without
further action by the board pending a final decision on the merits.
(ii) If any party appeals an order establishing a worker's wages or
the compensation rate at which a worker will be paid temporary or
permanent total disability or loss of earning power benefits, the
worker shall receive payment pending a final decision on the merits
based on the following:
(A) When the employer is self-insured, the wage calculation or
compensation rate the employer most recently submitted to the
department; or
(B) When the employer is insured through the state fund, the
highest wage amount or compensation rate uncontested by the parties.
Payment of benefits or consideration of wages at a rate that is
higher than that specified in (b)(ii)(A) or (B) of this subsection is
stayed without further action by the board pending a final decision on
the merits.
(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. 2 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 or her 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)(a) 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 funded or self-insured.
(b) The department shall establish procedures by rule to collect
information concerning self-insured claim overpayments resulting from
decisions of the board or court, and to recoup such overpayments from
state fund claims. If recovery is made in whole or in part on behalf
of a self-insurer from a worker's state fund claim, the amount
recovered shall be paid to the self-insurer by the department. The
department may provide overpayment information to a self-insurer when
the worker is entitled to benefits from which the self-insurer can
collect the amount due, in whole or in part, on behalf of the
department or another self-insurer. In these cases, the self-insurer
shall pay directly to the department any amounts recovered. The
department shall credit the amounts recovered to the appropriate
workers' compensation funds or shall forward any amounts collected on
behalf of another self-insurer, as the case may be.
(c) For purposes of this subsection, "recipient" does not include
health service providers whose treatment or services were authorized by
the department or self-insurer.
(d) The department or self-insurer may recover overpayments for
health services from any entity that provided health insurance to the
worker to the extent that the health insurance entity would have
provided health insurance benefits but for workers' compensation
coverage.
(e) 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.
(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.
NEW SECTION. Sec. 3 A new section is added to chapter 51.52 RCW
to read as follows:
(1) The department shall study appeals of workers' compensation
cases and collect information on the impacts of this act on state fund
and self-insured workers and employers. The study shall consider the
types of benefits that may be paid pending an appeal, and shall
include, but not be limited to:
(a) The frequency and outcomes of appeals;
(b) The duration of appeals and any procedural or process changes
made by the board to implement this act and expedite the process;
(c) The number of and amount of overpayments resulting from
decisions of the board or court; and
(d) The processes used and efforts made to recoup overpayments and
the results of those efforts.
(2) State fund and self-insured employers shall provide the
information requested by the department to conduct the study.
(3) The department shall report to the workers' compensation
advisory committee by July 1, 2009, on the preliminary results of the
study. By December 1, 2009, and annually thereafter, with the final
report due by December 1, 2011, the department shall report to the
workers' compensation advisory committee and the appropriate committees
of the legislature on the results of the study. The workers'
compensation advisory committee shall provide its recommendations for
addressing overpayments resulting from this act, including the need for
and ability to fund a permanent method to reimburse employer and state
fund overpayment costs.
NEW SECTION. Sec. 4 Section 2 of this act takes effect July 1,
2009.
NEW SECTION. Sec. 5 This act applies to orders issued on or
after the effective date of this section."
E2SHB 3139 -
By Committee on Labor, Commerce, Research & Development
NOT ADOPTED 03/07/2008
On page 1, line 1 of the title, after "appeal;" strike the remainder of the title and insert "amending RCW 51.52.050 and 51.32.240; adding a new section to chapter 51.52 RCW; creating a new section; and providing an effective date."