BILL REQ. #: H-0757.1
State of Washington | 62nd Legislature | 2011 Regular Session |
Read first time 02/04/11. Referred to Committee on Labor & Workforce Development.
AN ACT Relating to workers' compensation payments and records; amending RCW 51.32.220 and 51.48.017; adding new sections to chapter 51.32 RCW; and prescribing penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 A new section is added to chapter 51.32 RCW
to read as follows:
(1) Every self-insured employer shall maintain a place of business
in this state where the employer shall keep complete records of all
claims for compensation, administered by the employer under this
chapter. A self-insured employer may, under procedures established by
the department, keep such records in this state at places operated by
service companies. The records must be retained in, and may be removed
from, this state or disposed of, in accordance with rules established
by the director. Such records must be available to the director for
examination and audit at all reasonable times upon notice by the
director to the employer.
(2) With the permission of the director, a self-insured employer
may keep all claims records and process claims from a location outside
of the state. The director shall by rule prescribe the conditions and
procedure for obtaining permission of the director. At a minimum these
rules require that the employer shall make the files available for
inspection, within five days, within the state at a location requested
by the department, the injured worker or their beneficiary, or their
representatives. The expense of producing these records must be borne
by the employer. The director may revoke permission for failure of the
employer to comply with the rules. Such revocation must comply with
RCW 51.52.050. If the permission of an employer is revoked by the
director, the employer shall be allowed sixty days after the issuance
of the order to comply with subsection (1) of this section. The
expenses of examining and auditing the records of a self-insured
employer outside of this state must be paid by the employer.
(3) Notwithstanding subsection (1) of this section, a self-insured
employer may not have at any one time more than three locations where
claims are processed or records are maintained.
NEW SECTION. Sec. 2 A new section is added to chapter 51.32 RCW
to read as follows:
The director must assess against a self-insured employer who fails
to comply with section 1 of this act a penalty of five hundred dollars
per day for each day such failure continues. Where the failure to
comply is in reference to the request of an injured worker or their
beneficiary to inspect the file, such penalty must be awarded to the
injured worker or beneficiary.
NEW SECTION. Sec. 3 A new section is added to chapter 51.32 RCW
to read as follows:
An employer must establish proof with the director that the
employer:
(1) Has an adequate staff qualified to process claims promptly and
has the financial ability to make certain the prompt payment of all
compensation and other payments that may become due to the director
under this chapter.
(2) Where a service company is retained to administer claims on
behalf of a self-insured employer, the self-insured employer shall
demonstrate proof that the administrator the employer has retained has
an adequate staff qualified to process claims promptly.
NEW SECTION. Sec. 4 A new section is added to chapter 51.32 RCW
to read as follows:
When an employer or its representatives or agents requests a report
or other information in writing, or conducts an oral conversation with
a medical provider, the employer shall provide to the claimant a copy
of a written report from, or a memorandum describing any oral
conversation with a medical provider, within five days of the receipt
for the report or the communication with the medical provider,
whichever is shorter. This information must be provided regardless of
the source of the information, any claim of privilege or attorney work
product.
Sec. 5 RCW 51.32.220 and 2007 c 255 s 1 are each amended to read
as follows:
(1) For persons receiving compensation for temporary or permanent
total disability pursuant to the provisions of this chapter, such
compensation shall be reduced by an amount equal to the benefits
payable under the federal old-age, survivors, and disability insurance
act as now or hereafter amended not to exceed the amount of the
reduction established pursuant to 42 U.S.C. Sec. 424a. However, such
reduction shall not apply when the combined compensation provided
pursuant to this chapter and the federal old-age, survivors, and
disability insurance act is less than the total benefits to which the
federal reduction would apply, pursuant to 42 U.S.C. 424a. Where any
person described in this section refuses to authorize the release of
information concerning the amount of benefits payable under said
federal act the department's estimate of said amount shall be deemed to
be correct unless and until the actual amount is established and no
adjustment shall be made for any period of time covered by any such
refusal.
(2) Any reduction under subsection (1) of this section shall be
effective the month following the month in which the department or
self-insurer is notified by the federal social security administration
that the person is receiving disability benefits under the federal old-age, survivors, and disability insurance act: PROVIDED, That in the
event of an overpayment of benefits the department or self-insurer may
not recover more than the overpayments for the six months immediately
preceding the date the department or self-insurer notifies the worker
that an overpayment has occurred: PROVIDED FURTHER, That upon
determining that there has been an overpayment, the department or self-insurer shall immediately notify the person who received the
overpayment that he or she shall be required to make repayment pursuant
to this section and RCW 51.32.230.
(3) Recovery of any overpayment must be taken from future temporary
or permanent total disability benefits or permanent partial disability
benefits provided by this title. In the case of temporary or permanent
total disability benefits, the recovery shall not exceed twenty-five
percent of the monthly amount due from the department or self-insurer
or one-sixth of the total overpayment, whichever is the lesser.
(4) No reduction may be made unless the worker receives notice of
the reduction prior to the month in which the reduction is made.
(5) In no event shall the reduction reduce total benefits to less
than the greater amount the worker may be entitled to under this title
or the federal old-age, survivors, and disability insurance act.
(6) The director, 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 overpayment where the recovery would be against
equity and good conscience.
(7) Subsection (1) of this section applies to:
(a) Workers under the age of sixty-two whose effective entitlement
to total disability compensation begins before January 2, 1983;
(b) Workers under the age of sixty-five whose effective entitlement
to total disability compensation begins after January 1, 1983; and
(c) Workers who will become sixty-five years of age on or after
June 10, 2004.
(8)(a) If the federal social security administration makes a
retroactive reduction in the federal social security disability benefit
entitlement of a worker for periods of temporary total, temporary
partial, or total permanent disability for which the department or
self-insurer also reduced the worker's benefit amounts under this
section, the department or self-insurer, as the case may be, shall make
adjustments in the calculation of benefits and pay the additional
benefits to the worker as appropriate. However, the department or
self-insurer shall not make changes in the calculation or pay
additional benefits unless the worker submits a written request, along
with documentation satisfactory to the director of an overpayment
assessment by the social security administration, to the department or
self-insurer, as the case may be.
(b) Additional benefits paid under this subsection:
(i) Are paid without interest and without regard to whether the
worker's claim under this title is closed; and
(ii) Do not affect the status or the date of the claim's closure.
(c) This subsection does not apply to requests on claims for which
a determination on the request has been made and is not subject to
further appeal.
(9) If the department or self-insured employer issues an order
which results in an overpayment to the claimant, the department or the
self-insured employer, as the case may be, must itemize each
overpayment which will accrue as a result of the order. Any
overpayment not identified in the original order is deemed waived.
This subsection (9) does not apply to RCW 51.32.225. The order is
subject to the provisions of RCW 51.52.050.
Sec. 6 RCW 51.48.017 and 2010 c 8 s 14011 are each amended to
read as follows:
(1) If a self-insurer unreasonably delays or refuses to pay
benefits as they become due there shall be paid by the self-insurer
upon order of the director an additional amount equal to five
((hundred)) thousand dollars or twenty-five percent of the amount then
due, whichever is greater, which shall accrue for the benefit of the
claimant and shall be paid to him or her with the benefits which may be
assessed under this title. The reasonableness of the conduct must be
based on the totality of circumstances.
(2) Benefits include, but are not limited to, total temporary
disability or loss of earning power benefits, authorizing of treatment
or payment of medical bills, reimbursement for travel or other allowed
expenses, and permanent partial disability benefits. Unless otherwise
provided in this statute, an employer is required to respond to a
request for information, authorization, or payment within forty-eight
hours of the request, regardless of whether the request is oral,
electronic or in writing. Failure to timely respond to a request for
information is a violation of this section. Failure to comply with a
department order, within ten days of the issuance of that order, is a
violation of this section.
(3) The director shall issue an order determining whether there was
an unreasonable delay or refusal to pay benefits within thirty days
upon the request of the claimant. Such an order shall conform to the
requirements of RCW 51.52.050.
(4) A claimant is entitled to attorneys' fees and all reasonable
costs incurred before the department, the board of industrial insurance
appeals, or any appellate court, including but not limited to, expert
witness fees, for establishing entitlement under this section.