E2SHB 3139 -
By Senators Murray, McAuliffe, Hobbs, Marr, Berkey, Rasmussen, Rockefeller, Eide, Holmquist, Haugen, Shin, Kilmer, and Kastama
PULLED 03/07/2008
On page 2, line 27 of the amendment, after "stay." insert "If a self-insured employer prevails on the merits, any benefits paid may be recouped pursuant to RCW 51.32.240."
Beginning on page 3, line 15 of the amendment, strike all of section 2 and insert the following:
"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) 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.
(a) 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 a self-insurer, the self-insurer shall be
reimbursed the amount waived from the self-insured employer overpayment
reimbursement fund.
(b) The department shall collect information regarding self-insured
claim overpayments resulting from final decisions of the board and the
courts, and 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-insurer 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.
(c) If a self-insurer is not fully reimbursed within twenty-four
months of the final decision of the board or court 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 self-insured employer overpayment reimbursement fund.
(d) This act is null and void unless sections 3 and 4 of this act
are enacted.
(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."
On page 8, after line 23 of the amendment, insert the following:
"NEW SECTION. Sec. 3 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
self-insured employer shall retain from the earnings of each of its
workers 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. These moneys shall only be retained from employees and
remitted to the department in such manner and at such intervals as the
department directs and shall be placed in the self-insured employer
overpayment reimbursement fund. 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 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 this section may be retained from the earnings
of workers covered under RCW 51.16.210.
NEW SECTION. Sec. 4 A new section is added to chapter 54.44 RCW
to read as follows:
The self-insured employer overpayment reimbursement fund is created
in the custody of the state treasurer. Expenditures from the account
may be used only for reimbursing self-insured employers for benefits
overpaid to injured workers during the pendency of board or court
appeals in which the 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."
Renumber the remaining sections consecutively and correct any internal references accordingly.
E2SHB 3139 -
By Senators Murray, McAuliffe, Hobbs, Marr, Berkey, Rasmussen, Rockefeller, Eide, Holmquist, Haugen, Shin, Kilmer, and Kastama
PULLED 03/07/2008
On page 9, line 19 of the title amendment, after "51.32.240;" insert "adding a new section to chapter 51.32 RCW; adding a new section to chapter 51.44 RCW;"