Karen Hintz, Sedgwick CMS
Tammy Vibbert, Lakeside Industries

The Liaison Committee met with the representatives from the Department of Labor and Industries on January 9, 2008 and will meet again March 5, 2008.  If you have any issues that you would like addressed, please contact either Karen Hintz at 206-262-4439 khintz@sedgwickcms.com or Tammy Vibbert at 425-313-2659 tammyv@lakesideind.com.

PROTEST DETERMINATIONS.  As of December 31, 2007, there were a total of 733 protest requests pending – 187 with the adjudicators, 546 with the consultants.  Of those, 38 are over 180 days old back to April 2, 2007 and one dating back to February 2006 (litigation pending). 

VOCATIONAL DETERMINATIONS.  As of January 8, 2008, there were 37 E.A.R.’s pending.  The oldest request was dated December 12, 2007.  Bill Walkowski was hired to fill the vacancy.  Bill comes back from the State Fund, after working in the Self-Insurance Section for a number of years.

PENSION DETERMINATIONS.  As of January 9, 2008, there were 132 pension requests, with 7 over 180 days old.  An accurate account was not provided, but at least 12 had been reviewed and await further information, and the remaining requests await an initial review.   Those awaiting further information require wage orders, current medicals, or a PPD rating.  Currently the workload between the two pension desks is unbalanced due to the implementation of the four claims teams.  Each pension adjudicator was assigned two teams which, unfortunately, lead to one adjudicator receiving far more work than the other.  The Department is working to redistribute the work to resolve this problem.

HEARING LOSS CLAIMS PROCESS.  There has been 100% change in adjudicators handling hearing loss claims.  Steve Kazda and Tom Drosher are the current adjudicators.  There is no additional information or progress to report on the State Fund/self-insured joint order at this time.  The committee discussing the issue is no longer meeting, but some changes were made in an effort to issue joint orders and determine claim responsibility earlier in the claim. 

WAGE ORDERS.  No significant changes to the current process.  The Department believes that the implementation of the new teams should help them move towards consistency in wage orders.  Generic wage order training has been done, but because each employer is so different in the way they pay their employees, generic training is only a first step towards consistency.  They report a good exchange of information and problem solving between the adjudicators, auditors and trainers at their monthly team meetings.   With training and unit meetings, they expect better internal consistency over time.  We asked if wage orders are issued on the claims of insolvent employers.  The Department does issue wage orders on indemnity claims, pension claims, and converted medical only claims, for insolvent claims.  If employer records are not available, orders are issued on the best information available at that time.

ORCA/ORION UPDATE.  There has been considerable improvement in timeliness of claim initiation.  Resources had been provided to address backlog in attempt to bring claims current by year end January 2008.  As of January 5, 2008 there were 10667 indemnity claims pending initiation.  Best practice currently is once a claim is received it should be initiated into the Dept. system within 2 weeks and adjudicator action and allowance order should be issued within 30 days.  As of January 5, 2008 there were 3800 MO claims pending initiation.   Denials and closures are current and initiated within 24 hours of receipt with adjudicator action on those claims within 2 weeks.  The Department’s temporary help disappeared at the end of January 2008.

CLAIMS TEAM ISSUES.  Employer team claim assignments are being reviewed between the four teams due to volume discrepancy.  Once work load equalization is determined, an updated work assignment chart will be distributed.  To clarify a previous question, auditors work with all employers and adjudicators, and are not assigned to particular teams.  This is done to maintain their independence.  Auditors provide feedback to the adjudicator’s pre and post claim audits.

HEALTH CARE BENEFITS.  This issue revolves around monthly premium payment vs. hourly premium payment methodologies.  The Department has agreed to provide written clarification and send out to the community on the list serve.

SELF-INSURANCE FORMS.  The Department has an internal committee formed to implement the Governor’s “plain talk” initiative on letters and forms.  There is nothing formal in place at this time.  However, the new vocational rehab form for self-insurers is posted on the Department website.

EMPLOYER GUIDE TO SELF-INSURANCE.  A rewrite is in process of the “Employer Guide to Self-Insurance”, and a draft of the revisions should be completed by April 2008.  Once updated, this brochure will be available on the Department website.  The last time it was updated was January 1996!  The Department does not have staff dedicated to special projects such as this, and relies upon supervisors, department heads and others to complete these projects.  They are aware of the importance to keep their publications current, and they plan to put processes in place (once a project is completed) to maintain more regular and periodic reviews and updates. 

PENSION FUNDING ORDERS.  Delays have been primarily caused by choices that need to be made by the survivors, as well as the lack of supporting documentation that is required.  The Department had talked about putting together a “check list” of what is needed from a pensioner or beneficiary to help them better understand their benefit options, and to assist in expediting the funding notification process to the employer.  Despite our request, we've been informed that's not going to happen. What would be helpful would be to get copies of the pension benefit pamphlet, and many employers keep copies of the spouse/children APPLICATION FOR BENEFITS in their offices.  The self-insurance staff should be able to order the pamphlets for you from their warehouse. Having these two documents should help the spouse or dependents if there is a fatality. The pamphlet does provide information for total permanent disabled workers as well. [Updated Feb. 13, 2008]

TIME LOSS/ADDITIONAL BENEFITS/KOS.  The Department will issue a memo to clarify payroll deductions and taxes withheld on benefits.  Deductions cannot be taken from benefit payments, voluntary or not, if the benefits deducted would result in payment less than the amount of Time Loss benefits owed.  The worker cannot receive benefits less than the full benefit amount in which they are entitled – with the sole exception of allowed liens for child support (RCW 74.20A.260) and public assistance (RCW 43.20B.720). If a worker wishes to write a separate check back to the employer to cover benefits such as health care, 401K, etc. they may do so.  The Attorney General for the Department has issued an opinion on this, and you can find it HERE.

CONTINUTING EDUCATION CREDITS.  The Department finally responded to our August 2007 and October 2007 requests for Certified Claims Administrator CEC’s.  That information has been provided to us, and is posted in the January 2008 FYI news here at the website.  WSIA will be posting this CEC information, as well as our own WWCP CEC information, at the WSIA website for easy access.  The Department will be posting the information at their website as well, though after sending the information out to their Listserv in mid-February. 

SIEDRS UPDATE.  Mandatory data submission to the Department begins July 1, 2008.  There is a concern that many self administered employers and TPA’s are not currently testing, or will not be ready by the effective date.   The Department and WSIA will be contacting those who are not currently working with the Department to submit their data by the deadline.  It has been clarified for TPA’s that the individual submitter from the employer is not required to be on file with the Department in order to test or submit claim data, but that form will have to be submitted at some point.  Employers are designated a block of self insured claim numbers by the Department.  If an employer is using numbers outside of their assigned block or old forms, the data will not be accepted.  If there has been an employer acquisition or entity change, the last 3 years of claim numbers will be attached to the new entity to help avoid errors.  There has been little to no testing under these circumstances, and work flow or processes may be changed once it is better known how to handle.  Given that penalties and/or decertification is involved, please get started on this project TODAY!

posted 5 February 2008

UPDATED 13 FEBRUARY 2008

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