by Dave Kaplan

There's so much going on with your Association, I don't know where to begin!

I suppose I should start with the LEGISLATIVE SESSION, since that has the most impact on your organization's bottom line.

The list of workers' compensation bills proposed this session is almost endless in the scope and breadth of what's covered.  While WSIA and the Employer Coalition have put forward our proposals on Wage Simplification, Final Settlement Agreements, and a study of the increase in the number and total cost of pensions, only a few of our bills even got hearings.  None are likely to pass in this horrible political environment.

Just how bad is it this session?  Consider the following ideas that have gotten serious attention this session: restrictions on IME's and prohibiting ex parte contact in the management of a claim (without WRITTEN notification and injured worker buyoff); requiring employers to continue to pay benefits or include the value of the benefits in the definition of "wages" for the purposes of computing time loss (this is the so-called "banked-hours" issue); redefining "disability" because the trial attorneys didn't like a recent Washington Supreme Court decision; allowing Physician Assistants to sign off on claims involving time loss; providing the $150,000 additional death benefit for the beneficiaries of state employees who die from occupational diseases (now it's just injuries); changing the burden of proof on the rebuttable presumption regarding firefighter work exposures, and adding to the laundry list of cancers and conditions presumed to be caused by work related exposures/incidents; allowing the attorneys to get involved in claims earlier by obtaining all communications on a claim prior to it going to the BIIA, instead of just the claim file; requiring payment of attorney fees and costs if a claimant's attorney wins on medical issues; eliminate the Social Security offset; require the use of the wage at the time of injury for FUTURE payment of LEP benefits on a reopened claim, and prohibit the use of paid vacation, sick leave, etc. as part of consideration of being Kept on Salary; setting up an ombudsprogram for self-insured employers, despite not getting the expanded claims authority; requiring self-insured employers or State Fund to pay for medical treatment devices, including after the fact; defining and penalizing "claim suppression" by employers (a Department request bill); and the tripling of vocational benefits to $12,000 and expanding it to two years, with an option for injured workers to "opt-out" of receiving those benefits (a Governor/Department request bill).  These are but a few of the burdensome and expensive proposals that have been conjured up this session.  In fact, it's so bad that I've personally taken to lobbying and testifying much more this session than in the last five combined, in conjunction with our Lobbyist Kathleen Collins.

WSIA has been FIGHTING TO KEEP YOUR ASSESSMENT COSTS DOWN.  First, the Department announced at the last minute that your Administrative Assessments were going to up approximately 40%, including in-direct and direct costs from PRIOR years!  WSIA successfully stopped the charge for prior year costs, and reduced the costs associated with on-going charges; we effectively limited the increase to approximately a 25% increase.  Second, in administering the claims of insolvent employers, the Department was attributing a number of pensions to the Second Injury Fund, rather than against the surety of the insolvent employer.  The effect of that is that all self-insurers are assessed to pay for the Second Injury Fund costs (i.e. - socialized), where the individual, insolvent employer's surety got away without paying.  WSIA called the Department on this practice, and they promised to take a look at the issue.  Third, WSIA has successfully fought off a decrease in the Pension Discount rate from 6.5% (what it has been at for nearly 30 years) to 4.5%.  The net effect of changing the Pension Discount rate would be to require an additional $100 million from self-insurers to post against ALREADY FUNDED pensions.  Approximately $75 million of that cost would be in the form of Second Injury Fund assessments, and approximately $25 million would be on direct funded pensions.  Fourth, WSIA successfully got the Department to allow for the offset of reimbursement for the COLA on open time loss claims against the quarterly assessment for the Supplemental Pension Fund.  Our Assessments Committee has been battling to get the data we need from the Department so that we can propose a fair methodology for self-insurers to pay into the Supplemental Pension Fund -- the assessment of greatest cost to most self-insurers.

In response to the change in the self-insurance rules April 1, 2006, WSIA has been working to address the list of concerns regarding the Department's CLAIMS ADJUDICATOR CERTIFICATION.  This issue is covered in a number of places here at the website (FYI, President's Column), but I'll give you the short summary.  First, after about a 10 year fight, WSIA has pushed the Department into adopting rules that will allow for the maintenance of Claims Adjudicator Certification through a Continuing Education Units system.  While we were unable to avoid the initial certification requirement, the fact that the Department will allow for CEU's to maintain your certification is a HUGE step forward!  Second, in response to needs of the membership in passing the Department's test (and the limitations on being able to retake the test), WSIA has developed a study group or study course (for members only) to be held the day in advance of the test date.  Lastly, WSIA is preparing to address the concerns regarding the test itself: the application and application process; validity and layout and purpose of the test; and requirements for consideration of even being able to take the test.  We are proud of the efforts we have made on this issue, and we will continue to pursue all elements of our concerns until the Department adequately addresses them.

Lastly, I want to commend both the members of your LIAISON COMMITTEE (Tammy Vibbert of Lakeside Industries, and Karen Hintz of Sedgwick CMS) and the Department for taking steps to help facilitiate the prompt and thorough resolution of claims.  The result of our efforts in working with the Department are a series of claims facilitation checklists, that can be found thru a link on the homepage of the website.  These should help make sure that you have submitted the documentation the Department needs to issue orders on your claims, and issue those orders in a prompt fashion.  This is just SOME of the results you get when you refer your claims issues to the Committee!  Please, don't hesitate to send any of us an email with your specific claims issues.  You never know which ones will wind up helping ALL self-insurers!

There a lots of other things going on, but those listed above are by far the most significant to bring to your attention for now.

Please check back here once a month for updated thoughts and a rundown of what your Association is doing on behalf of your organization!

Posted 23 February 2007

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