We conduct regular audits of self-insured employers. There are three different kinds of audits: performance-based audits; issue-based audits, and complaint-based audits.

Performance-based audit

The Performance-based audit is conducted on a 2-year cycle. It begins in even-numbered years and includes 3 tiers.

Tier 1:
All self-insured employers are audited at the Tier 1 level. The area of performance reviewed may vary with each audit cycle, and is unique to Tier 1. A pass or fail threshold is set. A failed audit at Tier 1 requires the employer to participate in a Tier 2 audit.

Tier 2:
Only the employers who do not pass Tier 1 are required to participate in Tier 2. Generally, this review includes a different, but connected area of performance.

Tier 3:
Employers who do not pass Tier 2 are reviewed in Tier 3. Multiple related areas of performance are reviewed in Tier 3.

Issue-based audit

An issue-based audit reviews a specific compliance requirement. This may be across the board for all self-insured employers or third-party administrators or limited to a smaller group. The type of requirement and the scope of the audit are evaluated with the advice of the Audit Governance Committee and assigned at L&I's discretion.

Complaint-based audit

A complaint-based audit reviews specific matters about an individual self-insured employer or third-party administrator that are brought to L&I's attention. The type of requirement and the audit scope are determined based on the nature of the complaint that is registered.

If you have questions, call us at 360-902-6840.

The self-Insurance program issues most legal orders on claims including claim allowance and denial orders.

Self-insured employers are required to request claim allowance or denial from L&I within 60 days of the date they receive the claim. In some cases, a temporary order may be issued by L&I extending the time for a decision while additional information is gathered.

For additional information about claim validity decisions, you can review the Claim Validity module of the Claim Adjudication Guidelines.

For specific claim questions

Call the Self-Insurance program of L&I at 360-902-6901 and ask for the claim adjudicator assigned to the claim.

There is not always agreement about the claim-related decisions that are made. If an injured worker or their provider and their self-insured employer cannot agree about a claim-related outcome, or if the worker or provider believes an employer is delaying or not taking action, they can ask L&I to intervene.

When requesting help from L&I include:

• The workers name
• The claim number
• The action or inaction being disputed
• Any documentation to support the dispute

Report the dispute online through our Customer Service Portal.

or

Send a written dispute to:

Department of Labor & Industries
Self-Insurance
PO Box 44892
Olympia, WA 98504-4892

FAX: 360-902-6900

Claim questions?

Claim-specific questions: Call 360-902-6901 and ask for the claim adjudicator assigned to the claim.

General claim questions: email us at SITrainerquestions@Lni.wa.gov

Certification Services is responsible for assisting employers with:

• New employer certification
• Quarterly and annual reports
• Assessments
• Surety
• Employer account maintenance
• Pension billings
• And much more!

If you have any questions, contact Certification Services at CertificationSvcs@Lni.wa.gov