Maximum Time Loss & PPD Benefits

Increase by 5.018% Effective July 1, 2008

With an increase in the Statewide Average Monthly Wage, as calculated by the Employment Security Department, the new maximum time loss benefit and Permanent Partial Disability benefits will increase by 5.018% effective July 1, 2008.  The maximum monthly time loss benefit (120% of the SWAMW) will be $4,472.10 -- which is $53,665 (tax free) on an annual basis.  The PPD award schedule will also increase effective July 1, 2008.  For a copy of the Department's memo detailing both the Maximum and Minimum time loss benefits, click HERE.  One of our members, William Zachry of Safeway, Inc., recommends a review of your reserves on life pension cases, as well as checking with your excess carrier on claims likely to reach retention.  Sound advice.

Minimum Time Loss Benefit

Increase Takes Effect on July 1, 2008

The 2007 Legislature passed a new law increasing the minimum time loss benefit, effective for claims filed AFTER July 1, 2008.  The minimum benefit will be: 15% of the statewide average wage, plus $10 for a surviving spouse and each child of the worker (up to a max. of 5 children); OR 100% of the worker's wage at the time of injury.  [The 100% of the wage at the time of injury acts as a cap on the minimum based on the statewide average wage.]  This amount will change each year as the statewide average wage is recomputed each year, effective July 1st.  Workers will be entitled to a COLA increase each July 1st.  For a copy of the Department's memo detailing both the Maximum and Minimum time loss benefits, click HERE.

Vocational Rehabilitation

Benefits Increase on July 1, 2008

The maximum vocational training benefit increased from $12,000 to $12,240 effective July 1, 2008. The new benefit will apply to any plan approved on or after July 1, 2008. The increased benefit applies regardless of whether a worker chooses Option 1 or Option 2 after plan approval. This increase is the result of an annual adjustment that is required under the statute governing vocational rehabilitation services.  If you have any questions e-mail us at VocRehabProgram@LNI.wa.gov.

Medical Aid Fee Schedule

Fee Increases on July 1, 2008

As with all other workers' compensation benefits, you can expect to pay more for medical benefits.  The Medical Aid Rules and Fee Schedules (fee schedule) is effective for services provided on or after July 1, 2008.  You can get a full copy of the Medical Aid Rules and Fee Schedules at the DLI website at http://feeschedules.lni.wa.gov/.  In addition to this schedule there are a few errors caught along the way that are addressed in an "update."  You can find the update at the DLI website at http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2008/Updates2008.asp.

Department Per Diem & Travel

Fees Also Increase on July 1, 2008

Based on an increase in mileage reimbursement rates by the federal Internal Revenue Service, the Department of Labor & Industries has raised its mileage reimbursement schedule to reflect the higher price of fuel.  The rate will increase from $.505 to $.585 per mile -- a 15.8% increase in reimbursement costs.  Additionally, there are other reimbursement costs covered by a Department memo on the topic.  You can access that DLI travel reimbursement memo HERE.  As with all other benefit increases, this takes effect July 1, 2008.

Reminder - Effective June 12, 2008

You Pay for Closed Claim Travel for Prosthetics Repair

During the 2008 Legislative Session, SSB 6246 passed.  The bill required that the State Fund or self-insured employer pay for post-closure travel costs associated with prosthetics and orthodics (other than hearing aids.)  This is a constituent bill, and was an issue of fairness to the injured worker, in that they're having to travel to get their prosthetic or orthodic devices replaced, repaired or adjusted.  This does NOT apply to hearing aids.  Workers may also be reimbursed for reasonable travel expenses on closed claims when the Department or self-insurer requires workers to attend medical or vocational evaluations.  If you have questions regarding the application of this new law, contact the Self-Insurance Training unit at 360-902-6839.

Voc Rehab Option 2 Issues

Need Clarification and More Detail

While the Department begins the next process of rule drafting for the Voc Rehab Pilot Project (which will focus on Option 2 issues), a number of issues revolving around the Option 2 (opt-out) provisions have recently developed.  Regarding payment of an Option 2 as a lump sum (similar to a PPD pay out), that CAN occur, but under the following requirements: the request from the worker must be in writing; must be approved by the Department; and will not be considered until at least 70 days from the date of the Department's Option 2 order awarding the benefit. The decision to grant a cash-out request is discretionary and each request is reviewed on an individual basis.  Regarding how this lump sum payment will work in light of the recently passed "pay during appeal" legislation, you can NOT wait 70 days to begin paying Option 2 benefits - per E2SHB 3139, you must begin paying immediately.  The Option 2 award (equivalent to six months of timeloss) is paid in installments, with a downpayment being due immediately.  Just like for PPD awards, the requirement of E2SHB 3139 are satisfied if that first installment is paid immediately.  Also similar to PPD awards, a worker can request a lump-sum payment for the total amount of the Option 2 benefit.  Those requests can only be approved by L&I, and will only be considered after the order becomes final & binding (approximately 70 days later, allowing time for the order to be communicated by mail).  The Department will not grant lump-sum payment of the Option 2 benefit until they are certain no affected party has protested the Option 2 order.  And lastly, the Department is developing a form to help facilitate and track the use of vocational benefits in claims where the worker chose Option 2.  They hope to use the form for both State Fund and self-insured claims.  Watch for an email soliciting your feedback on the form!

IME Billing Code

Adjustment Being Considered

To address the concern of IME providers and examiners, the Department is considering a change in the IME fee schedule.  Currently there is a threshold of 750 pages from microfiche to be reviewed before additional fees kick in.  That threshold will likely be lowered to 500 pages.  WSIA will keep you informed as more information becomes available on when this change will likely take place.

SIEDRS Effective July 1, 2008,

Be Certain You are Plugged In TODAY!

After over a decade of prodding and fighting to get it done, the Department of Labor & Industries is now collecting a limited amount of self-insured claims data effective July 1, 2008.  With a handful of exceptions, the Department has nearly all TPA's and self-insured employers at least signed up for the program.  However, due to the last minute response on the part of a number of participants, it is taking some time for the Department to catch up with the flood of paperwork they received.  For ONLY those submitters who are approved to move from testing to production any time during the month of July, the Department will set the official enrollment date as July 1. As long as you are able to send us a production file with July’s data by August 10th, 2008, you will be in compliance with the mandate.  Meanwhile, they ask you to continue to submit test files while you await their review.  The more data they have available, the better able they will be able to make the decision about your performance.  And please be patient!  You have had OVER THREE YEARS to comply with this law.  If you waited to the last minute to sign up or begin testing, you'll have to continue to wait with the limited amount of technical support available.  The Department has been handling this admirably, though with the usual hiccups and bumps along the way.  Show them some respect and courtesy as you work through the process.  Thank you!

Permanent Heat Stress Rule Effective,

Train the Trainer Classes Offered to Supervisors

The recently adopted premanent rule on Heat Stress takes effect on July 5, 2008 ... though the emergency rules have been in place for over a year.  To help with your understanding of the rules, the Department is providing training.  You can find the schedule of training at their website at the bottom of the page http://www.lni.wa.gov/safety/topics/atoz/heatstress/default.asp.

Department Updates IME Provider Listing:

Who Can and Can't (Currently) Perform IMEs

The Department has updated its website to indicate which Examiners are no longer able to perform IMEs ... as lease until they update their provider information.  Examiners with last names beginning with A, D, G, J, M, P, S, V and Y were required to respond to their 2008 request.  If you did not respond, effective June 1, 2008 you will be listed as temporarily unavailable to schedule IMEs.  To check your status, go to www.imes.lni.wa.gov.  Under "Find a Medical Examiner" you can look up your name in the bottom green box of the query screen, and it will show your status.  For IME Firms, you are required to compare your roster with the Department's approved examiner list at www.imes.lni.wa.gov under "Find a Medical Examiner."  Over 282 examiners and firms responded to the 2008 Update, so a number of changes were made to the database.  Call the Department at 360-902-6815 if you have questions about your listings.

Department Moving Ahead With Plans to

Replace CACO Scores for Voc Providers

The Department of Labor & Industries announced on May 6th that it was proceeding with plans to replace the CACO performance measure.  The term to be used in place of CACO is "percent of useful outcomes."  This measure is considered a first step toward providing information about the quality and effectiveness of vocational services.  A new quarterly report will be issued October 1, 2008, using this "percent of useful outcomes" measure on referrals closed between June 2008 and September 2008.  Other performance measures will be added in 2009.  For more information, go to http://www.lni.wa.gov/ClaimsIns/Providers/Vocational/WhatsNew/default.asp. 

Self-Insurance Section Priority

Goals Laid Out For All to See

Ever wonder how the Department prioritizes your claims?  Well, no more!  Click HERE to go to a chart listing the WCA3 priorities, and estimated time line on various claims decisions.  Generally speaking, unit goals are: 5 days for new claims, denials and employer PPD closures; 30 days for wage orders, PPD closure requests, correspondence and penalty requests; and 45 days for TC closure requests.  This should help you out in determining whether any one claim you're having problems with needs attention, or whether there are other issues.

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 STILL 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.

If you are a self-insured employer or TPA and have dealt with this issue in other states, please contact Dave Kaplan at dave.kaplan@wsiassn.org or by phone at 800-736-7296.  Thank you!

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.

as of 6/30/2008