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Medical Examiners' Handbook


Book: A publication for independent medical examiners, attending doctors and consultants, this document contains guidelines, sample reports and billing procedures for preparing and conducting impairment ratings and independent medical exams in Washington's workers' compensation system. Beginning July 1, 2012, free Category I CME credits are available for completing the self-assessment associated with this handbook. Go to www.Imes.Lni.wa.gov and click on Medical Examiners Handbook for information on the exam. L&I and the authors have no financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this document.

Publication F252-001-000

Retrospective Rating Adjustment Protest


Used by employers to present L&I with a list of decisions they are protesting by adjustment period. The form requests all necessary elements needed for L&I to process a request for reconsideration.

Form F250-024-000

Worker's Compensation Insurance Manual WAC 296-17 Rates and Rating System


This chapter applies to rates and experience rating rules for workers compensation insurance.

Manual F213-173-000
Application for Amusement Ride or Air Supported Structure Operating Permit

To apply for a decal for an amusement ride or air supported structure.

Form F500-010-000
Application for Group Membership & Authorization for Release of Insurance Data

Used by employers who want to join a retrospective rating group; also, to authorize Labor & Industries to release the employers' insurance data to the retrospective rating group they want to join.

Form F250-016-000
Application for Group Retrospective Rating

Used by organizations to set up an agreement with L&I authorizing their participation in retrospective rating.

Form F250-004-000
Construction Elevator Installation Application and Inspection Data Report

Used by companies to apply for an Construction Elevator (Hoist) at a job site. One application per car and companies need to contact the Elevator Section for the appropriate installation and operating fee.

Form F621-001-000
Doctor's Worksheet for Rating Cervical and Cervico-Dorsal Impairment

Doctor's Worksheet for Rating Cervical and Cervico-Dorsal Impairment

Form F252-056-000
Doctor's Worksheet for Rating Dorso-Lumbar & Lumbo-Sacral Impairment

This worksheet is to help the attending physician perform impairment rating on their patients with permanent partial disability of the Dorso-Lumbar or Lumbo-Sacral spine.

Form F252-006-000
Evaluating Retro Groups

Fact sheet: Provides information to employers who are considering joining a Retrospective Rating (Retro) group and how to choose one that best fits the need of their company. Explains the process for enrollment, deadlines, group eligiblilty, assesment, distribution of funds, dues, fees, services, and exit clauses.

Publication F225-019-000
Faulty Water Heaters and Kids Don't Mix

Fact sheet: Designed for operators of childcare facilities, this fact sheet explains the importance of keeping boilers and pressure vessels operating safety. Provides an overview of inspection requirements, frequency, and fees.

Publication F620-059-000
Group vs. Individual Retrospective Rating Participation

Fact sheet: Provides information to employers interested in the Retrospective Rating Program who want to compare group vs. individual participation. Explains the differences in minimum premium amount, fees, services, refund potential, choice, and risk. Also includes contact information for enrolling.

Publication F225-016-000
Individual Retrospective Rating Plan Agreement

Used by employers to set up an agreement between them and L&I authorizing their participation in retrospective rating.

Form F250-003-000
Is Retrospective Rating Right for You?

Pamphlet: Provides information about L&I's Retrospective Rating Program. In Retro, employers can earn a partial refund of workers' compensation premiums if they reduce workplace injuries and lower associated claim costs.

Publication F250-006-000
Keys to Retro Success

Fact sheet: Provides information to employers who are considering joining a Retrospective Rating (Retro) group.Contains questions and suggestions to help determine if Retro is right for a business and information regarding annual participation.

Publication F225-018-000
Operating Boilers Safely

Fact sheet: Explains what you need to know to keep your boilers and pressure vessels operating safety. Provides an overview of inspection requirements, frequency and fees.

Publication F620-025-000
Operating Power Lawn and Yard-care Equipment: Safety for Teen Workers

Fact sheet: Overview of safety practices, plus information on what equipment employees under 18 can and cannot operate. Provides resources on requirements for hearing protection and PPE (personal protective equipment).

Publication F700-010-000
Rental Boiler Operating Permit - Good at this Location Only

To request a permit to use a rental boiler at one location only.

Form F620-042-000
Request for Duplicate Elevator Certificate

Used to request a duplicate elevator license or a duplicate operating permit for a conveyance.

Form F621-065-000
Retrospective Rating Enrollment Decisions

Fact sheet: Information for employers regarding choices they should make when enrolling in the Retrospective Rating (Retro) program including plan type, single-loss limit and upper and lower loss-ratio limits.

Publication F225-017-000

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