The latest news
- New Process for Self-Insured Pension Reviews.
- Save this date! Colloquium on Occupational Health Best Practices.
- Update 2012.
- L&I claim number on claim-related outgoing correspondence.
New Process for Self-Insured Pension Reviews
May 16, 2012.
The Self Insurance Pension Adjudicators work hard to consider and provide resolution to requests for pension review within 90 days. However, this goal is only possible when we receive all the information we need at the time of the request. Otherwise, the pension adjudicator spends hours reviewing claim files and requesting additional information. Sometimes, they review a claim multiple times and have to make several requests for additional information before they can make a final determination about a pension. This rework takes time, and delays a final pension determination on the claim.
To make more efficient use of pension adjudicators' time, we have developed some new processes, which will go into effect on April 23, 2012.
A new Pension Review Coversheet
All new requests for pension will require that the employer complete the Pension Review Coversheet (139 KB PDF). A sample of the form is attached, and we will post the form on our webpage soon. Using the coversheet will help ensure all needed information is submitted to the department.
Only complete requests for pension review will be referred to the Pension Adjudicator
Support staff will review incoming requests to confirm all the necessary information is attached. If any documentation is missing, support staff will notify the employer what documentation is still needed, and will only forward the pension request to the pension adjudicator if that additional information is received. The request for pension will be considered withdrawn If the necessary information is not provided.
Note: Requests for pension will not be considered "received" until all documentation has been submitted; the received date will be the earliest date used by the Department for the pension effective date.
The SIVRF will not be considered a request for pension review
Previously, a Self Insurance Vocational Report Form (SIVRF) that indicated a worker was not eligible for vocational services due to "combined effects", or "direct effects of the industrial injury" was considered a request for pension review. We will no longer consider a SIVRF to be a pension request. Instead, support staff will acknowledge receipt of the SIVRF, and remind employers that if they would like to request pension review, they need to submit the Pension Review Coversheet, along with all necessary documentation.
Worker requests for pension will be referred to the employer for input
When workers or their attorney request review for pension, we will notify the employer of the request, and ask that the employer respond. The employer can either agree that the claim is ready for pension review – and submit all necessary documentation – or disagree and provide an explanation why the claim is not ready for pension. This will allow us to avoid requesting documentation on a claim that is not actually ready for pension review, saving time for the pension adjudicator and providing resolution for the worker if their request cannot be addressed.
If you have any questions about our new processes, please feel free to contact Scott Corvin (360‑902‑6911) or Beth Hall (360‑902‑6937), the Self Insurance Pension Adjudicators.
Save this date! Colloquium on Occupational Health Best Practices
April 19, 2012.
The Colloquium sponsored by Self-Insured Employers and Labor & Industries (L&I) is coming to Seattle on May 21, 2012 from 8 am to 4 pm. This event comes at no cost to you. Featured are interesting speakers with presentations and discussions concerning workers compensation healthcare issues shared by Self-Insured Employers and L&I. In addition, the Colloquium is being sponsored by the Virginia Mason Medical Center at The Rainier Club!
The Rainier Club's dress code is business casual and is located at:
820 Fourth Avenue
Seattle, Washington 98104
A continental breakfast and lunch is being sponsored by Costco Wholesale Corporation.
The Colloquium has been submitted to the Self-Insurance Curriculum Review Committee (CRC) for Continuing Education Credits (CEUs). We will let you know the number of credits and categories of credits approved by the CRC soon.
Here are some presentations and speakers at a glance:
- Rapid Return to Function as a Quality Indicator~Robert Mecklenburg, MD.
- An Innovative Approach to RTW~Lloyd Hudson hosted by Katrina Zitnik of Costco.
- Activity Coaching as a Best Practice~ Carole Horrell & Terri Smith-Weller.
- Growth of the Provider Network~Janet Peterson.
- Top Tier~ Diana Drylie.
- Utilization Review (UR) Rep~ Nikki D'Urso.
- Stay at Work~ Chris Ver Eecke.
- Structured Settlement~ Debra Tollefson.
- Department of Health (DOH) Prescription Monitoring Program~ Jaymie Mai, PharmD.
Please RSVP by Friday, April 13, 2012
- Send your RSVP to Bonnie Crockett by:
- E-mail: CROE235@Lni.wa.gov.
Or - Phone: 360-902-6822.
- E-mail: CROE235@Lni.wa.gov.
- Let us know if you are bringing a guest.
Update 2012
April 13, 2012
This 1-day training course will be held from 8 a.m. to 4:30 p.m. in the auditorium at L&I headquarters in Tumwater, Wash. on the following dates:
- Wednesday, Aug. 22, 2012.
- Monday, Sept. 10, 2012.
We chose to publish these dates as soon as they were determined, to assist you in planning in advance. Self-Insurance’s annual training conference is not mandatory this year.
Once we have the agenda set, speakers' presentations will be submitted to the Curriculum Review Committee (CRC). We'll let you know how many and what category credits have been approved.
Registration will begin on June 18, 2012. We'll send out more information closer to registration.
L&I claim number on claim-related outgoing correspondence
April 13, 2012
L&I, workers, and providers often receive correspondence from self-insured employers or their third party administrators that doesn't include L&I's claim number. Many self-insured employers assign their own claim number and don't include the L&I's claim number on correspondence about the claim.
Failure to include the L&I claim number has resulted in delays, confusion, and additional administrative expenses for L&I, injured workers, and medical providers.
L&I let the self-insured community know on 01/15/12 about its plans to begin issuing penalties for claim‑related communication that both:
- Originates from the self-insured employer or their third party administrator, and
- Doesn't include the L&I claim number.
In addition to the L&I claim number, the self-insured employer or their third party administrator may choose to also include their assigned claim number.
Reference: WAC 296-15-350 (7) (www.leg.wa) states in part:
Handling of claims.
What elements must a self-insurer have in place to ensure appropriate handling of claims? Every self-insurer must:
(7) Include the department's claim number in all claim-related communications with workers, providers, and the department.
