Keep up with what's new in self-insurance
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Outgoing self-insurance communications by date:
Lumbar Spine Surgery Guideline 9/28/2021
CR-102 Proposed Rule Making for IME Appeals and Case Progress/Disputes - December 23, 2021
The Department of Labor & Industries
filed a CR-102 proposed rulemaking with
the Office of the Code Reviser.
A virtual public hearing is scheduled as follows:
Join electronic Zoom Meeting: https://lni-wa-gov.zoom.us/j/9361655337
Meeting ID: 936 165 5337
Join by phone: +1 253-215-8782 US (Tacoma)
Find your local number: https://lni-wa-gov.zoom.us/u/kdFrdfe0fg
Date: January 25, 2022
Time: 9:00 am
Written comments on the proposed rules will be accepted up to 5:00 PM (PST)
January 25, 2022. Any written comments should be sent to Suzy Campbell, via:
Department of Labor & Industries
PO Box 44270
Olympia WA 98504-4270
Anticipated Adoption Date
The proposed rules are scheduled for adoption on February 15, 2022 with a scheduled
effective date of March 20, 2022.
If you need additional information or have questions concerning this proposed rulemaking,
please contact Suzy Campbell at 360-902-5003.
Extended the Certification Requirements for all Claims Administrators - December 21, 2021
L&I’s Self-Insurance (SI) program has extended the certification requirements for all claims administrators through June 30, 2022, with certain conditions.
State law (WAC 296-15-360) requires the SI program to enforce the certification requirements, that enforcement was set to begin on Jan. 1, 2022.
The final extension is being offered to give claims administrators additional time to become certified after unforeseen setbacks to implementation and enforcement of these new requirements. After July 1, 2022, the state law will be enforced in full.
The conditions for extending certification requirements:
- All claims administrators who are not currently certified, but eligible to take the certification test (1 year of experience in the administration or oversight of claims under Title 51 RCW), will be allowed to take the certification test without completing the Core Curriculum training requirements of WAC 296-15-360(2)(b) through March 31, 2022.
- Any claims administrator who has not passed the certification test by April 1, 2022, will be required to register for and complete an L&I provided 72-hour training program from April through May 2022. Thereafter, training attendees will be allowed to take the certification test through June 30, 2022.
- All claims administrators who are not certified continue to be required to be mentored by a certified claims administrator.
Go to the SI webpage for more information.
Questions? Email: SITrainerQuestions@LNI.wa.gov
Reminder: Deadline for claims administrators to become certified is approaching - December 3, 2021
Effective January 1, 2022 enforcement goes into effect for every person making claim decisions for Washington state self-insured employers to be a certified claims administrator. If you have been managing claims for over 2 years you must be certified by January 1, 2022.
There is more information on our website at Claim Administrator Certification FAQs.
Training is available
Over the past couple of months, it has become apparent that folks are struggling with benefit calculations. The Self-Insurance Training Team will be offering an all-day training course focused on wage calculation, time-loss and loss of earning power (LEP) on 3 different dates this month.
The training is intended only for those who need to become certified by January 1, 2022. We will be offering similar training for others in 2022.
For those that need to become certified by January 1, 2022 you may register for one now!
Dec 16, 2021 08:00 AM Pacific Time (US and Canada)
Register in advance for this meeting:
Dec 21, 2021 08:00 AM Pacific Time (US and Canada)
Register in advance for this meeting:
Dec 29, 2021 08:00 AM Pacific Time (US and Canada)
Register in advance for this meeting:
Questions? Email Self-Insurance Training at SITrainerQuestions@lni.wa.gov or call 360-902-6904.
Upcoming Changes to L&I's Outpatient Drug Formulary - November 23, 2021
The Washington State Department of Labor & Industries announces changes to our Outpatient Drug Formulary effective January 1, 2022. The changes are available for review in our online Outpatient Drug Formulary PDF document.
Summary of changes:
- Added new drug classes:
|Drug class code||Drug class description||Drugs in class|
|J3B||Nicotinic Receptor Partial Agonist, alpha4beta2 specific||varenicline (Tyrvaya) nasal spray|
|Q51||Topical Janus Kinase (JAK) Inhibitors||ruxolitinib cream (Opzelura)|
|S1B||Thymus Tissue Replacement||thymus tissue-agdc (Rethymic Implant)|
|V16||Antineoplastic - Hypoxia Inducible Factor (HIF) Inhibitors||belzutifan (Welireg)|
|W0L||Antiviral – RNA Polymerase Inhibitor||remdesivir (Veklury)|
|Z28||Rho Kinase Inhibitor||belumosudil (Rezurock)|
- beclomethasone dipropionate (Qvar RediHaler), budesonide suspension for nebulization (Pulmicort), fluticasone propionate (Flovent Diskus/HFA), and budesonide/formoterol fumarate (Symbicort) now require authorization with coverage based on acceptance of pulmonary condition
- antiretrovirals now require prior authorization except for the following agents: darunavir, darunavir/cobicistat, dolutegravir, elvitegravir/ cobicistat/ emtricitabine/ tenofovir disoproxil, emtricitabine, emtricitabine/tenofovir disoproxil, emtricitabine/rilpivirine/tenofovir disoproxil, lamivudine, raltegravir, rilpivirine, ritonavir, tenofovir disoproxil, zidovudine
Self-Insurance Certification Services Update - November 8, 2021
The Self Insurance, Certification Services program will be presenting changes to the financial rules that were implemented in July 2021, and give a summary of the various self-insurance assessment funds.
Please join us for the presentation, which is set for 10 a.m. to 12 p.m. on Wednesday, Dec. 1, at:
The changes address the following:
- Criteria used to qualify for Self-Insurance.
- Surety for private, public, and group entities.
- Minimum surety requirement.
- Reporting requirements.
Questions? Email Brian Schmidlkofer: scbs235@Lni.wa.gov.
Self-Insurance is Offering a New Training Course: “Bridging the Gap” - November 2, 2021
Self-Insurance is offering this training course beginning November 2021. It is a 12-hour course held over two days. The course is designed to help claims administrators who are new to Washington state workers’ compensation learn to use the resources available to answer questions about workers’ compensation. It will also provide an overview for those who may be gearing up to take the Self-Insurance Claims Administrator Test. Topics include:
- Claim Validity
- Wage Calculations
- Loss of Earning Power (LEP)
- Minimum and Maximum Time-loss Rates
- RCWs and WACs
COST: There is no cost to you!
Credits have not been awarded yet.
Dec. 1: 8 a.m. to 3 p.m. & Dec. 2: 8 a.m. to 3 p.m.
Self-Insurance Training presents: UPDATE 2021 10/18/2021 - October 18,2021
Update 2021 Webinar Registration:
Dec. 15, 2021 - Zoom
8:00 to 12:00 p.m.
Lumbar Spine Surgery Guideline - September 28, 2021
A new Lumbar Spine Surgery guideline from L&I is now posted on the Treatment Guidelines and Resources page at www.Lni.wa.gov. Effective Sunday, Oct. 3, 2021, providers in L&I's Medical Provider Network will be required to follow this guideline as a best practice when treating certain lumbar conditions and procedures for injured workers.
L&I's Industrial Insurance Medical Advisory Committee and Lumbar Surgery Guideline Subcommittee developed this new guideline in partnership with L&I's Office of the Medical Director.
L&I proposes 3.1 percent increase in workers’ comp rates for 2022 - September 21, 2021
TUMWATER −The state Department of Labor & Industries (L&I) is proposing a small increase in the average price employers and workers pay for workers’ compensation insurance next year. If the proposal is adopted, it would be the first time in five years that workers’ compensation rates would go up, but on average, premiums in 2022 would still be less than in 2017.
The proposed 3.1 percent overall average rate increase is driven by cost-of-living adjustments for pensions, which were triggered by an increase in the state’s average wage. This is an average, meaning some employers will see their rates go down while others will see larger increases.
“L&I is working hard to help injured and ill workers as they heal and return to work, while managing the additional costs of about 5,600 COVID-19 claims for state fund workers exposed to the virus,” L&I Director Joel Sacks said. The agency, he said, will tap its contingency reserves to keep the proposed rate increase at a minimum.
“With the community’s help, we’ve made sure that we have a healthy contingency reserve so we’re ready to help employers and workers when they need it most, during tough times like we have now,” Sacks said.
“We built our contingency reserve through the premiums we charge and by carefully managing the workers’ compensation program to reduce work disability, keeping costs steady year after year while helping workers heal and return to work.”
Employers and workers pay into the workers’ compensation system to help cover the cost of providing wage and disability benefits for injured workers, as well as medical treatment of injuries and illnesses.
Washington state charges for workers’ compensation coverage based on hours worked. When looking at rates as a percentage of payroll, rates in Washington have gone down from 2012 to 2021.
Tapping into reserves during challenging economic times
In 2021, L&I took steps to help employers and workers reeling from the pandemic by tapping its contingency reserves to avoid an increase in premiums. This approach is also true for 2022. Under the current proposal, L&I will use contingency reserves to cover any gap between premiums and ultimate costs rather than proposing to raise rates even more.
When the pandemic hit, L&I also helped employers by allowing those struggling financially to defer premium payments, a practice that continues today. The agency also ensured the costs of COVID claims do not impact employers’ future rates.
If the proposed rate increase is adopted, the average net rate per $100 of payroll in 2022 will be $1.53, a 1.4 percent increase over 2021. Workers will continue to pay on average about a quarter of the premium, a similar percentage to that paid in 2021.
Public hearing planned
A public hearing is scheduled for 10 a.m. on Oct. 26 to take input on the rate proposal before a final decision is made. To support social distancing, the public hearing will be held virtually this year. Final rates will be adopted by Nov. 30 and go into effect Jan. 1, 2022.
2022 rates hearing
Join Zoom Meeting
Meeting ID: 889 8069 4211
People are encouraged to submit comments in writing to: Jo Anne Attwood, administrative regulations analyst, P.O. Box 41448, Olympia, WA 98504-4148; or email JoAnne.Attwood@Lni.wa.gov. All comments must be received by 5 p.m. on Oct 29.
More information about the proposal is available at www.Lni.wa.gov/2022Rates.
Workers’ comp facts:
• L&I workers’ compensation insurance covers about 2.6 million workers and nearly 180,000 employers in Washington.
• The proposed rate is an average. An individual employer’s actual rate change may be more or less depending on that employer’s industry and history of claims that result in wage replacement and/or disability benefits.
For media information: Herbert Atienza, (Herbert.atienza@Lni.wa.gov), L&I Public Affairs, 360-280-8674.
L&I Newsroom: https://Lni.wa.gov/news-events
Reminder about cybersecurity and protecting injured workers’ confidential information - July 28, 2021
Recently we’ve become aware of data breaches due to cyberattacks in the self-insured community. One occurred at a medical provider’s office, and the other at a third-party administrator’s (TPA) office. You may also have heard about similar incidents involving Washington state agencies.
No one is immune to cybercrime, and these recent events are an important reminder that we all have a responsibility to protect injured workers’ confidential information.
Know how to keep data safe
State laws require claim files and records of injured workers be kept confidential, and all organizations have a duty to keep personal information private and report security breaches.
In light of increasing threats of cyberattacks, please review all data handling procedures in your organization to ensure that they are secure and meet the expectations of the laws (RCW 51.28.070 and RCW 19.255).
What to do if you have a data breach
Data breaches must be reported to injured workers in a timely manner. If you share information about injured workers to vendors, contractors, or other third parties, the laws may apply to them, as well.
We encourage you to assist your injured workers with any potential damage caused by a data breach. Providing one year of credit monitoring is one example of an action you can take to help workers if their personal information has been compromised.
If you have questions about protecting injured workers’ confidential information, contact L&I’s privacy officer at PrivacyOfficer@Lni.wa.gov or 360-902-4220.
New Presumptive Coverage Laws for Health Care and Frontline Workers - May 28, 2021
Gov. Jay Inslee signs bills extending new workers’ comp protections to health care and frontline workers during a pandemic.
Two bills signed into law by Gov. Jay Inslee will grant presumptive workers’ compensation protections to health care and frontline workers during a public health emergency, such as the COVID-19 pandemic.
The new laws mean that it will be presumed health care and frontline workers contracted a contagious or infectious disease at work when they file a workers’ compensation claim for the disease and the disease is the subject of a public health emergency. Claims will be decided based on the new laws.
In order for a claim to be allowed, workers must provide proof that they contracted the disease, as well as meet other requirements.
For more details about the new laws and their impact on workers’ compensation benefits, check out the Frequently Asked Questions (FAQs). The Department of Labor & Industries is developing further guidance about the laws and will release more information and resources soon.
If you have questions about these new laws related to workers’ compensation, email HELSA@Lni.wa.gov.
Electronic option for the claim administrator certification coming in June; requirement enforcement delayed until next year - May 14, 2021
The Washington State Department of Labor & Industries (L&I) will begin offering an electronic option for the claim administrator certification test in June. During the past year, L&I was not able to offer in-person testing due to concerns over the COVID-19 pandemic and the need for social distancing. To allow more time for those who need to take the test, L&I will not begin enforcement of the July 1, 2021 requirement for claim administrators to become certified until January 1, 2022.
More information regarding the electronic option for the claims administrator certification test will be coming soon.
Questions? Call Self-Insurance training at 360-902-6904.