WSIA Submits Comments on Proposed

"Claim Suppression " and Vocational Rehabilitation Rules

Thank you to everyone who submitted comments and proposed changes to the "claim suppression and vocational rehabilitation pilot project rules.  WSIA consolidated your responses, added some of our own, and submitted them just prior to the January 31, 2008 deadline.  The Department is obligated to respond to every comment and question, and will hopefully take our thoughtful suggestions to heart when revising the rules and making them more workable.  Go to "CLAIM SUPPRESSION" to see those comments, and VOCATIONAL REHABILITATION to see those comments.

Department Clarifies "Granger" Decision

and Health Care Premium Payment Issue

After the Granger decision came out last year, and the Legislature passed a bill requiring employers to include the value of health care benefits at the time they stopped paying for them, there was confusion that arose over the payment of benefits by a monthly premium versus an hourly rate, and when that payment was considered to have "stopped."  The Department has a Management Update that speaks to this issue for clarification.  Go to MANAGEMENT UPDATE to read the information.

Vocational Rehabilitation Pilot Project

Information, Guidelines, Forms, Training, Draft Rules & Listserv

The new vocational rehabilitation pilot project began January 1, 2008.  There is a flood of information available to help you in complying with the requirements of the program.  Most information regarding all aspects of the project can be found at a special DLI webpage http://www.lni.wa.gov/ClaimsIns/Providers/Vocational/ImproveVoc/VIP.asp.  The scope of information covers everything from benefits provided, forms, process to have programs certified by the state as an approved vocational program, and other pertinent facts.

Until the draft rules have gone through the formal review process, the Department has adopted a specific set of guidelines for self-insured claims.  You can find them here at our website at http://www.wsiassn.org/documents/VocGuidelinesforSIEs_FINAL_4jan08_REVISED.pdf.  Please use these guidelines until the formal rules are adopted. [NOTE: THESE GUIDELINES HAVE BEEN REVISED TO ADDRESS ERRORS AND CONCERNS THAT WSIA EXPRESSED TO THE DEPARTMENT.  PLEASE USE THESE REVISED GUIDELINES.]

The new Self-Insured Vocational Reporting Form, a cover page that is to accompany all vocational communications with the Department, is posted at http://www.lni.wa.gov/forms/pdf/207190af.pdf.  This new form takes the place of the E.A.R.  Additionally, there will be a new Self-Insured Vocational Services Closing Form.  That has not yet posted, but can be found at http://www.lni.wa.gov/FormPub/results.asp?Keyword=self-insurance when it is.

After some discussions with the Department on January 10, formal training on the new vocational requirements is already being developed for self-administered and TPA self-insured claims adjudicators.  A focus group will be reviewing and providing feedback to the Department on the preliminary training program, some time before the end of the month.  Actual training for self-insured claims adjudicators will be provided in late-February, early March.  [NOTE: THIS IS A SLIGHT CHANGE FROM THE MID-FEBRUARY DATE PREVIOUSLY INDICATED BY THE DEPARTMENT.]

The draft rules have been out for awhile.  WSIA solicited your feedback back in October and November 2007, and submitted comments to the Department at that time.  As announced above, WSIA submitted responses to the proposed vocational rehabilitation rules.  You can find our comments here at VOCATIONAL REHABILITATION.

You can keep abreast of all issues related to the vocational pilot project by getting onto the special DLI Listserv with updated email information.  To make sure you get the most up to date information, sign up at http://www.lni.wa.gov/Main/Listservs/VocRehab.asp as soon as possible.

Lastly, there is a Vocational Fact Sheet put out from the Department earlier this week.  Here's the link to that document.  Fact Sheet

If you have any additional questions or concerns, please contact WSIA Executive Director Dave Kaplan at dave.kaplan@wsiassn.org as soon as possible.

Don't Shoot the Messenger!

Department Announces Initial Continuing Education Credits for Courses

The Department of Labor & Industries' Self-Insurance Section has finally reviewed the initial submittal of WSIA training programs for Continuing Education Credits to maintain the Certified Claims Administrator certification.  You can find the credits on a chart that WSIA will update periodically.  HERE is the link.   Only those courses taken after October 1, 2007 will be awarded CEC's by the Department.

It is important to remember that you can take any training programs and submit them to the Department for consideration for the awarding of CEC's.  If you pursue that approach, please be sure to let us know which programs you have submitted for credit consideration.  We will be reviewing the Department's evaluation of our program, and will be posting the credit information here at the website (along with our own CEC's for maintaining your WWCP designation).  If you have any questions, please don't hesitate to contact WSIA Training Coordinator Bonnie Prater at bonnie.prater@wsiassn.org.

Federal Law May Have Impact in

Washington Regarding Medicare Benefits

While Washington state has been fairly insolated from the Medicare Secondary Payer Act, mostly due to the fact that we do not have compromise and release and cannot settle out the medical portion of our claims, a provision in a recent federal law might impact self-insurers here in Washington.  WSIA is soliciting feedback from a number of sources to get an idea on how this might apply on our claims.  We await responses from the Department and from UWC, the federal organization we belong to that lobbies on workers' compensation and unemployment issues.  You can be certain we will share that information with you as soon as it becomes available.   Here's the text of their email to us:

On 12/29/2007, President Bush signed the "Medicare, Medicaid, and SCHIP Extension Act of 2007". The bill was sponsored by Senator Chuck Grassley (D-IA) and was passed in the House (12/19) and Senate (12/18) before the signing by the President. The bill passed unanimously in the Senate and 411-3 in the House. Grassley has long been an advocate for increased Medicare Secondary Payer enforcement and the passage of this bill into law has ramifications for Liability Insurance, Self Insurance, No Fault Insurance, and Workers' Compensation Insurance programs nationwide.

Of major importance to liability, self, no fault, and workers' compensation insurers is Section 111 ("Medicare Secondary Payer"), paragraph 8 ("Required Submission of Information by or on behalf of Liability Insurance (including Self-Insurance), No Fault Insurance, and Workers' Compensation Laws and Plans"), items (A)-(H). Here are a couple key sections of the law:

(A) REQUIREMENT - On or after the first day of the first calendar quarter beginning after the date that is 18 months after the date of the enactment of this paragraph (the law was passed on 12/20/07, making the following requirements begin July 1st, 2009), an applicable plan shall-

(i) determine whether a claimant (including an individual whose claim is unresolved) is entitled to benefits under the program under this title on any basis; and

(ii) if the claimant is determined to be so entitled, submit information described in subparagraph (B) with respect to the claimant to the Secretary in a form and manner (including frequency) specified by the Secretary.

(B) Required Information - The information described in this subparagraph is -

(i) the identity of the claimant for which the determination under subparagraph (A) was made: and

(ii) such other information as the Secretary shall specify in order to enable the Secretary to make appropriate determination concerning coordination of benefits, including any applicable recovery of claim.

(C) TIMING - Information shall be submitted under subparagraph (A)(ii) within a time specified by the Secretary after the claim is resolved through a settlement, judgment, award, or other payment (regardless of whether or not there is a determination or admission of liability).

(E) ENFORCEMENT

(i) In General - An applicable plan that fails to comply with the requirements under subparagraph (A) with respect to any claimant shall be subject to a civil money penalty of $1000 for each day of noncompliance with respect to each claimant (in addition to any other penalties prescribed by law and in addition to any other Medicare secondary payer claim under this title with respect to an individual).

What does it all mean?

Beginning on 7/1/2009; Liability Insurers, Self-Insurers, No Fault Insurers, and Workers' Compensation Insurers must determine Medicare beneficiary status on all claims and report those claims involving a Medicare beneficiary to the Secretary at the time of settlement, judgment, or award. If the reporting is not done in a timely manner, the Secretary may enforce a civil money penalty of $1000 per day per claim. Beyond the reporting requirements and financial penalties, this now provides Medicare huge amounts of previously difficult to collect primary payer data on liability, self-insured, no-fault, and WC claims which can be utilized to enforce their Secondary Payer rights. It will be very easy for Medicare to review settlements, judgments, and awards to determine if their interests were adequately considered in the settlement. Workers' Compensation has faced a similar situation (on a smaller scale) since 2002 with Medicare Set-Aside Arrangements. The scope of this law is much broader than MSAs though and adds liability and no-fault settlements into the process, with stiff financial penalties for non-compliance.

What can be expected?

The Secretary has two issues to address in this law, (1) what data to collect and (2) what timeframe to receive the information post-settlement, judgment, or award. The timing of the collection of data (post-settlement, judgment, or award) suggests that a copy of the the settlement agreement, judgment or award will be required submission to the Secretary. Since the intent is to enforce Medicare's Secondary Payer rights, it is reasonable to assume injury information, diagnosis codes, and primary payer data will be required. The language is broad enough to allow for the collection of medical information to determine if the settlement adequately protected Medicare's interest. It is likely that the timeframe will be shortly after the date of settlement, judgment, or award, but may be more frequent.

Department Announces Certified

Claims Administrator Testing Schedule for 2008

The Department of Labor & Industries has announced the dates for their Certified Claims Administrator testing.  The test dates are March 20, June 19, September 18, and December 18, 2008.  There is an application acceptance period for each exam.  It is now too late to apply for the March 20th test.  For the June 19 test, your application must be submitted between March 23 and May 4.  For the September 18 test, your application must be submitted between June 23 and August 3.  And for the December 18 test, your application must be submitted between September 22 and November 2.  You can find the application at the Department's website at http://www.lni.wa.gov/forms/pdf/207177af.pdf.  Also, as you know, WSIA provides a one-day review course the day before each of the Department test dates.  Review courses, offered only to employees of WSIA member organizations, will be held on March 19, June 18, September 17, and December 17 at a location in Olympia.  Watch the WSIA website's Training Programs & Conferences page for more details.

Clarification Regarding Claims Administrator Certification,

Continuing Education Requirements, and Deadlines

There has been a number of questions regarding the Continuing Education option, as an alternative to re-testing, for maintaining the state's Claims Administrator Certification.  Hopefully this will clarify and answer most of those questions.

If your certification expires before October 1, 2008 you MUST take the Certified Claims Administrator test.  There are no exceptions to that.  No grandfathering.  You MUST take the test again.  Once you are certified, you will have five years to either collect a minimum of 75 Continuing Education Credits (20 in claims processing/procedures; 20 in legal issues; 20 in medical issues; 2 in ethics; and 13 in elective topics), or take the test again.

There is a tiered structure for those people whose certification expires between October 1, 2008 and September 30, 2012.

If your certification expires between October 1, 2008 and March 31, 2009, you must earn a minimum of 30 credits (8 in claims processing/procedures; 8 in legal issues; 8 in medical issues; 1 in ethics; and 5 in elective topics).

If your certification expires between April 1, 2009 and September 30, 2009, you must earn a minimum of 35 credits (10 in claims processing/procedures; 10 in legal issues; 10 in medical issues; 1 in ethics; and 4 in elective topics).

If your certification expires between October 1, 2009 and March 31, 2010, you must earn a minimum of 40 credits (11 in claims processing/procedures; 11 in legal issues; 11 in medical issues; 1 in ethics; and 6 in elective topics).

If your certification expires between April 1, 2010 and September 30, 2010, you must earn a minimum of 45 credits (12 in claims processing/procedures; 12 in legal issues; 12 in medical issues; 2 in ethics; and 7 in elective topics).

If your certification expires between October 1, 2010 and March 31, 2011, you must earn a minimum of 50 credits (14 in claims processing/procedures; 14 in legal issues; 13 in medical issues; 2 in ethics; and 7 in elective topics).

If your certification expires between April 1, 2011 and September 30, 2011, you must earn a minimum of 55 credits (15 in claims processing/procedures; 15 in legal issues; 15 in medical issues; 2 in ethics; and 8 in elective topics).

If your certification expires between October 1, 2011 and March 31, 2012, you must earn a minimum of 60 credits (16 in claims processing/procedures; 16 in legal issues; 16 in medical issues; 2 in ethics; and 10 in elective topics).

If your certification expires between April 1, 2012 and September 30, 2012, you must earn a minimum of 65 credits (18 in claims processing/procedures; 18 in legal issues; 18 in medical issues; 2 in ethics; and 9 in elective topics).

The Department will assign credits to courses that are submitted by education providers.  A Committee meets monthly to review the submittals, and then makes recommendations for the number of credits to be awarded.  WSIA has already submitted all of our training programs for review, as well as a number of Region meetings, conferences, and non-WSIA programs.  We have yet to hear anything back on the number of credits to be awarded, but will post those as soon as we receive them.

The Department will maintain a web-based database for for Certified Claims Administrators to track and report their credit hours.

For more information, consult the rule at http://www.lni.wa.gov/rules/AO06/19/0619Adoption.pdf.

Trouble Finding a Medical Examiner?

New Department Search Feature Makes it Quick & Painless

Need help finding a medical examiner for a particular specialty?  The Department has added a search function to their list of approved examiners.  https://fortress.wa.gov/lni/imets/.

Updated Self-Insurance Section

Phone Contact Listing ... Including Team Assignments

Need an updated list of Self-Insurance section phone numbers?  Here’s the link to the latest and greatest list, http://www.lni.wa.gov/ClaimsIns/Files/SelfIns/SelfInsPhoneList.pdf, updated January 1, 2008 .  Note that the list now includes which adjudicator and which consultant work on which claims Team.  Check back at this link periodically for updated information.

Requesting Self-Insured and

Requesting State Fund Claims Files

In response to changes in public disclosure law, the Department of Labor & Industries has changed the way they process and respond to requests for prior industrial insurance claims files.  You will need to submit TWO requests: one to Norm Voiles for information on self insured claims (faxed to 360-902-6900), and then requests for State Fund claims histories to Paula Clayton (faxed to 360-902-6970.)  If you have questions on the status of State Fund claims information requests, you can call 360-902-5656.  Most State Fund requests will be handled within 10 business days.

You Pay for It, Use It!

DOSH Safety Materials Available for Your Use

The Department of Labor & Industries’ Division of Occupational Safety & Health has at least 27 downloadable safety videos, 75 industry fact sheets, 18 employee safety rule training kits, 85 online safety presentations, 52 construction industry toolbox talks, and over 2000 different safety, health, and risk management video titles for checkout in their safety library.  YOU pay for these services, so please take advantage of them.  You can find these materials at the DOSH webpage at the Department’s website at http://www.lni.wa.gov/safety/.

Electronic Filing of Claims Appeals

At the Board of Industrial Insurance Appeals

Did you know you can file your claims appeals electronically, online?  You can!  Go to the Board of Industrial Insurance Appeals website at www.biia.wa.gov and click on the E-filing logo.  Your appeal is submitted instantly, saving time and postage.  You are able to print a copy for your records, and a receipt showing that your submittal was received.  Give it a try!

as of 2/5/2008