Disputes, protests and appeals

Your responsibility

If you disagree with L&I over an adjudicative or reserving issue

You must:

• File a written protest or appeal within sixty days after you receive the decision you disagree with.
• File a written protest or appeal as applicable to the retro adjustment order and notice within thirty days after you receive this order. This will preserve your right to relief if you prevail in your claim protest or appeal.

Note: We cannot provide relief in the computation of the retrospective premium even if your claim protest or appeal produces relief, unless you have also protested or appealed the retro refund/assessment notice and order.

• Send your protest to the address indicated in the order that you are protesting or appealing.

Note: Be sure that you file your protest or appeal within the time frame indicated in the order.

• Work cooperatively with L&I and the medical caregivers treating your injured employee(s) so that they can recover from the injury and return to work as soon as possible.

Our responsibility

When we receive notification of your written protest or appeal

We will:

• Monitor the protest or appeal for resolution.
• Recalculate the retrospective premium requirement if the relief you requested is granted and you preserved your rights by protesting the retro order and notice.
• Notify you in writing of our decision.

Your responsibility

If you disagree with L&I over the open status of a claim

You must:

• Notify us in writing immediately when you discover an open claim that you believe should be closed.

Note: Every month we will send you a report that details the claims activity related to your individual account if you are in an individual plan. If you discover a claim that you believe should have been closed and is not reflected as such on the report or you believe the information needed to close the claim is available to L&I, you should bring it to our attention immediately. For retro groups we will notify the sponsoring organization that a report is ready to download and the organization can download the report at their leisure. If you discover a claim that you believe should have been closed and is not reflected as such on the report or you believe the information needed to close the claim is available to L&I, you should bring it to our attention immediately. If an employer or sponsoring organization uses a third party administrator, it is the responsibility of the employer or sponsoring organization to forward the reports to the third party administrator. L&I does not distribute retro performance reports to any party other than the employer if an individual plan or organization that sponsors the retro group for group reports.

• Protest or appeal in writing as applicable and within the time specified in the retro adjustment order and notice the claim status you are in disagreement with to preserve your right to the relief you are seeking.

Note: Approximately one year after the coverage period has ended, we will notify you of the amount of refund or additional assessment. This notification will be in a legal document referred to as an "order and notice." You should receive an adjustment report that details the status of each claim and their related cost prior to the order and notice.

• Send your written request for reconsideration to:
  Department of Labor & Industries
  Retrospective Rating Program
  PO Box 44180
  Olympia, WA 98504-4180.

Our responsibility

Upon receipt of your request for reconsideration

We will:

• Review the open status of the claims you specified in your inquiry, protest or appeal.
• Recalculate the retrospective premium requirement if we determine that all of the information necessary to close the claim was in the department's possession at the time of the valuation date.
• Notify you in writing of our decision.
• Provide you instructions on how to request reconsideration or appeal our decision.
• Refund the additional premium or reduce the assessment as applicable.

Your responsibility

If you disagree with L&I's decision

You must:

• Protest or appeal the assessment in writing within the time specified in the retro adjustment order and notice.
• Pay the amount in dispute, or provide a surety bond or an assignment of savings in lieu of the payment pending the outcome of the disagreement and by the due date indicated in the order.

Note: You cannot participate in the retrospective rating program unless you pay the assessment, provide a surety bond or assignment of savings. If you have paid the amount covered by the disagreement and it is resolved in your favor, we will refund this money. We will not pay interest on this money. If you owe additional premium, it is due thirty days after we communicate the decision to you. We will charge penalties on any additional premium not paid when it is due (RCW 51.48.210 (www.leg.wa.gov)).

• Send your written protest or appeal to:
  Department of Labor & Industries
  Retrospective Rating Program
  PO Box 44180
  Olympia, WA 98504-4180.

Our responsibility

Upon receipt of your protest

We will:

• Review the issues outlined in your protest or appeal.
• Notify you in writing of our decision.

[Statutory Authority: RCW 51.18.010(1) (www.leg.wa.gov). 02-23-089, § 296-17-90453, filed 11/20/02, effective 1/1/03.]

This rule applies to retro coverage period(s) established prior to January 1, 2011.

The courts can take judicial notice of the Washington Administrative Code (WAC) only as published by the Office of the Code Reviser (www.leg.wa.gov). The text contained in this Web page may reflect minor changes when compared with the WAC.

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