S-2173               _______________________________________________

                                         SUBSTITUTE SENATE BILL NO. 5280

                        _______________________________________________

State of Washington                              50th Legislature                              1987 Regular Session

By Senate Committee on Commerce & Labor (originally sponsored by Senators Tanner, Deccio, Vognild, Smitherman and Newhouse)

Read first time 3/2/87.

AN ACT Relating to industrial insurance; amending RCW 51.32.110; and adding a new section to chapter 51.52 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

        Sec. 1.  Section 11, chapter 14, Laws of 1980 and RCW 51.32.110 are each amended to read as follows:

          Any worker entitled to receive any benefits or claiming such under this title shall, if requested by the department or self-insurer, submit himself or herself for medical examination, at a time and from time to time, at a place reasonably convenient for the worker and as may be provided by the rules of the department.  If the worker refuses to submit to medical examination, or obstructs the same, or, if any injured worker shall persist in unsanitary or injurious practices which tend to imperil or retard his or her recovery, or shall refuse to submit to such medical or surgical treatment as is reasonably essential to his or her recovery or refuse or obstruct evaluation or examination for the purpose of vocational rehabilitation or does not cooperate in reasonable efforts at such rehabilitation, the department, with notice to the worker, or the self-insurer ((upon approval by the department)), with notice to the worker and the department may suspend any further action on any claim of such worker so long as such refusal, obstruction, noncooperation, or practice continues and reduce, suspend, or deny any compensation for such period:  PROVIDED, That the  department or the self-insurer shall not suspend any further action on any claim of a worker or reduce, suspend, or deny any compensation if a worker has good cause for refusing to submit to or to obstruct any examination, evaluation, treatment or practice requested by the department or the self-insurer, or required under this section.  When a self-insured employer reduces, suspends or denies any compensation under this section, the self-insurer shall enter a written order, communicated to the worker and the department's self-insurance section.  The order shall contain the following statement clearly set forth in bold face type:  "This order constitutes notification that your compensation benefits are being reduced, suspended or denied for failure to cooperate in accordance with RCW 51.32.110.  If, for any reason, you disagree with this determination, you may protest in writing to the Department of Labor and Industries, Self-Insurance Section, within sixty days of the date you received this order."  In the event the department receives such a protest, the department shall investigate and review the claim evidence and enter a determinative order as provided for in RCW 51.52.050:  PROVIDED, That the worker must be advised in writing by the self-insurer of the consequences for failure to cooperate prior to the effective date of the reduction, suspension or denial of compensation and be allowed a reasonable time for compliance:  AND PROVIDED FURTHER, If the department determines that the self-insurer has improperly reduced, suspended or denied benefits as they became due or such reduction, suspension or denial is not in compliance with this section then, upon order of the department, the self-insurer shall pay an additional amount equal to the greater of five hundred dollars or the amount of the benefits otherwise due.  If the worker necessarily incurs traveling expenses in attending ((for)) examination ((pursuant to the request of the department)), such traveling expenses shall be repaid to him or her out of the accident fund upon proper voucher and audit or shall be repaid by the self-insurer, as the case may be.

          If the medical examination required by this section causes the worker to be absent from his or her work without pay he or she shall be paid for such time lost in accordance with the schedule of payments provided in RCW 51.32.090 as amended.

NEW SECTION. Sec. 2.  A new section is added to chapter 51.52 RCW to read as follows:

          In addition to appeals by a person aggrieved by an order, decision or award of the department, a self-insurer or the department may petition the board for an order determining whether the department or the self-insurer is required to pay benefits under this title pursuant to a particular claim:  PROVIDED, That, pending final resolution of the dispute or closure of the claim, whichever first occurs, prompt payment of benefits shall be made as required by this title by either the department or self-insurer according to the coverage of the employer where the claim is filed and according to whether the claim on its face is a claim based on a new injury or occupational disease or a request for reopening of a previous claim.

          If upon final determination the entity who has paid benefits under this title is determined not responsible for the claim, they shall be reimbursed by the responsible entity for all amounts paid to the point of final determination.