The provider's responsibilities

If you are the first doctor to diagnose a worker for an occupational injury or disease, you are responsible for reporting to L&I or the self-insured employer. If you aren’t sure whether you need to file, see Deciding whether to file a claim for a patient, below.

Filing a claim

To initiate a claim, for your patient, fill out and send one of the following forms:

• Report of Industrial Injury or Occupational Disease to L&I. (For more information, see Filling out the Accident Report.)

You can now file an ROA online and bill an additional $10 (code 1040M). Find out how online claim-filing could work in your office and how it helps your patients.

• Providers Initial Report (PIR) to the self-insured employer.

To determine if your patient is insured through L&I or a self-insured employer, you can find out by:

1. Asking the patient.
2. Checking the self-insured employer list or
3. Calling L&I’s Self-Insurance section at 800-848-0811 toll-free or 360-902-6500.

If you treat injured workers at a self-insured employer’s on-site medical facility, find out about requirements about reporting and record keeping by contacting L&I's Self-Insurance Section at 360-902-6842.

File the claim right away

• Fax the ROA within 2 days to: 800-941-2976 or 360-902-6690.
• COHE providers, fax your ROAs to special COHE fax numbers.

If you fax the ROA, don’t mail the original to L&I, unless you are requested to do so. Save the original ROA in your files for legal purposes.

Notifying employers of claims

• You are not required to mail the ROA to the employer.
• You may ask the State Fund injured worker to deliver a copy of the completed ROA to their employer after the initial visit.
• L&I will notify the employer about the claim after we receive the ROA from you.

Billing L&I

Find out how to get paid for your services, including how to submit reports.

Deciding whether to file a claim for a patient

If you think a condition is not work-related:

• You must file the claim anyway.
• You can indicate that the condition is not work-related on the accident report (see Determining Work-Relatedness section in the Attending Doctor's Handbook, page 7).
• You can also inform the patient that the inappropriate filing of a claim may delay coverage by other insurers.

If the injury is minor:

• File a claim whenever you treat an injured worker.  
• Provisions of state law apply regardless of the severity of the injury. See below for laws and rules.

If you think a condition is work-related, but your patient does not want to file a claim:

• You are required to inform the injured worker of their rights.
• If the worker objects after hearing their rights, it is not your responsibility to file a report.
• L&I cannot pay you for the visit unless a claim is filed.

If your patient is afraid of retaliation for filing a claim:

• Let the patient know that they are protected against such discrimination.

• See the Attending Doctor's Handbook, page 22, for what to do if your patient has been discriminated against for filing a claim.

Additional information

• WAC 296-20-025(2) (www.leg.wa.gov) — Initial treatment and report of accident.

• RCW 51.28.020 (www.leg.wa.gov) — Worker's application for compensation — Physician or licensed advanced registered nurse practitioner to aid in. (Expires June 30, 2007.)

• RCW 51.48.025 (www.leg.wa.gov) — Duty of employer to report injury or disease — Contents — Penalty. (Expires June 30, 2007.)

• Title 51 RCW (www.leg.wa.gov) — Industrial Insurance