John Klor Named

WSIA's Amicus Subcommittee Chair

In March 2008, John Klor of Wallace, Klor and Mann, P.C. was named chair of WSIA's Amicus Subcommittee.  John replaces Craig Staples of the Law Office of Craig Staples.  Craig served as chair of for three years, helping to direct review and discussion of court cases in which the Washington Self-Insurers Association might file an amicus brief in support of our members or an important issue in workers' compensation law.  The Amicus Subcommittee reviews cases, then makes recommendations to the WSIA Board of Directors on whether or not to pursue the filing of an amicus brief on any particular case.  John Klor has been an active member of the Association, volunteering on our Legal Subcommittee and as a speaker at a number of our conferences.  We thank Craig Staples for his many able years of service, and we welcome John Klor to his new role with the Association.  If you have interesting court cases that you believe may wind up on appeal, please contact Dave Kaplan at the Association if you'd like consideration of your case to be supported by an amicus brief.  Please note that very few cases are selected for consideration, and for support, so the case should be significant and one in which there is a chance for a positive outcome.

Minimum Time Loss Benefits

Increase Beginning 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.  Some training on this issue will be provided in the Department's "Update 2008" training (mandatory for Certified Claims Administrators).  Additional training will be included as part of WSIA's training materials in our upcoming classes.

Department Establishes a

Continuing Education ListServ

For those of you trying to keep up with the Department's Continuing Education Credits issues, AND who are ALREADY SIGNED UP FOR THE DEPARTMENT'S ListServ, you can get continuing education information as well!.

Go to http://www.lni.wa.gov/Main/Listservs/ClaimsIns/SelfInsurance.asp, which is the normal ListServ signnup.  Then at the bottom, fill in your name and email address, then click on "continuing education information", then click on "update your options."   If you are NOT signed up for any Department ListServ's, click on "join the list", but still be sure to click on "continuing education information."

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 5/29/2008