ESHB 1725 -
By Committee on Labor, Commerce & Consumer Protection
ADOPTED 04/05/2011
Strike everything after the enacting clause and insert the following:
"Sec. 1 RCW 51.04.030 and 2004 c 65 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, including chiropractic care,
and including care provided by licensed advanced registered nurse
practitioners, 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 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 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 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,
licensed advanced registered nurse practitioner, 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 and its
associated billing or payment instructions and policies 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. 2 RCW 51.04.082 and 1986 c 9 s 2 are each amended to read as
follows:
Any notice or order required by this title to be mailed to any
employer may be served in the manner prescribed by law for personal
service of summons and complaint in the commencement of actions in the
superior courts of the state, but if the notice or order is mailed, it
shall be addressed to the address of the employer as shown by the
records of the department, or, if no such address is shown, to such
address as the department is able to ascertain by reasonable effort.
If requested by the employer, any notice or order may be sent by secure
electronic means except orders communicating the closure of a claim.
Correspondence and notices sent electronically are considered received
on the date sent by the department. Failure of the employer to receive
such notice or order whether served or mailed shall not release the
employer from any tax or any increases or penalties thereon.
Sec. 3 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 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 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 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 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 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, served
by ((registered or certified mail)) a method for which receipt can be
confirmed or tracked, 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 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
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, 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 for payments due to the state fund.
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)) a method for which receipt can be confirmed
or tracked; or by any authorized representatives of the director. 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, such property shall be
delivered forthwith to the director or the director's authorized
representative 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 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. 4 RCW 51.32.240 and 2008 c 280 s 2 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
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 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 first attempt at recovery 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) For purposes of this subsection, "recipient" does not include
health service providers whose treatment or services were authorized by
the department or self-insurer.
(e) The department or self-insurer shall first attempt recovery of
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.
(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)) a method for which receipt can be confirmed or
tracked 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. 5 RCW 51.48.120 and 1995 c 160 s 5 are each amended to read
as follows:
If any employer should default in any payment due to the state fund
the director or the director's designee may issue a notice of
assessment certifying the amount due, which notice shall be served upon
the employer by mailing such notice to the employer by ((certified
mail)) a method for which receipt can be confirmed or tracked to the
employer's last known address or served in the manner prescribed for
the service of a summons in a civil action. Such notice shall contain
the information that an appeal must be filed with the board of
industrial insurance appeals and the director by mail or personally
within thirty days of the date of service of the notice of assessment
in order to appeal the assessment unless a written request for
reconsideration is filed with the department of labor and industries.
Sec. 6 RCW 51.48.150 and 1995 c 160 s 6 are each amended to read
as follows:
The director or the director's designee is hereby authorized to
issue to any person, firm, corporation, municipal corporation,
political subdivision of the state, a public corporation, or any agency
of the state, a notice and order to withhold and deliver property of
any kind whatsoever when 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
any agency of the state, property which is or shall become due, owing,
or belonging to any employer upon whom a notice of assessment has been
served by the department for payments due to the state fund. The
effect of a notice and order to withhold and deliver shall be
continuous from the date such notice and order to withhold and deliver
is first made until the liability out of which such notice and order to
withhold and deliver arose is satisfied or becomes unenforceable
because of lapse of time. The department shall release the notice and
order to withhold and deliver when the liability out of which the
notice and order to withhold and deliver arose is satisfied or becomes
unenforceable by reason of lapse of time and shall notify the person
against whom the notice and order to withhold and deliver was made that
such notice and order to withhold and deliver has been released.
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)) a method for which receipt can be confirmed
or tracked, or by any duly authorized representatives of the director.
Any person, firm, corporation, municipal corporation, political
subdivision of the state, public corporation or any agency of the state
upon whom service has been made is hereby required to 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 a notice and order to
withhold and deliver, any property which may be subject to the claim of
the department, such property shall be delivered forthwith to the
director or the director's duly authorized representative upon service
of the notice to withhold and deliver which will be held in trust by
the director for application on the employer's indebtedness to the
department, or for return without interest, in accordance with a final
determination of a petition for review, or in the alternative such
party shall furnish a good and sufficient surety bond satisfactory to
the director conditioned upon final determination of liability. Should
any party served and named in the notice to withhold and deliver fail
to make answer to such notice and order to withhold and deliver, within
the time prescribed herein, it shall be lawful for the court, after the
time to answer such order has expired, to render judgment by default
against the party named in the notice to withhold and deliver for the
full amount claimed by the director in the notice to withhold and
deliver 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, then the employer shall be entitled to assert
in the answer to all exemptions provided for by chapter 6.27 RCW to
which the wage earner may be entitled.
Sec. 7 RCW 51.52.050 and 2008 c 280 s 1 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)) or if the worker, beneficiary,
employer, or other person affected thereby chooses, the department may
send correspondence and other legal notices by secure electronic means
except for orders communicating the closure of a claim. Persons who
choose to receive correspondence and other legal notices electronically
shall be provided information to assist them in ensuring all electronic
documents and communications are received. Correspondence and notices
must be addressed to such a person at his or her last known postal or
electronic address as shown by the records of the department.
Correspondence and notices sent electronically are considered received
on the date sent by 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. 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.
(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. If a
self-insured employer prevails on the merits, any benefits paid may be
recouped pursuant to RCW 51.32.240.
(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."
ESHB 1725 -
By Committee on Labor, Commerce & Consumer Protection
ADOPTED 04/05/2011
On page 1, line 2 of the title, after "program;" strike the remainder of the title and insert "and amending RCW 51.04.030, 51.04.082, 51.24.060, 51.32.240, 51.48.120, 51.48.150, and 51.52.050."