President

WSIA President's Column

Bill Johnson

Simpson Investment Company
President, WSIA

The WSIA staff and Board of Directors have their fingers on the pulse of most issues which impact the management of workers’ compensation claims and safety. However, sometimes it is important to focus on just a few of the larger issues facing the self-insured community now and in the coming year.

LEGISLATIVE ISSUES

As has been the case for nearly a decade, the Washington Self-Insurer’s Association legislative agenda has been the basis for most of the Employer Coalition’s agenda. This next year promises to be no different. WSIA’s legislative agenda, and that of our State Fund employer brethren, are very similar:

Wage Simplification - attempting to simplify the calculation of wages;
Final Settlement Agreements - allowing for the settlement of workers' compensation claims, short of having to put someone on the pension rolls;
Changing the Basis for the COLA on Benefits - changing the basis for the COLA from the State Average Wage to something that is more aligned with the economy that we all face;
Capping Attorney Fees - we believe there should be a cap limiting the amount plaintiff attorneys can collect from a claimant’s pension benefits, etc;
Restricting the Use of the WC Trust Funds - while this affects the State Fund more than self-insurers, WSIA supports the concept that workers' compensation funds should be used ONLY for costs related to workers' compensation and safety (injury prevention). Currently, tens of millions of those funds are being used to fund other programs administered by the Department of Labor & Industries, such as wage and hour, grain elevator inspections, etc.

There is no proposal to address any concerns regarding the "pay during appeal" legislation that passed in 2008. First, we have not yet received a response from the Department to the concerns we raised in July 2008. Second, there are likely to be legal challenges to the "pay during appeal" law or its implementation by either or both workers and employers. Lastly, we need to know specifically what change(s) we hope to make, and work with labor and the trial lawyers to implement the change(s). Given the makeup of the Legislature, it's unlikely anything approaching a repeal of the 2008 legislation would even get a hearing.

We hope to hear something back from the Department on our “pay during appeal” questions by the end of this week (11/21/2008).

MEDICARE REPORTING ISSUES

In December 2007 Congress slipped a little provision into a popular piece of legislation. This provision requires that insurers (whether for general health care, liability, or workers’ compensation) report to Medicare/Medicaid every claim where the claimant is Medicare eligible. The mandatory reporting deadline is October 1, 2009. Required Reporting Entities (RRE’s – otherwise known as insurers) are required to register by July 1, 2009. RRE’s are allowed to designate a reporting Agent (i.e., TPA, etc.), but the burden is on the self-insured employer to register.

Penalties for non-compliance can be up to $1000 per day per claim. Don’t get caught flat-footed on this one! WSIA is working to sort through the large amount of information provided by CMS (Centers for Medicare and Medicaid) to help provide you the latest information you need to comply. However, you should start your own research into this issue by visiting the CMS website at https://www.cms.hhs.gov/MandatoryInsRep/. Specifically, you’ll want to review: the federal Statutory Language that created this requirement; the Timeline for compliance; CMS’s comments regarding the use of Social Security Numbers (required); the Supporting Statement (which has a lot of good background and other key information on what data is required to be reported); the Registration Process; and the Interim Format of the Data Elements required to be submitted electronically to CMS.

WSIA had initially contemplated having the Department of Labor & Industries act as an agent on behalf of all self-insurers; but the Department does not collect many of the data elements required under this federal law, and it does not appear that the Department would want to act as an agent on our behalf.

CMS will be holding a series of telephone conference calls to answer questions (which are best submitted in advance). The last call for liability insurers (which includes workers’ compensation self-insurers) was on October 29, 2008. You can find the transcript of that call HERE. The next opportunity to participate will be in the calls scheduled for January 22, 2009 and January 28, 2009. ALSO, if your organization is self-insured for anything OTHER than workers’ compensation (personal liability, group health, etc.), you will need to comply with this law as well. Check the Timeline for compliance with those lines of coverage, conference call opportunities to have your questions answered, and their reporting dates.

DEPARTMENT RESPONSES TO OUR CONCERNS

Much of our past communication regarding the Department has dealt with complaints about what they have or have not done, things that we perceive that they are not doing correctly, etc. In an effort to work together as partners with the Department in this complex issue called Workers Compensation, I want to point out some things the Department has done to help and support the self-insured employer’s in Washington:

When there was a backup in the handling of claims – particularly those related to reopening, denial, and closure – the Department adopted a revised prioritization of those claims; and drafted and provided us with a series of Claims Checklists (posted at the WSIA website) to ensure that self-insurers can help facilitate their own claims by providing needed documentation up front. (You can find those HERE).

When we raised concerns about the discrepancies between adjudicators in the issuance (or non-issuance) of wage orders, the Department reorganized to establish claims teams to help provide more consistency.

When we raised concerns about the different processes within the Self-Insurance Section (adjudicators, consultants, trainers, auditors) and between the Self-Insurance Section and State Fund claims personnel, Judy Schurke established a committee within the Department to look at these issues, and to propose solutions. We should be hearing from the Department on what they propose in the next few weeks.

When claims processing was backed up due to the implementation of the ORCA/ORION system, Self-Insurance Program Manager Jean Vanek fought to get the resources needed to ensure timely and accurate scanning of self-insurance documents. While not perfect, things have noticeably improved over the past year.

Leading up to and since the mandatory reporting for the SIEDRS project (Self-Insured Electronic Data Reporting System) took effect on July 1, 2008, the Department has worked with self-insurers and TPA’s to ensure compliance, rather than rushing out to penalize employers.

Despite a number of vacancies in the two positions handling such claims, the Department has managed to eliminate the backlog of claims awaiting a determination of eligibility for vocational rehabilitation benefits, and is now in compliance with the deadlines established in state law.

In response to our concerns, the Department is in the process of updating their website pages dedicated to self-insurance – making them easier to find, and much more useful.

While progress has been slow regarding Certified Claims Administrator testing and Continuing Education Credits, the Department has indicated that they are open to consideration of changes to the current system and has asked us to bring our suggestions forward. WSIA is establishing a committee to do just that.Lastly, these and other issues are not going to sit by the wayside. At the November 5, 2008 Liaison Committee meeting, the Department shared a “Self-Insurance Solutions” chart. (To see the chart, click HERE.) The purpose of the chart is to track and address all of the concerns that WSIA has brought to their attention. At each quarterly meeting, the Department employees responsible for each item are to give a report on the progress being made. As Jean Vanek expressed to our representatives, “a no-progress report at these meetings is not acceptable.” We have both Jean Vanek and Judy Schurke to thank for formally addressing our many concerns.

As you interact with the Department, please take the time to thank them for the progress they ARE making regarding our concerns. While resolution of our concerns may take much longer than we would like, it’s important to recognize the Department when they do good work on our behalf.

Finally, thank YOU for bringing these issues to our attention! Without your issues being brought to the attention of the WSIA Board of Directors, to our Liaison Committee members, and to WSIA Executive Director Dave Kaplan, we can not effectively voice your concerns. Please, continue to act as our “early warning system” when issues arise. This is OUR association, and it only works effectively when we all participate.

Updated 17 November 2008

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