The Provider's Responsibilities
If you're the first doctor to diagnose a worker for an occupational injury or disease, you're responsible for reporting to L&I or the self-insured employer.
If the claim might be federal, tribal, or another insurer, find out how to file claims, and bill the correct entity.
If you aren’t sure whether you need to file, see Deciding when to file an accident report for your patient.
To file a claim here in Washington State, follow these 4 steps:
Step 1: Find out if your patient is insured through L&I or a self-insured employer
There are 3 ways you can find out:
- Ask the patient.
- Check the self-insured employer list.
- Call L&I’s Self-Insurance Section at 360-902-6901.
Step 2: File a claim right away
To initiate a claim for your patient, fill out one of the following forms:
- If your patient is insured through L&I, you should fill out a Report of Industrial Injury or Occupational Disease (ROA), either:
- If your patient is insured through a self-insured employer, you should fill out the Providers Initial Report (PIR) (F207-028-000)
Step 3: Get paid
- If your patient is insured through L&I, go to Billing L&I and Submitting Bills and Reports.
- If your patient is insured through a self-insured employer, go to Billing Self-Insured Employers.
Step 4: Get the worker further treatment if necessary
You must be in our network to treat an injured worker beyond the initial visit. If you are not, you can join our network, or refer the worker to another provider that is in our network.
Laws & Rules
- WAC 296-20-025(2) - Initial treatment and report of accident
- RCW 51.28.020 - Worker's application for compensation — Physician or licensed advanced registered nurse practitioner to aid in
- RCW 51.48.025 — Duty of employer to report injury or disease — Contents — Penalty.
- Title 51 RCW - Industrial Insurance