Self-Insurance conducts audits of Self-Insured Employers and Third-Party Administrators to ensure compliance with Washington State industrial insurance laws. Title 51 RCW provides the department authority to audit employer records and require employers to make their records available for review. Audits are a learning opportunity to correct any deficiencies you may have.

What will the auditor review?

The audit will include, but is not limited to, Workers Comp requirements such as:

• Procedures for when a worker gets injured
• Communications with the injured worker and the department
• Wage Calculations
• Time-loss Payments
• Rotating Topics (Commonly called Issue-based audits)

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.

Cycle Lengths

Our audit cycles start on July 1 and last 3 years. During that 3 years period, we will audit all employers who are part of the program.

If you became self-insured in the middle of a cycle, we will still meet with you to review any actions you may have taken and provide guidance if have any findings.

What happens after the audit?

You will be notified of any audit findings. You or your representative will have 10 days to request a walkthrough of the findings from the auditor before the audit is finalized. The walkthrough MUST be scheduled within 15 days of the request.

Additional Resources

Claims Adjudication Guidelines - Wages
Lump Sum Matrix

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