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:

1. Ask the patient.
2. Check the self-insured employer list.
3. 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:
  • Online (recommended) - you can bill an additional $10 (code 1040M).
    Find out why we recommend online claim filing, how it works, and how it helps your patients.
  • Fax a paper copy within 2 days to 1-800-941-2976 or 360-902-6690. Order forms online.
• 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.

• Become an L&I Provider
• Find a provider to refer your patient