PSRS Audits

Private Sector Rehabilitation Services (PSRS)


L&I's vocational complaint process

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  • Expand or collapse. Why does L&I have a vocational complaint process?

    We need to ensure Washington injured workers and employers receive vocational services that comply with applicable laws, rules and policies, and accepted standards of service.

    The Private Sector Rehabilitation Services (PSRS) unit is responsible for reviewing and acting on vocational services complaints.

  • Expand or collapse. Who can make a complaint?

    Any vocational services stakeholder can make a complaint. This includes (but is not limited to) injured workers or their representatives, employers, medical providers, claim managers, and vocational services specialists.

    Complaints must be sent to us in writing and cannot be anonymous.

  • Expand or collapse. Does L&I investigate all complaints?

    No. For example, we won't investigate the following:

    • A request for billing review without stating a specific concern.
    • A complaint about unsatisfactory VRC work without listing specific rules-related concerns.
  • Expand or collapse. I didn't perform the services on this referral. Why did I receive a complaint letter?

    Complaints about vocational work are always addressed to the assigned VRC, even if the complaint is about another VRC who did most of the work.

    The assigned VRC is responsible for any audit finding. PSRS may need to investigate a complaint, but this doesn't mean the review will result in findings.

  • Expand or collapse. How should I respond to a complaint?

    Sometimes PSRS needs to review the claim file, including case notes to respond to specific issues such as billing concerns.

    If we request the file, please send it within the time frame noted. We will include instructions on how to attach it to a secure email.

    You're also encouraged to send us a written response to the complaint. Help us understand the issues by including any relevant information.

  • Expand or collapse. My audit letter asks me to provide file documents. What information do I need to include?

    You only need to provide your case notes for the dates specified in the audit letter and any supporting documentation to substantiate the work performed. Examples include copies of letters you sent and notes from your claim file review.

    You don't need to send copies of medical information that are in the claim file.

    Even though we have access to your reports, you should also send the progress and closing reports referenced in your case notes.

  • Expand or collapse. What's the first step of the complaint process?

    After accepting a complaint, the PSRS supervisor or designee calls the VRC to discuss the complaint. This discussion helps us determine whether

    • the issue can be readily resolved,
    • only a written response is needed, or
    • PSRS needs to request a copy of the VRC's file.

    We will notify the firm manager of the complaint by e-mail.

    Firm managers will receive copies of all initial letters sent.

  • Expand or collapse. What happens next?

    A vocational services specialist (PSRS auditor) will review

    • your response to the complaint,
    • the imaged claim file or LINIIS, and
    • case notes and file documentation you sent.

    A complaint investigation does not always entail a full audit review of the file.

  • Expand or collapse. How long does the complaint review take?

    We complete most complaint reviews within 60 days of our receipt of the file. We may contact you if it will take longer than 60 days.

    The time it takes to complete a review depends on the complexity of the issues and whether the file was requested.

  • Expand or collapse. Can I call and talk to the auditor?

    Yes. You can call to discuss the complaint process or ask other questions about the review.

  • Expand or collapse. What happens when the complaint review is done?
    • The PSRS auditor drafts a complaint audit report. If findings appear to justify penalty or recoupment, a second auditor examines the report. This peer-review process helps maintain consistency with other audit findings.
    • The PSRS supervisor reviews all reports to ensure auditors' consistency and fairness.
    • The final report is sent to the VRC and a copy is sent to the firm manager.
    • The auditor sends the complainant a written response, summarizing the final findings of the complaint.

Disagreeing with audit findings

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  • Expand or collapse. What if I disagree with audit findings?

    If you disagree with audit findings, you can send a request for reconsideration to Private Sector Rehabilitation Services or appeal to the Board of Industrial Insurance Appeals (BIIA).

  • Expand or collapse. Where do I send my request for reconsideration?

    Send your request for reconsideration to the following address:

    Attn: Robert "Rheo" Aieta, CRC
    Private Sector Rehabilitation Services Manager
    Department of Labor & Industries
    Private Sector Rehabilitation Services
    PO Box 44326
    Olympia WA 98504-4326
  • Expand or collapse. What should I include in my request?

    Your reconsideration request should address the specific findings in the audit report, including the following details:

    • The specific audit finding.
    • The claim number, finding number, and WAC violation. (Sometimes claim numbers and finding numbers are for the same WAC violation.)
    • The specific reasons you believe the decision/finding is wrong.

    The PSRS auditor will review the findings and issue a decision.

    Note: Any mitigation requested because of personal circumstances (for example, recent hospitalization) may result in reduced penalties, but does not result in the removal of any findings for violation of WAC 296-19A (www.leg.wa.gov).

    Reconsideration requests are evaluated on logical, not emotional arguments.

  • Expand or collapse. How much time do I have to send my reconsideration request?

    Send your request for reconsideration or to appeal as soon as possible. You have the following amount of time, depending on your specific situation:

    • 60 days, if penalties or corrective action is assessed.
    • 20 days, if an adjustment to a previous payment has been reduced or if a demand for repayment is assessed.

    If the request is not received within this time, the decision becomes final.

  • Expand or collapse. What if I still disagree?

    You may appeal to the BIIA. There are 2 options:

  • Expand or collapse. May I appeal directly to the Board first?

    Yes. You may appeal directly to the BIIA without first requesting reconsideration. However, after receiving your appeal, the Board will notify L&I, so L&I has an opportunity to reconsider its original decision.

  • Expand or collapse. For more details

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