Commonly Seen Errors In Department Audits

1. Commonly Seen Errors In Department Audits And How To Fix Them.

3. Rights & Obligations • WAC 296-15-400 • Within 30 days of Hire • Substantially Similar/WAC 296-15-001 • Problems Found in Audits • Not using form • Modifying form • Not providing form to all new employees

4. Recommendations • Form available on L & I website • Add to orientation checklist

5. When Worker Files A Claim • Provide Department booklet • Names, address, phone number of person or organization handling claim Problems Found in Audits • Not providing booklet • Timely providing

6. Recommendations • Booklet available on Department website or can be ordered from Department • Provide with SIF-2

7. Claim Filing Procedure Errors • WAC 296-15-320 • Problems Found in Audits • Providing Self-Insurer Accident Report (SIF-2) when notified of injury or illness • Timely delivery of completed (SIF-2s) to claim management entity • Only Department provided SIF-2s may be used

8. Notice of self-insurance RCW 51.14.100(1) Problems Found in Audits • Substantially identical form • Listing person or position on site • State Fund Notices • Reasonable number of notices

9. Recommendations • Form available on Department website

10. Claims Log • WAC 296-15-200 • Designate location of official log in writing • Problems Found in Audits Date claim closed by Order and Notice Whether claim is time loss or medical only Unreported claims

11. Onsite Medical Treatment • Medical facilities and employers who treat their workers at their onsite medical facility • Treatment by physician, nurse practitioner, physician assistant, or registered nurse under doctors standing orders • Provide injured worker with opportunity to file claim form (SIF-2) • Documentation of refusal and notification of one-year filing statute.

12. Treatment log for medical only claims with treatment exclusively at employer’s medical facility.

13. Date stamping incoming correspondence • WAC 296-15-350(8) • Legibly date stamp with date received and where received • Includes doctor notes, activity prescription forms, state fund accident reports, physicians initial reports, and other reports received by employer or claims management entity • Punch dates are not legible

14. Failure to request allowance or denial within 60 days from date claim filed • RCW 51.14.130 and WAC 296-15-420 • Check for allowance orders • Does not apply to medical only claims unless requesting denial or interlocutory order • Penalty per RCW 51.14.140 and RCW 51.48.080

15. Payment of first time loss within 14 days • RCW 51.32.190(3) • Payment within 14 days after notice of a claim • Notice of claim or claim arrival date • Injured worker makes application for benefits • Claim elements-description of injury, diagnosis of medical condition, treatment or treatment recommendation • Hospitals and employers with onsite medical facility

16. Recommendations • Review process of filing claims • Communication, communication, communication • Training employees

17. Benefits Not Paid as Entitled • RCW 51.32.010 • Communication, communication, communication • Learn the employer’s payroll system • WAGES/ RCW 51.08.178 • Obtain & review daily payroll records to determine employment pattern • Averaging hours • Use full weeks and full months

18. Multiple rates of pay • Substantial number of hours at different rates of pay, treat each as separate rate of pay • Rates of pay at time of injury • Change of circumstances • Raises • Change of jobs • Change of shifts

19. Health Care Benefits (medical, dental, vision) • Bonuses • Loss of Earning Power Benefits • Communication, communication, communication • Determine if eligible any time return to work light or modified duty • Eight hours versus average daily hours • Updated date of injury wages • Bonuses

20. C.O.L.A. – July 1

21. Return to Modified or Light Duty Work • RCW 51.32.090(4) • Communication, communication, communication • Provide worker with copy of light duty job description when contacting physician for release to light duty • Document light duty offer and injured worker’s decision • Determine if LEP due

22. SIF-5 Information • WAC 296-15-420 and WAC 296-15-450 • Required for Department to monitor claim and make determinations • Should report what has taken place at time of completion

23. Most common SIF-5 errors • Date of first payment • Release for work date • Return to work date Final report includes all dates- light duty, full duty

24. Employer Closures • RCW 51.32.055 (9) (a) • Jurisdictional errors • Did not return to work with employer of record • Null and Void Orders WAC 296-15-450(6) • Untimely filing of EC Order and Final SIF-5

25. Medical Only Claims • Communication, communication, communication • May become compensable claim • Determine if LEP due for return to work light duty • Verify return to work full duty

26. Worker Hours Salaried Employees • WAC 296-17-31021(2) • Report all salaried employees by same method • Actual hours worked or assumed 160 hours per month • Complete and accurate time records of all hours worked, whether paid or not

27. Personal Services Labor Contracts • RCW 51.08.180 and RCW 51.08.195 • Independent contractor providing essentially personal labor for employer is a worker • Must meet ALL six parts of test described in RCW 51.08.195 to be exempt

28. Department Web Site • RCWs, WACs, Forms, Publications, Self-Insurance information • lni.wa.gov/ClaimsIns/Insurance/SelfInsure/ • At lni.wa.gov web site, click on Business Links, then Self-Insurance