Governor Names Denise McKay

as First Self-Insured Ombudsman

On January 9, 2009 Governor Gregoire announced that Denise McKay will serve as the first Self-Insurance Ombudsman.  Created by legislation in 2007, the Self-Insurance Ombudsman is to act as an advocate for the workers of self-insured employers in the resolution of their claims issues.  Ms. McKay was selected from an exceptionally strong field of candidates.  She will be responsible for establishing the self-insurance ombudsman program for injured workers of self-insured employers. The Ombudsman position is charged with responding to injured workers’ complaints, concerns and questions in an impartial, efficient and timely manner. The Ombudsman will make recommendations to the Governor and L&I based on analysis of claim issues and trends.  Denise has more than 18 years of experience in workers’ compensation and risk management, including 12 years as a claims adjudicator at L&I, from 1988 to 2000. Beginning in 2001, she worked at the Department of Personnel where she established the return-to-work program for state agencies, and organized various training and conference opportunities. Denise was a Risk Specialist at OFM from 2005 to 2007, and most recently has been the Project Enterprise Risk Manager at the Department of Revenue.  DLI Director Judy Schurke stated "Denise’s skills in workers’ compensation, and her knowledge of return-to-work programs, give her an excellent background for resolving complex issues with injured workers and employers.  While the position is appointed by the Governor, Denise reports directly to me [Judy]. Her appointed term is for six years, effective January 12. Because the legislative bill states the Ombudsman may not be physically housed within the Industrial Insurance Division, Denise will be located in the Director’s Office."  WSIA hopes that the new Ombudsman will be a fair and thoughtful advocate for the worker, geared toward resolving claims issues rather than in creating them.

New Mileage Reimbursement Rate

Took Effect January 1, 2009

The Department announced that the mileage reimbursement rate dropped from $.585 per mile to $.550 per mile, effective January 1, 2009.  To see the rates for the past several years, click HERE.

Department Announces

Assessment Rates for Self-Insurers for 2009

The Department of Labor & Industries has released the 2009 assessment rates for self-insurer's Administrative Assessments, Second Injury Fund, and for the new Self-Insured Overpayment Reimbursement Fund.  The rates for the Administrative Assessment (both the Base Rate and the Adjusted Rate) will decline a bit from the prior fiscal year.  The rate for the Second Injury Fund will also decline, in small part due to slightly lower projected costs for 2009 and in large part due to the amount of excess reserves carried forward from 2007.  The new Self-Insured Overpayment Reimbursement Fund is funded through a $.0004 rate per hour ON WORKERS, to fund employer reimbursement for overpayments resulting from benefits paid on appeal that are later overturned at the Board of Industrial Insurance Appeals or in Court.  The Supplemental Pension Fund and Asbestos Fund assessments will be released around the first week in December 2008, when the State Fund rates are finalized.  Click HERE for the memo on the Administrative Assessment. Click HERE for the memo on the Second Injury Fund assessment.  Click HERE for the memo on the Supplemental Pension Fund, Asbestos Fund, and Self-Insured Employer Overpayment Reimbursement Fund assessments.  In addition, the Department also released the third quarter memo on the Insolvency Trust Fund rate.  Click HERE for the memo on the Third Quarter Insolvency Trust Fund assessment.

Department Provides Self-Insured

Overpayment Reimbursement Fund Insert

The Department has provided an insert for self-insured employers to include with future paychecks, explaining the assessment for the Self-Insurer Overpayment Reimbursement Fund assessment.  As outlined above, the SIORF assessment began January 1, 2009, and is paid by the workers for reimbursing self-insured employers for benefits mistakenly paid on appeal.  You can access the paycheck insert HERE.

SIEDRS Rules Adopted,

Take Effect January 23, 2009

A public hearing was held on December 2, 2008 to consider the draft rules governing the Self-Insured Electronic Data Reporting System.  Based on the feedback at the hearing, only a few minor changes were made to the SIEDRS rules that were adopted.  As required by the 2003 statute, the Department is to adopt rules that will ensure self-insured employer compliance with data submittal.  To effectuate that, the proposed rules include penalties (mostly monetary) up to and including decertification for non-compliance.  If you would like to review the final rules, click HERE.

To Address Employer Concerns,

Department Reiterates IME Fee Schedule

After a number of complaints by self-insured employers and their Third Party Administrators, the Department of Labor & Industries sent out notices in November and December 2008 reiterating that IME providers are not to receive, and self-insured employers are not to pay, fees in excess of those provided in the Medical Aid Fee Schedule.  The December 2008 cover MEMO to self-insurers from Self-Insurance Program Manager Jean Vanek outlines the Department's authority to address this concern.  The November 2008 LETTER to IME providers from the Health Services Analysis section outlines the concern, and provides the billing codes under which IME services can be billed.  And lastly, there's a LIST of helpful tips from the Self-Insurance Section on handling IME bills.  While it is up to each individual employer and provider to decide on how best to comply with the law, it is important to restate the Department's position on this issue.

Department Adopts Policy

Changes on Claim Reopenings

After soliciting public comment, the Department has adopted changes to four policies governing reopenings.  Policy 16.20 governs Criteria for Reopening.  Policy 16.31 governs the 90-day time limit to act on reopenings.  Policy 16.35 governs the payment of Time Loss and Loss of Earning Power on pending reopening requests.  And draft interim Policy 16.40 governs the processing and reopening of requests for benefits in excess of seven (ten) years.  To read the policy changes, click on each of the policies in this paragraph.

Board of Industrial Insurance Appeals

Business Representative Search Update

The business community, through the Association of Washington Business, made recommendations to the Governor's office back in late November 2008.  We are still waiting for the Governor to announce an appointment.  WSIA has received a number of concerned calls regarding the vacancy on the Board of Industrial Insurance Appeals, and we share your concerns.  We encourage you to politely contact the Governor's office at http://governor.wa.gov/contact/default.asp and leave a message asking that she expedite the Business Representative appointment to the Board of Industrial Insurance Appeals.

Long-time NCSI, Montana S-I Fixture

George Wood Passes Away

Long-time National Council of Self Insurers and Montana Self-Insurers fixture George Wood passed away December 17, 2008 at the age of 82.  A World War II veteran, George had an active career in the workers' compensation community for over 50 years.  He served on the Board of the National Council of Self Insurers from 1972 until his death.  George was so committed to self-insurance that he was at the Washington Self-Insurers Association's first organizational meeting in June 1972, and our Association's 25th Anniversary in 1997.  Known for bringing his buffalo jerky to NCSI meetings, George will best be remembered for being a man of grace, charm, humor and thoughtfulness.  He was a kind and gentle man.  He leaves a big hole in everyone’s hearts, but, for those who know him, a head full of wonderful memories.

Department Announces New Medical Aid Fee Schedule,

Based on Two-Year Review

In 1993 when the department initially began using CPT & HCPCS codes, there were insufficient Department of Labor & Industries resources to review all the codes for appropriateness of use within the L&I benefit. This led to inconsistencies in coverage decisions.  Over the last two years the Office of the Medical Director and Health Service Analysis have been reviewing all the available codes. They initially thought that the review would be complete before they established our new fees in July 2008, but circumstances intervened and the review was not complete until late August.  L&I is implementing the results of that review with the new codes in January 2009. This will result in some codes being covered for the first time, others being removed from the covered list and some that will require prior authorization.   A new fee schedule has been posted on the L&I web site http://feeschedules.LNI.wa.gov with the effective dates 1/1/2009 through 6/30/2009.

Department Adopts New Crane Safety Rules,

Implementation Begins January 1, 2009

The Department of Labor & Industries finalized the rules concerning Crane safety.  The rules were a required outcome from legislation that became law in 2007.  You can find the text of the new rules HERE.  The effective date of most of the rules was January 1, 2009, with some rules taking effect January 1, 2010.

Department Releases Updated

Third Party Contact Phone List

At the request of self-insured employers, the Department has provided an updated list of contacts within the Third Party Recovery Unit.  Click HERE to see the updated Phone List for the Third Party Claims Unit.

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.

Department Publishes

Helpful Leave Guide

With the adoption of yet more leave laws by the Legislature, the Department of Labor & Industries has developed a table listing all of the leave laws, and what the requirements are.  You can find the leave listing table at http://www.lni.wa.gov/WorkplaceRights/files/FamilyLeaveLawsTable.pdf.  For more detailed information on each type of leave, go HERE.  Coordination of leave benefits with workers' compensation benefits will become an even bigger issue in the future, so watch the WSIA website for more information.

as of 1/12/2009