reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-315 - Definitions

Current through Register Vol. 24-14, July 15, 2024
(1)
Tobacco
			 products:
For purposes of this rule, tobacco products are limited to
			 those that are smoked, including cigarettes, pipes and cigars.
(2)
User of tobacco products:
For the purposes of this rule, a user of tobacco products is a
			 "smoker."
(3)
Current
			 smoker:
A current smoker is a regular user of tobacco products, has
			 smoked tobacco products at least one hundred times in his/her lifetime, and as
			 of the date of manifestation did smoke tobacco products at least some
			 days.
(4)
Former
			 smoker:
A former smoker has a history of tobacco use, has smoked tobacco
			 products at least one hundred times in his/her lifetime, but as of the date of
			 manifestation did not smoke tobacco products.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.32.185. 03-12-046, §
				  296-14-315, filed 5/30/03, effective
				  7/1/03.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-320 - Does the presumption apply to current smokers with heart or lung conditions?

Current through Register Vol. 24-14, July 15, 2024
No. The presumption never applies to current smokers with heart
				or lung conditions.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.32.185. 03-12-046, §
				  296-14-320, filed 5/30/03, effective
				  7/1/03.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-325 - When does the presumption apply to firefighters, emergency medical technicians (EMTs), fire investigators and law enforcement officers who are former smokers with heart or lung conditions?

Current through Register Vol. 24-14, July 15, 2024
(1)
Heart
			 problems:
The presumption for heart problems applies if a firefighter or
			 EMT as defined in
			 RCW  41.26.030(17)(a), (b),
			 (c), and (h)  or fire investigator is a former
			 smoker and last smoked two years or more prior to the cardiac event. The
			 presumption for heart problems also applies if a law enforcement officer as
			 defined in
			 RCW  41.26.030(19)(b), (c),
			 and (e)  is a former smoker and last smoked
			 two years or more prior to the cardiac event.
(2)
Lung conditions:
The
			 presumption for lung conditions in firefighters, EMTs, and fire investigators
			 will apply:
(a) For
asthma
if
			 they are a former smoker and last smoked five years or more prior to the date
			 of manifestation of the disease; or
(b) For
chronic obstructive pulmonary
			 disease/emphysema/chronic bronchitis
if they are a former smoker who
			 last smoked fifteen years or more prior to the date of manifestation of the
			 disease; or
(c) For
lung
			 cancer
if they are a former smoker who last smoked fifteen years or more
			 prior to the date of manifestation of the disease.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-330 - What tobacco use may exclude a firefighter, emergency medical technician (EMT), fire investigator, or law enforcement officer from a presumption of coverage?

Current through Register Vol. 24-14, July 15, 2024
The following table summarizes the situations listed in WAC
				296-14-310
				through
				296-14-325
				under which a presumption of coverage may not apply for firefighters and EMTs
				as defined in
				RCW  41.26.030(17)(a), (b),
				(c), and (h)  and fire investigators; and law
				enforcement officers as defined in
				RCW  41.26.030(19)(b), (c),
				and (e)  due to tobacco use.
Medical condition
Presumptions shall not
						  apply
Presumption shall
						  apply
Heart problems experienced within seventy-two hours of
						  exposure to smoke, fumes, or toxic substance
Firefighters, EMTs, fire investigators, and law
						  enforcement officers that are current smokers
Firefighters, EMTs, fire investigators, and law
						  enforcement officers that never smoked tobacco
Firefighters, EMTs, fire investigators, and law
						  enforcement officers that are former smokers and last smoked
less
than two years prior to the cardiac event
Firefighters, EMTs, fire investigators, and law
						  enforcement officers that are former smokers and last smoked two years or
more
prior to the cardiac event
Asthma
Firefighters, EMTs, and fire investigators that are
						  current smokers
Firefighters, EMTs, and fire investigators that never
						  smoked tobacco
Firefighters, EMTs, and fire investigators that are
						  former smokers and last smoked
less
than five years before date of
						  manifestation of the disease
Firefighters, EMTs, and fire investigators that are
						  former smokers and last smoked five years or
more
before date of
						  manifestation of the disease
Chronic obstructive pulmonary disease/emphysema/chronic
						  bronchitis
Firefighters, EMTs, and fire investigators that are
						  current smokers
Firefighters, EMTs, and fire investigators that never
						  smoked tobacco
Firefighters, EMTs, and fire investigators that are
						  former smokers and last smoked
less
than fifteen years before date
						  of manifestation of the disease
Firefighters, EMTs, and fire investigators that are
						  former smokers and last smoked fifteen years or
more
before date
						  of manifestation of the disease
Lung cancer
Firefighters, EMTs, and fire investigators that are
						  current smokers
Firefighters, EMTs, and fire investigators that never
						  smoked tobacco
Firefighters, EMTs, and fire investigators that are
						  former smokers and last smoked
less
than fifteen years before date
						  of manifestation of the disease
Firefighters, EMTs, and fire investigators that are
						  former smokers and last smoked fifteen years or
more
before date
						  of manifestation of the disease
Statutory Authority:
				  RCW
				   51.04.020,
				  51.32.185. 03-12-046, §
				  296-14-330, filed 5/30/03, effective
				  7/1/03.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-340 - Frontline workers-Verification for contraction of an infectious or contagious disease that is the subject of a public health emergency-RCW 51.32.181

Current through Register Vol. 24-14, July 15, 2024
(1) Verification
			 that an infectious or contagious disease has been contracted requires written
			 documentation of:
(a) A diagnosis from a
			 medical provider made by examination; or
(b) A positive test administered or verified
			 by a medical facility, testing facility, pharmacy, or the employer's
			 facility.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-341 - Health care workers-Verification for contraction or quarantine due to an infectious or contagious disease that is the subject of a public health emergency-RCW 51.32.390

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Verification that an infectious or contagious disease has been contracted
			 requires written documentation of:
(a) A
			 diagnosis from a medical provider made by examination; or
(b) A positive test administered or verified
			 by a medical facility, testing facility, pharmacy, or the employer's
			 facility.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-350 - Claim allowance and wage determination in occupational disease cases

Current through Register Vol. 24-14, July 15, 2024
(1) The liable
			 insurer in occupational disease cases is the insurer on risk at the time of the
			 last injurious exposure to the injurious substance or hazard of disease during
			 employment within the coverage of
			 Title
			 51 RCW which gave rise to the
			 claim for compensation. Such
			 Title
			 51 RCW insurer shall not be
			 liable, however, if the worker has a claim arising from the occupational
			 disease that is allowed for benefits under the maritime laws or Federal
			 Employees' Compensation Act.
(2)
			 The compensation schedules and wage base for claims shall be based on the
			 schedule in effect on the date of disease manifestation. Compensation shall be
			 based on the monthly wage of the worker as follows:
(a) If the worker was employed at the time
			 the disease required medical treatment or became totally or partially
			 disabling, whichever occurred first, compensation shall be based on the monthly
			 wage paid on that date regardless of whether the worker is employed in the
			 industry that gave rise to the disease or in an unrelated industry.
(b) If the worker was not employed, for
			 causes other than voluntary retirement, at the time the disease required
			 medical treatment or became totally or partially disabling, whichever occurred
			 first, compensation shall be based upon the last monthly wage paid.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-410 - Reduction, suspension, or denial of compensation as a result of noncooperation

Current through Register Vol. 24-14, July 15, 2024
(1)
Can the department or self-insurer reduce, suspend or deny industrial
			 insurance benefits from a worker?
The department or the self insurer,
			 after receiving the department's order, has the authority to reduce, suspend or
			 deny benefits when a worker (or worker's representative) is noncooperative with
			 the management of the claim.
(2)
What does noncooperative mean?
Noncooperation is behavior by the
			 worker (or worker's representative) which obstructs and/or delays the
			 department or self-insurer from reaching a timely resolution of the claim.
(a) Noncooperation can include any one of the
			 following:
(i) Not attending or cooperating
			 with medical examinations or vocational evaluations requested by the department
			 or self-insurer.
(ii) Failure to
			 keep scheduled appointments or evaluations with attending physician or
			 vocational counselor.
(iii)
			 Engaging in unsanitary or harmful actions that jeopardize or slow
			 recovery.
(iv) Not accepting
			 medical and/or surgical treatment that is considered reasonably essential for
			 recovery from the industrial injury or occupational disease.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-4121 - What does the term "willful misrepresentation" mean with regard to the receipt of workers' compensation benefits?

Current through Register Vol. 24-14, July 15, 2024
This term is found in
				RCW
				 51.32.240(5) which provides
				a fifty percent penalty, in addition to any overpayment, whenever any payment
				of benefits has been induced by "willful misrepresentation." The law goes on to
				state that it is willful misrepresentation for a person to obtain payments or
				other benefits in an amount greater than that to which he or she would have
				otherwise been entitled. Willful misrepresentation includes making a willful
				false statement or the willful misrepresentation, omission, or concealment of
				any material fact.
(1) Willful means a
			 conscious or deliberate false statement, misrepresentation, omission, or
			 concealment of a material fact with the specific intent of obtaining,
			 continuing, or increasing workers' compensation benefits. Failure to disclose a
			 work-type activity must be willful in order for a misrepresentation to have
			 occurred.
(2) The assessment of the
			 fifty percent penalty does not apply to those instances where the
			 misrepresentation is not willful, as defined above. For example, a worker
			 receives wages at the time of injury of $10.25 per hour, but he inadvertently
			 indicates on the report of industrial injury or occupational disease that his
			 pay is $10.75 per hour. The state fund employer fails to submit a completed
			 report form and the time-loss compensation benefit rate is based on wages of
			 $10.75 per hour. When this information is provided to the employer, worker, and
			 medical provider by legal order, no interested party submits a protest within
			 the statutory time frame, but further investigation later reveals the
			 misinformation. An overpayment determination under
			 RCW
			  51.32.240(1) may be
			 appropriate upon discovery of the correct hourly pay rate, but the worker has
			 not engaged in willful misrepresentation with specific intent to obtain
			 benefits to which he would have otherwise not been entitled.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020, and 2004 c 243.
				  04-20-024, § 296-14-4121, filed 9/28/04, effective
				  11/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-4122 - For purposes of determining willful misrepresentation, what does the term "specific intent" mean?

Current through Register Vol. 24-14, July 15, 2024
"Specific intent" means the commission of an act or the
				omission of information with the knowledge that such an act or omission will
				lead to wrongfully obtaining benefits. For example, a worker who completes a
				document knowingly misrepresenting that he/she is unable to perform work or
				work-type activities has committed an act. Submitting this document to the
				department or self-insurer in order to wrongfully receive workers' compensation
				benefits under
				Title
				51 RCW represents specific
				intent.
Examples of the omission of information with the intent of
				obtaining benefits include, but are not limited to, failure of the worker to
				advise the department or self-insurer of a return to work or of
				self-employment; or failure to provide the department or self-insurer with
				complete information about skills and abilities that would have changed the
				outcome of a vocational assessment or the department's decision to provide
				vocational services. Not providing this information to the department or
				self-insurer represents specific intent because the omission of it can cause
				continued workers' compensation benefits to which the worker would not have
				been entitled had the information been provided.
The following is an example of a situation that does not
				represent "specific intent": An injured worker's wife is hired to manage the
				mobile home park where they live. Wages were paid to her for the management
				duties. The injured worker would occasionally answer the telephone when his
				wife was not available and he opened and closed the park gates each morning. He
				did not engage in the maintenance work of the park, provide tours of the park
				to prospective customers or perform any other park management duties. The
				worker did not report this activity to the department, his physician or his
				vocational counselor. The worker's omission of information is not considered
				"willful misrepresentation" with "specific intent" to receive benefits to which
				he would not be otherwise entitled.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020, and 2004 c 243.
				  04-20-024, § 296-14-4122, filed 9/28/04, effective
				  11/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-4123 - What is meant by "work-type activity"?

Current through Register Vol. 24-14, July 15, 2024
(1) Work-type activity means any activity for
			 which a reasonable person would expect to be compensated or for which a
			 reasonable employer would expect to pay compensation.
(2) Work-type activity does not mean
			 exploration of a job for a short period of time to determine whether the worker
			 can do the job so long as:
(a) The worker does
			 not receive wages, income, or anything of value; and
(b) The worker or his/her family has no
			 financial interest in or benefits from the worker's job exploration.
Activity done intermittently or as a hobby that does not
				generate income will not generally rise to the level of repeated work-type
				activity.
For example, a worker who is receiving wage replacement
				benefits volunteers two hours each day for a recognized charity greeting
				customers and operating the cash register. His treating physician is aware of
				this activity and encourages it to keep him more active, but does not release
				him to work or to perform this function more than two hours daily. The worker
				does not initially inform the department of his activity because he receives no
				compensation and would not expect to. The department learns of the volunteer
				work when the worker completes a worker verification form indicating the
				volunteer activity. No willful misrepresentation of a work-type activity has
				occurred in this case.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-4124 - What are considered as "wage replacement benefits"?

Current through Register Vol. 24-14, July 15, 2024
Wage replacement benefits include temporary total disability
				(time-loss compensation benefits), temporary partial disability
				(loss-of-earning power benefits), and total permanent disability or survivor
				benefits (pension).
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020, and 2004 c 243.
				  04-20-024, § 296-14-4124, filed 9/28/04, effective
				  11/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-4125 - How does the department calculate the amount of overpayment charged to a claimant when a determination of "willful misrepresentation" has been made in initial claim adjudication?

Current through Register Vol. 24-14, July 15, 2024
Overpayments are assessed in cases where there has been willful
				misrepresentation.
When it is determined that a claim was initially accepted as an
				industrial injury or occupational disease based on willful misrepresentation,
				the overpayment calculation includes all wage replacement benefits, permanent
				partial disability benefits, medical benefits, vocational benefits, and other
				medical aid fund benefits paid on the claim.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020, and 2004 c 243.
				  04-20-024, § 296-14-4125, filed 9/28/04, effective
				  11/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-4127 - How are penalties determined?

Current through Register Vol. 24-14, July 15, 2024
As provided in
				RCW
				 51.32.240, the penalties equal fifty percent
				of the total overpayment amount.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020, and 2004 c 243.
				  04-20-024, § 296-14-4127, filed 9/28/04, effective
				  11/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-4128 - When may the department impute wages in cases where willful misrepresentation has been determined?

Current through Register Vol. 24-14, July 15, 2024
The department may impute wages when:
The worker is self-employed; or
Appropriate payroll records are not available; or
The employer is paying the worker in cash or material without
				maintaining appropriate payroll records; or
There is no employer but the worker has engaged in a repeated
				pattern of work-type activities or has willfully misrepresented his or her
				physical restrictions.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020, and 2004 c 243.
				  04-20-024, § 296-14-4128, filed 9/28/04, effective
				  11/1/04.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-420 - Payment of benefits - Aggravation reopening/new injury

Current through Register Vol. 24-14, July 15, 2024
(1) Whenever an application for benefits is
			 filed where there is a substantial question whether benefits shall be paid
			 pursuant to the reopening of an accepted claim or allowed as a claim for a new
			 injury or occupational disease, the department shall make a determination in a
			 single order. Where one of the claims is with a self-insured employer and
			 another is with a state fund employer, such determination shall be made jointly
			 by the program managers for claims administration and self insurance, or their
			 respective designees.
(2) Pending
			 entry of the order, benefits shall be paid promptly by the entity which would
			 be responsible if the claim were determined to be a new injury or occupational
			 disease.
(3) The department is
			 required to act under this rule only if:
(a)
			 There is substantial evidence that the worker will be determined to be entitled
			 to benefits on one of the claims; and
(b) There is uncertainty regarding which of
			 the entities is responsible.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-520 - Why is it important to establish the worker's monthly wage?

Current through Register Vol. 24-14, July 15, 2024
The department or self-insurer is required to establish a
				monthly wage that fairly and reasonably reflects workers' lost wages from all
				employment at the time of injury or date of disease manifestation. This monthly
				wage, which is calculated using the formulas in
				RCW
				 51.08.178, represents the worker's lost
				earning capacity. This monthly wage is used to calculate the rate of the
				worker's total disability compensation or beneficiary's survivor benefits under
				Washington's Industrial Insurance Act.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020 and 142 Wn.2d 801
				  (2001). 03-11-035, § 296-14-520, filed 5/15/03, effective
				  6/15/03.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-522 - What does the term "wages" mean?

Current through Register Vol. 24-14, July 15, 2024
The term "wages" is defined as:
(1) The gross cash wages paid by the employer
			 for services performed. "Cash wages" means payment in cash, by check, by
			 electronic transfer or by other means made directly to the worker before any
			 mandatory deductions required by state or federal law. Tips are also considered
			 wages but only to the extent they are reported to the employer for federal
			 income tax purposes.
(2) Bonuses
			 paid by the employer of record as part of the employment contract in the twelve
			 months immediately preceding the injury or date of disease
			 manifestation.
(3) The reasonable
			 value of board, housing, fuel and other consideration of like nature received
			 from the employer at the time of injury or on the date of disease manifestation
			 that are part of the contract of hire.
Exception:
Payments for items other than board, housing, fuel or
							 other consideration of like nature made by the employer to a trust fund or
							 other entity for fringe benefits do not constitute wages.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020 and 142 Wn.2d 801
				  (2001). 03-11-035, § 296-14-522, filed 5/15/03, effective
				  6/15/03.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-524 - How do I determine whether an employer provided benefit qualifies as "consideration of like nature" to board, housing and fuel?

Current through Register Vol. 24-14, July 15, 2024
To qualify as "consideration of like nature" the employer
				provided benefit must meet all of the following elements:
(1) The benefit must be objectively critical
			 to protecting the worker's basic health and survival at the time of injury or
			 date of disease manifestation.
(a) The
			 benefit must be one that provides a necessity of life at the time of injury or
			 date of disease manifestation without which employees cannot survive a period
			 of even temporary disability.
(b)
			 This is not a subjective determination. The benefit must be one that virtually
			 all employees in all employment typically use to protect their immediate health
			 and survival while employed.
(c)
			 The benefit itself must be critical to protecting the employee's immediate
			 health and survival. The fact that a benefit has a cash value that can be
			 assigned, transferred, or "cashed out" by an employee and used to meet one or
			 more of the employee's basic needs is not sufficient to satisfy this
			 element.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-526 - Is the value of "consideration of like nature" always included in determining the worker's compensation?

Current through Register Vol. 24-14, July 15, 2024
(1)
			 No. The value of other consideration of like nature is only included in the
			 worker's monthly wage if:
(a) The employer,
			 through its full or partial payment, provided the benefit to the worker at the
			 time of injury or on the date of disease manifestation;
(b) The worker received the benefit at the
			 time of injury or on the date of disease manifestation.
This section is satisfied if, at the time of injury or on the
				date of disease manifestation:
(i) The
			 employer made payments to a union trust fund or other entity for the identified
			 benefit; and
(ii) The worker was
			 actually eligible to receive the benefit.
Example:
At the time of the worker's industrial
				injury, the employer paid two dollars and fifty cents for each hour worked by
				the employee to a union trust fund for medical insurance on behalf of the
				employee and her family. If the employee was able to use the medical insurance
				at the time of her injury, the employer's monthly payment for this benefit is
				included in the worker's monthly wage, in accordance with (d) of this
				subsection. This is true even where the worker's eligibility for this medical
				insurance is based primarily or solely on payments to the trust fund from past
				employers.
(c)
			 The worker or beneficiary no longer receives the benefit and the department or
			 self-insurer has knowledge of this change.
If the worker continues to receive the benefit from a union
				trust fund or other entity for which the employer made a financial contribution
				at the time of injury or on the date of disease manifestation, the employer's
				monthly payment for the benefit is
not
included in the worker's
				monthly wage.
Example:
An employer contributes two dollars and
				fifty cents for each hour an employee works into a union trust fund that
				provides the employee and her family with medical insurance. If the employer
				stops contributing to this fund, but the worker continues to receive this
				benefit, the employer's monthly payment for the medical insurance is not
				included in the worker's monthly wage.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-528 - How do I determine the value of a benefit that qualifies as "consideration of like nature"?

Current through Register Vol. 24-14, July 15, 2024
The amount paid by the employer for the benefit at the time of
				injury or on the date of disease manifestation represents the amount that may
				be included in the worker's monthly wage.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020 and 142 Wn.2d 801
				  (2001). 03-11-035, § 296-14-528, filed 5/15/03, effective
				  6/15/03.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-530 - Is overtime considered in calculating the worker's monthly wage?

Current through Register Vol. 24-14, July 15, 2024
(1) When the
			 worker's monthly wage is computed under
			 RCW
			  51.08.178(1), only the
			 overtime hours the worker normally works are taken into
			 consideration.
(2) When the
			 worker's monthly wage is computed under
			 RCW
			  51.08.178(2), the overtime
			 pay is included in determining the worker's wages.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020 and 142 Wn.2d 801
				  (2001). 03-11-035, § 296-14-530, filed 5/15/03, effective
				  6/15/03.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6200 - What is a residence modification?

Current through Register Vol. 24-14, July 15, 2024
A residence modification is a permanent change to an existing
				residence or a repair of a modification previously approved and paid for by the
				department or self-insured employer, or a modification made when constructing a
				new residence.
Household appliances such as refrigerators, washers, and
				dryers, are generally not residence modifications and the department or
				self-insured employer will approve them only under unique circumstances as
				approved by the supervisor.
Example: As part of an approved residence modification, the
				kitchen counters are lowered. To meet the needs of the worker, the department
				or self-insured employer may approve the purchase of a drop-in range or
				cooktop.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6200, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6202 - What is the residence modification benefit?

Current through Register Vol. 24-14, July 15, 2024
The residence modification benefit is a sum of money used to
				modify a worker's residence for purposes of safety, mobility and activities of
				daily living, when those modifications are made necessary by the nature of the
				worker's condition subsequent to a catastrophic injury. Activities of daily
				living are tasks required for self-care, communication and mobility and
				include, but are not limited to, bathing, bed mobility, dressing, eating,
				grooming, toileting and transfers.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6202, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6204 - Which workers may be eligible to receive benefits for residence modifications?

Current through Register Vol. 24-14, July 15, 2024
Residence modification benefits are only available to workers
				with an allowed catastrophic injury claim. Catastrophic injuries are the most
				serious of conditions and include, but are not limited to, head trauma,
				paralysis and amputation.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6204, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6206 - Which residences may be eligible to be modified?

Current through Register Vol. 24-14, July 15, 2024
Before the department or self-insured employer will consider an
				application for modification, the residence must meet the following
				criteria:
(1) The residence must be
			 structurally sound and free of obvious structural defects. The department may
			 request a safety inspection. The department or self-insured employer will not
			 pay for a residence to be brought up to state and local code except as required
			 to complete a necessary and approved modification.
(2) The residence can be adapted to be
			 suitable for the worker's needs for purposes of daily living.
(3) In the opinion of the worker's health
			 care providers, the worker can live in the residence after
			 modification.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6206, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6208 - When may the worker request residence modification benefits?

Current through Register Vol. 24-14, July 15, 2024
The worker may request residence modification at any time when
				his or her allowed claim is either open or the worker has been determined to be
				permanently and totally disabled.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6208, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6210 - What is the maximum amount of the residence modification benefit?

Current through Register Vol. 24-14, July 15, 2024
The maximum amount of the benefit is the state's average annual
				wage at the time that each modification request is approved. The department or
				self-insured employer will not pay for modifications that exceed the maximum
				amount. The department or self-insured employer may make several payments, so
				long as the total paid does not exceed the maximum benefit.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6210, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6212 - Can the worker receive additional modification benefits for the same residence?

Current through Register Vol. 24-14, July 15, 2024
The department can pay for additional or subsequent residence
				modifications so long as the cost does not exceed the maximum benefit in effect
				at the time that each modification request is approved.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6212, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6214 - Can a worker receive residence modification benefits for more than one house?

Current through Register Vol. 24-14, July 15, 2024
No. The department or self-insured employer will pay for
				residence modifications on only one residence for each catastrophically injured
				worker.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6214, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6216 - How can a worker begin the process of requesting residence modification benefits?

Current through Register Vol. 24-14, July 15, 2024
The worker may inquire about residence modification benefits by
				contacting his or her adjudicator. The department or self-insured employer will
				then refer the worker to a residence modification consultant for
				evaluation.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6216, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6218 - How does the department or self-insured employer determine the worker's residence for purposes of residence modification?

Current through Register Vol. 24-14, July 15, 2024
The department or self-insured employer will consider modifying
				a residence when the worker lives in and considers the residence to be his or
				her permanent residence. It is not required that the worker own or rent the
				residence.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6218, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6220 - What type of residence may the department or self-insured employer modify?

Current through Register Vol. 24-14, July 15, 2024
The department or self-insured employer may modify a standard
				house, a residential unit in a multiunit dwelling, or a manufactured/mobile
				residence.
The department or self-insured employer will only authorize
				modification of manufactured/mobile residences when the factory assembled
				structures division of the department reviews and approves the plans in
				advance.
The department or self-insured employer will not approve
				modification of commercial coaches.
The department or self-insured employer will not approve
				modification of recreational vehicles or recreational park trailers used as
				permanent residences, unless the local jurisdiction allows recreational
				vehicles or recreational park trailers to be used as a dwelling, and the
				factory assembled structures division of the department reviews and approves
				the plans in advance.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6220, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6222 - What is a residence modification consultant, and how are they involved in the process of residence modification?

Current through Register Vol. 24-14, July 15, 2024
When the worker has notified the department or self-insured
				employer of his or her intention to request a residence modification, the
				department or self-insured employer will require an on-site evaluation by a
				residence modification consultant.
A residence modification consultant must be either a licensed
				physical or occupational therapist, or licensed nurse, and must be trained or
				experienced in both rehabilitation of catastrophic injuries and in modifying
				residences. The department or self-insured employer will pay for the services
				of the residence modification consultant pursuant to department provider
				rules.
The residence modification consultant will assist the worker,
				the contractor and the worker's health providers to determine what
				modifications will be requested and submit a written report to the department
				or self-insured employer and the worker. If modifications are approved, the
				residence modification consultant may assist the worker and the contractor if
				requested by the department or self-insured employer.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6222, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6223 - Will the department pay for professional services needed to design a residence modification?

Current through Register Vol. 24-14, July 15, 2024
Yes. However, the department or self-insured employer will not
				pay for professional services prior to approval of the residence
				modification.
If approved, the cost of architectural, engineering, predesign
				and planning services will be included in the residential modification benefit.
				The cost for services should be included in the residence modification
				request.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6223, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6224 - What must the worker submit to the department in a completed request for a residence modification?

Current through Register Vol. 24-14, July 15, 2024
For the department to process a residence modification request,
				the worker must provide the adjudicator with at least the following
				information:
(1) Documentation of
			 residence ownership. If the worker does not own the residence, he or she must
			 submit the actual owner's proof of ownership and written legal permission
			 signed by the actual owner to modify the residence as indicated in the proposed
			 plan; and
(2) A report signed by
			 the residence modification consultant for all necessary modifications;
			 and
(3) Competing and detailed bids
			 from two licensed, registered and bonded contractors.
Exceptions:
If it is not possible to obtain two bids, a written
							 explanation of the circumstances must be provided.
If family or friends will perform free labor, they
							 need not be licensed, registered and bonded, but must still submit a bid for
							 the cost of materials.
(4) A
			 copy of the acknowledgment of responsibilities letter signed by both the worker
			 and the contractor. A copy of this form can be obtained from the
			 department.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6224, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6226 - What other information must be submitted to the department in a completed application for a residence modification?

Current through Register Vol. 24-14, July 15, 2024
(1) The attending health services provider
			 may need to submit medical documentation verifying the worker's condition and
			 the necessity for any residence modification.
(2) The residence modification consultant
			 must submit an evaluation, based on an in-home inspection, of the worker's
			 needs for safety, mobility and activities of daily living. This evaluation must
			 be in the form of a written report with pictures or drawings.
(3) Any additional information requested by
			 the department or self-insured employer that might be needed to evaluate a
			 specific request.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6226, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6228 - Who will approve or deny a request for residence modification?

Current through Register Vol. 24-14, July 15, 2024
The department will pay the benefit only with the approval of
				the supervisor of industrial insurance. A self-insured employer may pay the
				benefit without the supervisor's approval, but may not deny the benefit. The
				supervisor of industrial insurance alone has the authority to deny a residence
				modification benefit.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6228, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6230 - What will the supervisor consider when approving or denying a residence modification request?

Current through Register Vol. 24-14, July 15, 2024
The supervisor will consider requests for residence
				modifications on a case-by-case basis. The supervisor may approve all or part
				of the requested modifications, based on what is reasonable and necessary for
				the individual worker.
In order to determine what is reasonable and necessary, the
				supervisor will review the completed application and will consider at least the
				following:
(1) Whether the worker is
			 eligible to receive a residence modification benefit; and
(2) The needs and preferences of the
			 individual worker, based on information provided by the injured worker;
			 and
(3) Whether the proposed
			 residence is appropriate for modification; and
(4) Whether the proposed modifications are
			 appropriate for the style, nature and condition of the residence; and
(5) The attending health care provider's
			 opinions of the medical condition, physical needs of the worker and whether the
			 worker can reside in the residence after the modifications are complete;
			 and
(6) The residence modification
			 consultant's evaluation of whether the proposed modification is necessary to
			 meet the worker's current need for safety, mobility and activities of daily
			 living; and
(7) Whether the
			 contractor's proposed plan will satisfy the necessary modification;
			 and
(8) Whether the proposed plans
			 submitted by the contractors are consistent with state guidelines for specially
			 adapted residential housing, if any; and
(9) The contractor's proposed modification
			 plan is consistent with the guidelines established by the United States
			 Department of Veterans Affairs in their publication entitled "
Handbook
			 for Design: Specially Adapted Housing
," or the recommendations
			 published in "
The Accessible Housing Design File
" by Barrier
			 Free Environments, Inc.; and
(10)
			 Whether the proposed modifications are being provided at the least cost while
			 maintaining quality.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6230, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6232 - What happens if the residence modification costs exceed the maximum benefit?

Current through Register Vol. 24-14, July 15, 2024
The department or self-insured employer may approve a payment
				of a portion of a residence modification request, not to exceed the maximum
				benefit. The department or self-insured employer will identify the portions of
				the residence modification for which payment will be approved based on the
				worker's current need for safety, mobility and activities of daily
				living.
If the costs of the proposed modifications of an existing
				residence exceed the benefit, the worker is responsible for payment of the
				balance of the costs. The worker must choose one of the following
				options:
(1) Adjust their request for
			 modifications to remain within the benefit; or
(2) Obtain additional financing. If the
			 worker chooses to obtain additional financing, he or she must submit to the
			 department written verification of the additional financing from the funding
			 source. The supervisor will deny the residence modification if the worker is
			 unable to cover the additional costs.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6232, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6234 - Can a worker apply the residence modification benefit to the cost of building a new residence?

Current through Register Vol. 24-14, July 15, 2024
Yes. However, the benefit may be applied only to the cost
				difference between a standard residence structure and the modified
				structure.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6234, filed 2/28/06, effective
				  4/1/06.