Workers' Compensation—General. The Industrial Insurance Act (Act) provides that a worker who is injured in the course of employment or injured or disabled from an occupational disease is entitled to workers compensation benefits. Benefits may include medical, temporary time-loss, vocational rehabilitation benefits, and permanent disabilities benefits. The Department of Labor and Industries (L&I) administers the workers' compensation system.
If a workplace accident occurs and the worker receives treatment from a physician or advanced registered nurse practitioner (ARNP), the worker must report the accident to the employer and the employer must report it to L&I. L&I must immediately notify the worker of the worker's rights to receive health services from a physician or an ARNP, and must list the types of providers authorized to provide services.
A physician or ARNP who attends an injured worker must inform the worker of the worker's rights under the Act and assist the worker in applying for benefits. A physician who attended the worker may file an application on behalf of a worker to L&I using facsimile mail.
Attending Providers. An injured worker is entitled to proper and necessary care from a physician or ARNP of the worker's choice and within L&I's medical provider network. Workers with open claims are required to have ongoing treatment from a provider in the network.
That provider is typically referred to as the worker's attending provider. The worker may receive care from a nonnetwork provider only for an initial office or emergency room visit.
The types of providers who may be attending providers are established in various parts of the Act and L&I rules. There is no definition of attending provider in the Act. L&I rules define attending provider as a person licensed to independently practice one or more of the following professions:
Other provider types may provide treatment, but may not be attending providers.
Attending providers are the only providers who may sign accident forms, initial reports, and certify time-loss compensation. L&I rules allow physician assistants to also sign any certificates, forms, or other required documents that the physician assistant's supervising physician may sign. However, a physician assistant may not rate permanent disability or impairment or perform independent medical examinations or consultations. In addition, only attending providers who are physicians or chiropractors can perform impairment ratings, which are exams conducted if a worker, after reaching maximum medical improvement, is left with permanent functional limitations.
The Act outlines other duties and obligations of a physician or ARNP who attends the injured worker. For example, the physician or ARNP may:
Mental Health Issues. Mental health treatment may be authorized for mental health conditions caused or aggravated by an accepted condition. For certain workers, there is a presumption that posttraumatic stress disorder is a compensable occupational disease. Psychologist have a doctorate degree, two years of supervised experience, and successfully complete an examination to be licensed.
Attending Providers. A definition of attending provider is created, and state licensed psychologists are added as attending providers for those claims that are solely for mental health conditions. Attending provider means a person who is:
Various references to "attending physician or licensed advanced registered nurse practitioner," "physician who attended the worker," and "provider" are replaced with the term "attending provider." This includes provisions regarding attending providers reviewing medical reports, certifying the worker's ability to perform work, providing input regarding participation in vocational rehabilitation, receiving reports on independent medical examinations, and submitting reports to L&I.
Other Changes. The provision specifying that any physician or licensed advanced registered nurse practitioner who examined or treated the worker may be required to testify in a hearing is broadened to include any health service provider who examined or treated the worker.
L&I's form notifying the injured worker of the right to services is changed to reference the right to receive health services from a provider, rather than only from a physician or ARNP.
The provision allowing physicians to transmit applications to L&I electronically using facsimile is removed and instead, applications for benefits may be transmitted electronically.