Use this information and these tools to help you calculate worker benefits:

• Medical Bill Interest Calculator
• Loss of Earning Power (LEP) Calculator

If you have questions or need assistance completing the form, contact our training unit at 360-902-6904.

• Loss of Earning Power (LEP) Calculation Worksheet
• Minimum Time-Loss Rates
• Maximum Time-Loss Rates
• Cost of Living Adjustment (COLA) Chart, 5-decimal increment and cumulative factors
• Cost of Living Adjustment (COLA) Chart, 10-decimal increments only
• Death and Burial Rates

A permanent partial disability (PPD) is a permanent impairment that results from the workplace injury or occupational disease. When this occurs, a worker may be eligible to receive a PPD benefit.

In order to qualify for a PPD benefit, the impairment must be rated by a qualified doctor.

Reference PPD Down Payment Amounts.

Every year the PPD award schedules are updated. We have included the most recent schedules below to help you calculate the award.

• 2022 PPD schedule
• 2021 PPD schedule
• 2020 PPD schedule
• 2019 PPD schedule
• 2018 PPD schedule
• 2017 PPD schedule
• 2016 PPD schedule
• 2015 PPD schedule
• 2014 PPD schedule
• 2013 PPD schedule
• 2012 PPD schedule
• 2011 PPD schedule
• 2010 PPD schedule
• 2009 PPD schedule
• 2008 PPD schedule
• 2007 PPD schedule
• 2006 PPD schedule
• 2005 PPD schedule
• 2004 PPD schedule
• 2003 PPD schedule
• 2002 PPD schedule
• 2001 PPD schedule
• 2000 PPD schedule

Note: If you need a PPD award schedule from earlier years, email us at SItrainerQuestions@Lni.wa.gov

Forms

A complete list of self-insurance forms is on the Forms & Publications page. Many of these forms and templates are available in other frequently used languages.

Effective July 1, 2019, Self-Insured Employers began using specific forms to request the following orders from the department: allowance, closure, denial, interlocutory, or overpayment. The Forms and templates were updated May of 2020. Refer to the new and updated forms summary and the training matrix for more information on these changes. 

• Claim Allowance Request (F207-215-000) 
• Claim Closure (F207-216-000) 
• Claim Denial (F207-217-000) 
• Interlocutory Request (F207-218-000) 
• Overpayment Request (F207-219-000) 

Templates

Effective July 1, 2019 Self-Insured Employers will use letter templates to communicate key actions to workers during the course of a claim, including: wage calculation, starting, stopping or denying compensation benefits, accepting or denying newly-contended conditions, authorizing or denying treatment, and assessing overpayments or underpayments.

• Calculation of Monthly Wage as a Basis for Time-Loss Compensation (F207-227-000) 
• Accept Newly Contended Condition (F207-220-000) 
• Deny Newly Contended Condition (F207-221-000) 
• Assessment of Overpayment (F207-222-000) 
• Notice of Underpayment (F207-223-000) 
• Provisional Compensation Benefits (F207-224-000)
• Start, Stop or Deny Compensation Benefits (F207-225-000)
• Treatment Decision (formerly Treatment Authorized/Denied) (F207-226-000) 
• Self-Insurer Beneficiary Application Letter (F207-236-000)
• Self-Insurance IME Assignment Letter (F207-238-000)

Note: Unless disputed, L&I will no longer issue wage orders, overpayments, or acceptance/denial of newly contended conditions.

• Substantially Similar Forms
  Make sure your forms or templates meet the definition of substantially similar.

To make it easier for claim managers to do business with L&I, we have created useful coversheets and checklists.

• Pension Review Coversheet
  Use this coversheet when requesting L&I review a claim for pension.
• Stipulation Coversheet
  Required information for self-insured employers/worker attorneys requesting a stipulation.
• Suspension Request Coversheet
  A checklist for self-insured employers requesting suspension of benefits for non-cooperation.
• No-Show Fee Request Checklist
  Required information for self-insured employers requesting a no-show fee order.
• Willful Misrepresentation Checklist
  Use this when requesting a willful misrepresentation order on a claim.
• Release of Medical Records and Patient Privacy In Workers' Compensation
  Use this to help obtain worker medical records.

Medical Provider Network Status Report (MPNSR)

Self-insured employers can use the network status MPNSR tool or download the Provider Network Status Report (PNSR), a daily file of providers' network status to determine which providers can provide ongoing treatment to injured workers in Washington State.

The network status tool will allow self-insured payers and providers to have access to the same timely accurate information. Additional provider information can be found on the self-insurance providers page.

If you have questions or concerns, please contact our Provider Account Credentialing team at provnet@Lni.wa.gov.

Reasonably Convenient Location (RCL) Tool

L&I developed the Reasonably Convenient Location tool to help self-insured employers identify where residents in the worker’s community likely travel for care to various medical specialties (RCW 51.36.070). These locations are determined by:

• The number of providers in each county participating in the Medical Provider Network (MPN).
• The closest driving distance between the starting location and each county seat.

Additional Resources:
The RCL tool does not list or display where individual medical providers are available. If you wish to find where an IME might be scheduled, access the Find a Medical Examiner (FAME) search engine. To find individual locations of medical providers, use the Find a Doctor search engine.

How to use the search feature on the Reasonably Convenient Location tool:

• Open the RCL Location Tool (Excel)
• Start with the cursor in the city field next to “Enter Worker’s Location”
• Type in the workers starting city or select the city from the drop down options
• Review the list of specialties to find the location where worker will likely travel

Example:

This tool is updated monthly.

If you need to determine what county an IME location is in, please use this list:
https://www.courts.wa.gov/court_dir/?fa=court_dir.countycityref