reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6236 - How is a worker advised that the supervisor has approved or denied the request for residence modification benefits?

Current through Register Vol. 24-14, July 15, 2024
The department will notify the worker, contractors, homeowner
				(if not the worker), residence modification consultant, attending health
				services provider and employer of the supervisor's decision in
				writing.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6236, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-6238 - Who receives payment from the department?

Current through Register Vol. 24-14, July 15, 2024
The department will pay the contractor directly and/or
				reimburse the worker for any payment already made to the contractor for
				approved and completed residence modifications. In order to determine that
				modifications have been satisfactorily completed, the department will require
				the following documents to be submitted before releasing final payment:
(1) A signed letter of satisfaction from the
			 worker; and
(2) A positive report
			 of a final inspection from the appropriate inspection authorities, if required;
			 and
(3) A report of an inspection
			 from the residence modification consultant if requested by the department;
			 and
(4) A release of lien form
			 signed by the contractors or subcontractors or both.
Statutory Authority:
				  RCW
				  51.04.010,
				  51.04.020,
				  51.32.240, and 2005 c 411.
				  06-06-065, § 296-14-6238, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-8810 - Pension tables, pension discount rate and mortality tables

Current through Register Vol. 24-14, July 15, 2024
(1) The department
			 uses actuarially determined pension tables for calculating pension annuity
			 values, required pension reserves, and actuarial adjustments to monthly benefit
			 amounts.
(a) The department's actuaries
			 calculate the pension tables based on:
(i)
			 Mortality tables from nationally recognized sources;
(ii) The department's experience with rates
			 of mortality, disability, and remarriage for annuity recipients;
(iii) A pension discount rate of 4.0 percent
			 for state fund pensions;
(iv) A
			 pension discount rate of 5.5 percent for self-insured pensions, including the
			 United States Department of Energy pensions; and
(v) The higher of the two pension discount
			 rates so that pension benefits for both state fund and self-insured recipients
			 use the same reduction factors for the calculation of death benefit options
			 under RCW
			  51.32.067.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-900 - Authority to use special assistant attorneys general

Current through Register Vol. 24-14, July 15, 2024
WAC
				296-14-900 through
				296-14-940 implement
				RCW
				 51.12.102 and
				51.24.110, which authorize the
				department to use private attorneys as special assistant attorneys
				general.
Statutory Authority:
				  RCW
				  51.24.110 and
				  51.12.102. 98-19-001, §
				  296-14-900, filed 9/2/98, effective 10/5/98. Statutory Authority: Chapters
				  51.04, 51.08,
				  51.12, 51.24 and
				  51.32 RCW and 117 Wn.2d 122 and 121
				  Wn.2d 304. 93-23-060, § 296-14-900, filed 11/15/93, effective 1/1/94.
				  Statutory Authority:
				  RCW
				  51.24.110. 88-08-026 (Order 88-03), §
				  296-14-900, filed 3/31/88.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-910 - Lists of special assistant attorneys general

Current through Register Vol. 24-14, July 15, 2024
(1) The department must determine from the
			 application and other sources if an attorney qualifies to be placed on the
			 lists of attorneys eligible to represent the department as special assistant
			 attorneys general. The department may consult with the Washington State Bar
			 Association and the office of the attorney general to make the
			 determination.
(2) The office of
			 the attorney general must appoint qualified attorneys as special assistant
			 attorneys general. Once appointed, these attorneys become eligible to represent
			 the department. Appointed attorneys serve at the pleasure of the office of the
			 attorney general, and the appointments may be canceled without cause.
(3) The department must compile and maintain
			 lists of attorneys eligible to represent the department as special assistant
			 attorneys general. Referrals may be made from the lists and contracts entered
			 into.
(4) Once a year, the
			 department must provide a current copy of its lists of attorneys to the office
			 of the attorney general and to the Washington State Bar Association.
Statutory Authority:
				  RCW
				  51.24.110 and
				  51.12.102. 98-19-001, §
				  296-14-910, filed 9/2/98, effective 10/5/98. Statutory Authority: Chapters
				  51.04, 51.08,
				  51.12, 51.24 and
				  51.32 RCW and 117 Wn.2d 122 and 121
				  Wn.2d 304. 93-23-060, § 296-14-910, filed 11/15/93, effective 1/1/94.
				  Statutory Authority:
				  RCW
				  51.24.110. 88-08-026 (Order 88-03), §
				  296-14-910, filed 3/31/88.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-920 - Qualifications of special assistant attorneys general

Current through Register Vol. 24-14, July 15, 2024
To be eligible for placement on the department's lists of
				attorneys, an attorney must:
(1) Be an
			 active member of the Washington State Bar Association;
(2) Meet bar association requirements of the
			 state the action is in, if other than Washington;
(3) Maintain a trust account in compliance
			 with the rules of professional conduct; and
(4) Have and maintain in force professional
			 liability insurance.
Statutory Authority:
				  RCW
				  51.24.110 and
				  51.12.102. 98-19-001, §
				  296-14-920, filed 9/2/98, effective 10/5/98. Statutory Authority:
				  RCW
				  51.24.110. 88-08-026 (Order 88-03), §
				  296-14-920, filed 3/31/88.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-930 - Applying for special assistant attorney general

Current through Register Vol. 24-14, July 15, 2024
(1) Application forms may be obtained from
			 the office of the attorney general, the Washington State Bar Association, or
			 the department.
(2) The applicant
			 must:
(a) Complete the form and send it to
			 the department; and
(b) Inform the
			 department and the office of the attorney general immediately of any changes in
			 his or her qualifications.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-940 - Removal of special assistant attorneys general

Current through Register Vol. 24-14, July 15, 2024
(1)RCW
			  51.12.102 and
			 51.24.110 and WAC
			 296-14-900 through
			 296-14-940 do not give private
			 attorneys on the special assistant attorneys general lists any right to expect
			 employment.
(2) Private attorneys,
			 unless representing the department in a specific case, must not:
(a) Refer to themselves as "special assistant
			 attorney general"; or
(b) Include
			 this designation on any correspondence or pleadings relating to
			 services.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-955 - Attorney's fees

Current through Register Vol. 24-14, July 15, 2024
(1) The department
			 of labor and industries (hereinafter department) shall fix a reasonable
			 attorney fee to be paid by the worker, crime victim, or beneficiary for
			 services rendered with the department if written application therefor is made
			 by the attorney, worker, crime victim, or beneficiary, as provided in
			 RCW
			  51.52.120.
(a) Fees will be set only for services
			 rendered prior to the notice of appeal;
(b) On closed claims, fees will only be set
			 if written application is received by the department within one year from the
			 claim closure date as indicated on the department order.
(c) If such application for fixing of a fee
			 is made by the attorney, it shall set forth therein the monetary amount which
			 the attorney considers reasonable for all services rendered with the
			 department, the reason such fee is considered to be reasonable, and a detailed
			 breakdown of the time spent by the attorney in representing the injured
			 worker.
(d) In all instances, the
			 department shall afford to all parties affected a minimum of ten days in which
			 to submit comment and material information which may be helpful to the
			 department in setting a fair and reasonable fee.
(e) The department will provide copies of
			 information sent to the department to the attorney, worker, crime victim, or
			 beneficiary upon request.
(f)
			 Informal contact may be made with the parties to determine the feasibility of
			 reaching an agreement on the amount of the fees.
(g) Additional information necessary to reach
			 a decision may be requested by the department.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14 - Industrial insurance › Section 296-14-970 - Worker's review of claim file

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Pursuant to
			 RCW
			  51.28.070, workers may be allowed to review
			 their claim file(s) upon written request to the department or self-insurer. The
			 written request should contain the worker's name, claim number, signature, and
			 the information requested. If the request is approved, the department or
			 self-insurer shall provide a copy of the claim file to the worker.
(2) Reasons for denying release of a claim
			 file, to a worker shall include, but not be limited to the following:
(a) Presence of psychological, mental health,
			 or physical treatment records, investigative reports or other records, release
			 of which may not be in the interest of the worker.
(b) Medical opinion or other documented
			 information indicates the worker is a danger to himself or herself or
			 others.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-010 - Negotiating settlements - How is a structured settlement agreement negotiated in a state fund claim?

Current through Register Vol. 24-14, July 15, 2024
(1) In a state
			 fund claim, any party may submit a structured settlement application form to
			 the department.
(2) The department
			 will perform an initial review and determine if negotiations should proceed.
			 When deciding whether to enter into negotiations for a structured settlement,
			 the department will consider the following nonexclusive factors:
(a) Worker's age;
(b) Nature and extent of injury(ies) or
			 disease(s) related to the claim;
(c) Nature and extent of disabilities related
			 to the condition(s) accepted under the claim;
(d) Other medical conditions unrelated to the
			 claim;
(e) Other open or closed
			 worker compensation claims for the worker;
(f) Other settlements for injuries or
			 diseases;
(g) Worker's life
			 expectancy;
(h) Worker's marital or
			 domestic partnership status;
(i)
			 Number and age of dependents;
(j)
			 Worker's sources of present and future income and benefits;
(k) Worker's employment history;
(l) Worker's education history;
(m) Worker's labor market;
(n) The effect a structured settlement
			 agreement might have on other benefits the worker is receiving or entitled to
			 receive.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-020 - Employers

Current through Register Vol. 24-14, July 15, 2024
(1)
Who is an
			 affected employer?
An employer is an affected employer if the cost of
			 the claim which may be the subject of a structured settlement agreement is
			 included in the calculation of the employer's experience factor used to
			 determine premiums. The department will send notice of any structured
			 settlement agreement negotiations to an affected employer.
(2)
How will an affected employer be
			 notified of a structured settlement agreement negotiation?
When the
			 department decides to begin settlement discussions, the department will notify
			 all affected employers by mail, and will request the employer's participation
			 in the negotiations.
(3)
How
			 long does an affected employer have to respond to the department's notice of a
			 negotiation?
An affected employer has fourteen calendar days from the
			 date the notice is sent to respond to the department's request for
			 participation.
(4)
What
			 happens if an affected employer does not respond to the department's notice of
			 a negotiation?
If the employer does not respond to the request within
			 fourteen calendar days, the department will consider that the employer has
			 declined to participate and will proceed with scheduling negotiations without
			 the employer.
An affected employer who declines to participate as a party to
				a structured settlement agreement will be bound by the terms of the agreement
				including any impact the structured settlement may have on the employer's
				experience factor or on the employer's industrial insurance
				premiums.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.04.030, and 2011 1st sp.s. c 37
				  § 305. 12-07-065, § 296-14A-020, filed 3/20/12, effective
				  4/20/12.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-030 - Continuation of benefits - Do Title 51 RCW benefits stop during settlement negotiations?

Current through Register Vol. 24-14, July 15, 2024
The department or self-insured employer must continue to manage
				the industrial insurance claim and pay benefits to which the worker is entitled
				during any settlement negotiation until the agreement is
				final.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.04.030, and 2011 1st sp.s. c 37
				  § 305. 12-07-065, § 296-14A-030, filed 3/20/12, effective
				  4/20/12.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-040 - Settlement issues - Can issues outside of Title 51 RCW be settled as part of a structured settlement agreement?

Current through Register Vol. 24-14, July 15, 2024
No. Issues outside of
				Title
				51 RCW including, but not
				limited to, continued employment or discrimination claims cannot be settled
				within the structured settlement agreement.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.04.030, and 2011 1st sp.s. c 37
				  § 305. 12-07-065, § 296-14A-040, filed 3/20/12, effective
				  4/20/12.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-050 - Future claims - Can future claims be settled as part of a structured settlement?

Current through Register Vol. 24-14, July 15, 2024
Future industrial injury or occupational disease claims may not
				be settled as part of a structured settlement. Future claims include, but are
				not limited to:
(1) Work-related
			 injuries that have not yet occurred or occupational diseases that have not yet
			 manifested;
(2) Applications for
			 industrial injury or occupational disease benefits that have not yet been
			 filed; and
(3) Claims for future
			 death benefits or survivor benefits when death results from the
			 injury.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.04.030, and 2011 1st sp.s. c 37
				  § 305. 12-07-065, § 296-14A-050, filed 3/20/12, effective
				  4/20/12.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-060 - Burden to Title 51 RCW funds - How does a self-insured employer obtain prior approval for a structured settlement agreement if the agreement will burden or impact any funds covered under Title 51 RCW?

Current through Register Vol. 24-14, July 15, 2024
(1) If a self-insured employer is considering
			 subjecting a fund covered under
			 Title
			 51 RCW to any responsibility or
			 burden as a result of a structured settlement agreement, the self-insured
			 employer will:
(a) Notify the department in
			 writing and give the director or the director's designee at least thirty days
			 to either approve or deny the request; and
(b) Provide the following information:
(i) A copy of the complete claim file(s) of
			 the injured worker;
(ii) Any other
			 information relevant to the proposed agreement; and
(iii) All terms of the structured settlement
			 agreement, including an explanation of the anticipated impact on the
			 fund(s).
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-070 - Protests - What if there is an outstanding protest on a claim that has a final settlement agreement?

Current through Register Vol. 24-14, July 15, 2024
Any outstanding protests on a claim with a final settlement
				agreement are deemed to have been resolved by the agreement.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.04.030, and 2011 1st sp.s. c 37
				  § 305. 12-07-065, § 296-14A-070, filed 3/20/12, effective
				  4/20/12.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-080 - Payments - What is a periodic payment schedule?

Current through Register Vol. 24-14, July 15, 2024
Periodic payment for the purpose of
				RCW
				 51.04.063 structured settlements means
				payments that are made monthly unless the parties agree to a different payment
				schedule. In no case will payments be made more often than every two
				weeks.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.04.030, and 2011 1st sp.s. c 37
				  § 305. 12-07-065, § 296-14A-080, filed 3/20/12, effective
				  4/20/12.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-14A - Claim resolution structured settlement agreements › Section 296-14A-090 - Prior agreements

Current through Register Vol. 24-14, July 15, 2024
(1)
How
			 can I get a copy of a prior settlement agreement?
The department must
			 keep copies of all final structured settlement agreements. Any party who is
			 actively negotiating a new structured settlement agreement can request a copy
			 of prior agreements involving the same worker, if any exist, from the
			 department.
(2)
What is
			 active negotiation?
Parties will be considered in active negotiations
			 when the requirements of
			 RCW
			  51.04.063(1) have been met,
			 one hundred eighty days have passed since the claim was received by the
			 department or self-insurer, the order allowing the claim is final and:
(a) All parties have agreed to attempt to
			 resolve the claim(s) through a structured settlement agreement;
(b) The parties are discussing potential
			 resolutions; and
(c) No resolution
			 has been reached.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-001 - Definitions

Current through Register Vol. 24-14, July 15, 2024
(1) "Self-insurance
			 electronic data reporting system (SIEDRS)": SIEDRS is a computer system that
			 collects claim data electronically from self-insurers. Effective July 1, 2008,
			 all self-insurers must send timely and accurate claim data to SIEDRS in the
			 required format.
(2) "Substantially
			 similar":
(a) The text of the department's
			 document has not been altered or deleted; and
(b) The self-insurer's document has the text:
(i) In approximately the same font
			 size;
(ii) With the same emphasis
			 (bolding, italics, underlining, etc.); and
(iii) In approximately the same location on
			 the page as the department's document.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-021 - Self-insurance qualifications

Current through Register Vol. 24-14, July 15, 2024
(1)
What factors does the department consider whether an employer qualifies
			 for self-insurance certification?
The department will consider whether:
(a) An employer satisfactorily demonstrates:
(i) Stability: Has been in business for three
			 years prior to applying for self-insurance without substantial changes in
			 principle ownership, structure, or operations.
(ii) Safety: Has a written accident
			 prevention program in place in accordance with DOSH standards in Washington
			 state for at least six months prior to making application.
(iii) Sufficiency: Has net worth of
			 twenty-five million dollars, or revenue of fifty million dollars, or annual
			 workers compensation premium payments or loss costs of one million dollars, to
			 be adjusted once every five years as indexed to the U.S. Consumer Price Index
			 beginning in 2025. This subsection does not apply to cities and counties, or
			 groups, authorized under
			 RCW
			  51.14.150.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-024

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
				  RCW
				   51.04.020,
				  51.14.020,
				  51.32.190,
				  51.14.090, and
				  51.14.095. 06-06-066, §
				  296-15-024, filed 2/28/06, effective
				  4/1/06.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-027 - Additional requirements for subsidiaries and acquisitions

Current through Register Vol. 24-14, July 15, 2024
(1)
What if
			 an individual firm is a subsidiary of a corporation?
(a) If an individual self-insured firm has a
			 parent (owner of fifty percent and/or having controlling financial interest),
			 the parent must provide the department with its written guarantee, L&I form
			 F207-040-000, to assume responsibility for all workers' compensation
			 liabilities of the subsidiary if the subsidiary defaults on its
			 liabilities.
(b) If a parent fails
			 to provide a guarantee, the department will require the subsidiary to provide
			 surety at one hundred twenty-five percent of its actual requirement. The
			 subsidiary must continue to provide surety at the higher level as long as it
			 has no parental guarantee.
(c)
			 Certification of an individual self-insurer will include all of its
			 subsidiaries (fifty percent owned and/or financial interest controlled by) or
			 divisions doing business in Washington, as well as new acquisitions after
			 certification becomes final. One certificate will be issued to an approved
			 self-insurer. The subsidiaries or divisions will be considered one self-insurer
			 for all industrial insurance purposes.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-121 - Surety for a self-insurance program

Current through Register Vol. 24-14, July 15, 2024
(1)
What is
			 surety?
Surety is the legal financial guarantee each self-insurer must
			 provide to the department for its self-insured workers' compensation program.
			 Failure to provide surety in the amount required by the department will result
			 in the withdrawal of the self-insurer's certification. If a self-insurer
			 defaults, the department will use its surety to cover these costs.
(a) Surety for all entities must be provided
			 on the department's form. The original will be kept by the department. Surety
			 must cover all self-insurance claims liabilities associated with the claims
			 occurring during the time an employer functions as a self-insurer. Excluding
			 public entities and groups. Surety amounts for public entities and groups are
			 covered by WAC
			 296-15-151 and
			 296-15-161
			 respectively.
(b) Surety may not be
			 used by a self-insurer to:
(i) Pay its
			 workers' compensation benefits; or
(ii) Serve as collateral for any other
			 banking transactions.
(c) Surety is not an asset of the
			 self-insurer and will not be released by the department if the self-insurer
			 files a petition for dissolution or relief under bankruptcy laws.
(d) The department will determine the amount
			 of surety each self-insurer must provide annually. Surety can also be
			 determined by an independent qualified actuary (associate or fellow of the
			 casualty actuarial society). The surety estimate is subject to the approval of
			 the department's actuary.
(e)
			 Surety may be increased by a maximum of 25 percent of the estimated claim
			 liabilities. These increases will be based on the self-insurer's credit rating
			 or the director's discretion.
(f)
			 Surety for privately held entities are required to submit audited financial
			 reports prepared by a certified public accountant annually. Failure to provide
			 timely updates will result in increased surety requirements. If the latest
			 financial reports are older than 12 months past their fiscal year, surety will
			 be increased by 10 percent over the required surety calculated by the
			 department. If the latest financial reports are older than 24 months, surety
			 will be increased by 25 percent over the required surety calculated by the
			 department and the department will proceed to decertify the employer from
			 self-insurance.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-123 - Monitoring certification

Current through Register Vol. 24-14, July 15, 2024
(1) To maintain
			 certification, a self-insured employer must remain in good standing with
			 department reporting requirements and payment of assessments, and continue to
			 demonstrate they have the ability to promptly provide benefits to its injured
			 workers based on an analysis of the audited financial statements and related
			 information for that employer.
(2)
			 Credit rating evaluation for financial monitoring.
(a) Credit rating equal to or below B+/B1:
			 Self-insurer must increase their surety by ten percent of estimated claim
			 liabilities.
(b) Credit rating
			 equal to or below CCC+/Caa1: Selfinsurer must increase their surety by
			 twenty-five percent of estimated claim liabilities.
(c) Credit rating equal to or below
			 CCC-/Caa3: Selfinsurer will be placed on corrective action for one year. If no
			 improvement in credit rating, then certification may be withdrawn.
(d) To assess an employer's ability to
			 promptly provide any and all required benefits to its injured workers, the
			 department will utilize these and other financial information. The department
			 may also utilize industry standards and other relevant information in its
			 analysis.
(e) In addition to the
			 actions and other relevant information utilized in (a) through (d) of this
			 subsection, the department, with the director's discretion, may consider
			 general economic conditions to evaluate whether a self-insurer's certification
			 may be maintained or withdrawn.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-125 - Default by a self-insurer

Current through Register Vol. 24-14, July 15, 2024
(1) What is a
			 default? A default occurs when a self-insured employer no longer provides
			 benefits to its injured workers in accordance with Title 51 of the Revised Code
			 of Washington, or is determined to otherwise fail to meet the requirements of a
			 self-insured employer under Title 51 RCW. A default can be a voluntary action
			 of the self-insured employer, an action brought on by the employer's inability
			 to pay the obligation, or an action brought on by the department.
(2) What happens when the department first
			 learns a self-insured employer has discontinued meeting its obligations under
			 Title 51 RCW? The department will send notice to the self-insurer that if it
			 does not send confirmation within 10 calendar days that it intends to continue
			 to meet its obligations under Title 51 RCW, the department will determine that
			 the self-insurer has defaulted. If the self-insurer does not respond to the
			 department and resume meeting its obligations under Title 51 RCW within 10
			 days, the self-insured employer is determined to have defaulted.
(3) What happens when the department
			 determines that the self-insured employer has defaulted? The following actions
			 occur when a default by a self-insured employer is determined:
(a) The department assumes jurisdiction of
			 the claims of the defaulting self-insurer and begins to provide benefits to
			 those injured workers.
(b) If the
			 self-insurer is a private entity, or a public entity or group that has provided
			 surety consistent with WAC
			 296-15-121, the department makes
			 demand upon the surety provided by that self-insurer for the full amount of the
			 surety. The proceeds of the surety are deposited with the department and accrue
			 interest, which will be used to supplement the surety in providing benefits to
			 those injured workers.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-140 - Expense of out-of-state audit

Current through Register Vol. 24-14, July 15, 2024
(1)
When is a self-insurer charged for audit expenses?
The
			 self-insurer must reimburse the department for all travel, per diem and
			 documented expenses as related to the audit when the department representative
			 travels outside the state of Washington.
(2)
How much will the self-insurer be
			 charged?
The self-insured employer is billed the actual costs that the
			 department incurred.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.14.020,
				  51.32.190,
				  51.14.090, and
				  51.14.095. 06-06-066, §
				  296-15-140, filed 2/28/06, effective 4/1/06; Order 74-38, § 296-15-140,
				  filed 11/18/74, effective 1/1/75.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-151 - Surety for a public entity's self insurance program

Current through Register Vol. 24-14, July 15, 2024
(1) Surety for public entities must be
			 provided on a department developed form consistent with WAC
			 296-15-121(2).
			 The original will be kept by the department. Required surety must cover at a
			 minimum one hundred twenty-five percent of the expected workers' compensation
			 claim costs occurring in the next calendar year or five hundred thousand
			 dollars, whichever is higher. The surety required may be increased up to the
			 total outstanding liabilities associated with claims occurring during the time
			 an employer functions as a self-insurer based on the credit rating of the
			 employer.
(2) Public entities must
			 provide a public entity surety certification which will provide an estimate of
			 the next calendar year's expected claim costs and the current estimate of the
			 outstanding claim liabilities.
(3)
			 Credit rating evaluation for financial monitoring.
(a) For entities with acceptable credit
			 ratings above B+/B1, the surety requirement will be one hundred twenty-five
			 percent of the next calendar year's expected claim costs or five hundred
			 thousand dollars, whichever is higher.
(b) For entities with credit ratings at or
			 below B+/B1, the surety requirement will be the highest of the above amount,
			 but not less than fifty percent of the current estimate of outstanding claim
			 liabilities.
(c) For entities with
			 credit ratings at or below CCC+/Caa1, the surety requirement will be the
			 highest of the above amount, but not less than one hundred percent of the
			 current estimate of outstanding claim liabilities.
(d) In addition to the actions and other
			 relevant information utilized in (a) through (c) of this subsection, the
			 department, with the director's discretion, may consider general economic
			 conditions to evaluate whether a self-insurer's certification may be maintained
			 or withdrawn.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-161 - Surety for a group self - insurance program

Current through Register Vol. 24-14, July 15, 2024
(1)
How does the department determine
			 the required surety level for a group self-insurer?
The department will require that each group provide an
				actuarial report prepared by an independent qualified actuary (associate or
				fellow of the casualty actuarial society) that shows the following:
(a) Development of the next year's rates and
			 allocation to members;
(b)
			 Calculation of outstanding claims liabilities cover all years after being
			 certified to self-insure; and
(c)
			 Statement of the adequacy of the group's contingency reserve (assets and
			 liabilities).
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-181 - Funding the benefits of an insolvent self-insurer

Current through Register Vol. 24-14, July 15, 2024
(1)
What happens when a self-insurer
			 defaults on (stops paying) workers' compensation benefits and
			 assessments?
When a self-insurer stops paying workers' compensation
			 benefits or assessments, and the default is not due to a claims administration
			 decision, the department will take over its surety and claims.
(2)
If a defaulting self-insurer has
			 multiple types of surety, who determines the order in which surety will be
			 used?
The department has the sole authority to determine the order in
			 which surety types will be used.
(3)
What happens if the defaulting
			 self-insurer's surety is exhausted?
When surety is exhausted, the
			 insolvency trust (all self-insurers except school districts, cities and
			 counties) will be assessed quarterly to cover the claim costs paid on behalf of
			 the defaulted self-insurer.
(4)
Who is on the insolvency trust board?
The insolvency trust board
			 consists of the director or designee, three representatives of self-insured
			 employers and one representative of workers. Representatives are nominated by
			 the self-insured and labor communities and are appointed by the director for
			 overlapping two year terms.
(5)
What does the insolvency trust board do?
The board advises the
			 department on insolvency trust matters. The department makes all final
			 decisions.
(6)
What annual
			 report is provided on the insolvency trust fund?
The department provides
			 an annual written status report on the insolvency trust fund as of the end of
			 the previous calendar year to the workers' compensation advisory committee. The
			 report is presented at the committee's first quarterly meeting no later than
			 March 31.
Statutory Authority:
				  RCW
				  51.04.020,
				  51.14.020,
				  51.32.190,
				  51.14.090, and
				  51.14.095. 06-06-066, §
				  296-15-181, filed 2/28/06, effective 4/1/06. Statutory Authority:
				  RCW
				   51.14.077,
				  51.14.120(7),
				  51.14.150(4),
				  51.14.160,
				  51.44.040(3),
				  51.44.070 and
				  51.44.150. 99-23-107, §
				  296-15-181, filed 11/17/99, effective
				  12/27/99.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-200

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
				  RCW
				   51.04.020. 86-14-079 (Order 86-25), §
				  296-15-200, filed 7/1/86; 83-07-009 (Order 83-8), § 296-15-200, filed
				  3/8/83; Order 77-19, § 296-15-200, filed 9/26/77; Order 75-28, §
				  296-15-200, filed 8/29/75, effective
				  1/1/76.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-221 - Self-insurers' reporting requirements

Current through Register Vol. 24-14, July 15, 2024
(1)
What information must self-insurers report to the department?
Each
			 self-insurer must provide the department:
(a)
			 The name, title, address and phone number of the single contact person who is
			 the liaison with the department in all self-insurance matters. This contact
			 will be sent all department correspondence and is responsible for forwarding
			 information to appropriate parties for timely action.
(b) A copy of its current policy of applying
			 sick leave, health and welfare benefits or any other compensation in
			 conjunction with, or as a substitute for, time loss benefits.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-223 - Self-insurance administrative assessment

Current through Register Vol. 24-14, July 15, 2024
(1) The administrative assessment covers the
			 department's administrative costs, including direct and indirect expenses of
			 each department division, the University of Washington environmental research
			 facility, and the board of industrial insurance appeals. The assessment is paid
			 quarterly at the same time a self-insurer submits its quarterly
			 report.
(2) The administrative
			 assessment rate is determined annually for each fiscal year. Each self-insured
			 employer uses one of three rates:
(a) The
			 base administrative rate is based on the actual costs of the previous fiscal
			 year and the anticipated costs of the upcoming fiscal year. This rate is used
			 by any active self-insured employer certified after the fiscal year used for
			 calculation.
(b) The adjusted
			 administrative assessment rate includes the base rate with adjustments for over
			 or under collections from prior periods. This rate is used by any active
			 self-insured employer certified during or prior to the fiscal year used for
			 calculation.
(c) Employers who have
			 voluntarily surrendered their self-insurance certificate must pay the inactive
			 rate until one year after all self-insurance liabilities and responsibilities
			 are terminated. Usually, administrative assessment payments for inactive
			 self-insurers can stop after reporting total claims costs of zero dollars for
			 four consecutive quarters. Payments may again be due if any future costs are
			 reported.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-227 - Self-insurance insolvency trust fund assessment

Current through Register Vol. 24-14, July 15, 2024
(1) The insolvency trust fund assessment is
			 paid by all insolvency trust members to cover claim payments made by the
			 department on behalf of insolvent self-insurers. The assessment is paid
			 quarterly at the same time a self-insurer submits its quarterly report.
(a) Self-insured school districts, cities,
			 and counties are exempt from and are not covered by this insolvency trust.
			 These self-insurers are not liable for the insolvency trust fund
			 assessment.
(b) Any interest earned
			 on insolvency trust fund assessments paid by self-insurers will be added to the
			 balance of the insolvency trust fund.
(c) Failure to pay an insolvency trust fund
			 assessment is grounds for withdrawal of self-insurance certification.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-229 - Self-insurance supplemental pension fund (SPF) and asbestosis fund assessments

Current through Register Vol. 24-14, July 15, 2024
(1) The SPF
			 relieves employers from cost-of-living increases on benefits paid to workers.
			 The SPF assessment is paid quarterly at the same time a self-insurer submits
			 its quarterly report.
(a) The SPF rate is
			 determined annually for each calendar year.
(b) The total SPF assessment due each quarter
			 is calculated by multiplying the SPF assessment rate by a self-insurer's worker
			 hours during that quarter.
(c)
			 One-half of the SPF assessment may be withheld from employee wages or
			 salaries.
(d) Self-insurers may
			 request reimbursement from the SPF quarterly, as authorized under
			 Title
			 51 RCW, or they may deduct
			 eligible SPF reimbursement amounts directly from their quarterly SPF
			 assessment. If requesting reimbursement from the SPF quarterly, the
			 self-insurer must use a form substantially similar to L&I form F207-011-000
			 or, if there is Social Security offset, L&I form F207-011-222.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-231 - Self-insurance electronic data reporting system (SIEDRS)

Current through Register Vol. 24-14, July 15, 2024
(1)
What is SIEDRS?
SIEDRS is a
			 computer system that collects claim data electronically from self-insurers.
			 Effective July 1, 2008, all self-insurers must send timely and accurate claim
			 data to SIEDRS in the required format.
(2)
How often must a self-insurer
			 report claim data to SIEDRS?
All claims opened during a calendar month,
			 as well as any updates made during that month to claims opened after the
			 self-insurer's enrollment date (postenrollment claims), must be reported to
			 SIEDRS by the tenth calendar day of the following month. Data can be submitted
			 more often, but not more than once per day.
Newly certified self-insurers must begin submitting data by the
				tenth calendar day of the month following their date of certification. For
				example, if an employer is certified to self-insure effective January 1st, data
				must be submitted to SIEDRS by February 10th.
(3)
What is the required format?
Data submitted to SIEDRS must comply with all requirements outlined in the
			 SIEDRS Enrollment Package (Publication F207-194-000).
(4)
When must a self-insurer correct
			 errors?
Error corrections must be submitted to SIEDRS within ten
			 calendar days of notification of the error. Notification occurs on the date
			 SIEDRS provides the error report to the self-insurer.
(5)
What happens if a self-insurer
			 doesn't comply with SIEDRS requirements?
(a) The department may assess penalties for
			 failure to comply with SIEDRS requirements. The department will consider
			 penalties when a self-insurer:
(i) Refuses or
			 fails to send data files to SIEDRS.
(ii) Repeatedly reports late.
(iii) Repeatedly fails to correct errors on
			 time.
(iv) Demonstrates repeated
			 and uncorrected inaccuracies in reporting format.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-232 - Self-insurance medical bill electronic data interchange

Current through Register Vol. 24-14, July 15, 2024
(1) Self-insurers are required to report
			 medical bills incurred from their workers' compensation claims according to
			 department guidelines.
(a) All bills
			 associated with qualifying claims must be reported, and the department will
			 establish a minimum threshold percentage for reporting of bill to claims to
			 monitor compliance.
(b) Qualifying
			 claims include claims for which:
(i) The date
			 of injury (DOI) was on or after January 1, 2020.
(ii) The claim was initiated during a time
			 that the employer was self-insured, and the liability for that claim remains
			 with the employer.
Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-15 - Workers' compensation self-insurance rules and regulations › Section 296-15-255 - Hearings for corrective action or withdrawal of certification

Current through Register Vol. 24-14, July 15, 2024
(1) This section
			 applies only to proceedings to withdraw certification or for corrective action
			 instituted by the director in response to a petition filed with the department
			 pursuant to
			 RCW
			  51.14.090. This section shall not apply to
			 actions instituted by the director to withdraw certification pursuant to
			 RCW
			  51.14.080 nor to corrective action instituted
			 by the director pursuant to
			 RCW
			  51.14.095.
(2) When there is a petition for such action
			 by any employee or union or association having a substantial number of
			 employees in the employ of the self-insured, the director or the director's
			 designee may, in the director's or designee's sole discretion, hold a hearing
			 to determine whether or not there are grounds for action. In reviewing such a
			 petition, the director or the designee may require additional information from
			 a petitioner before deciding whether to hold a hearing under this
			 section.
(3) Any such hearing shall
			 be conducted in accordance with the department's rules governing administrative
			 hearings. The director will notify all parties at least twenty days prior to
			 the date of the hearing. The notice shall include the following:
(a) Nature of proceedings;
(b) Legal authority for holding the
			 hearing;
(c) Reference to the
			 section of statutes and rules involved;
(d) A description of matters
			 asserted;
(e) The date, time, and
			 place of the hearing.
All parties will be allowed to respond and present evidence and
				arguments on the issues involved.
Within thirty days of the hearing date, the department will
				provide written notification of the proceedings, findings, and conclusions to
				all hearing participants.