Changes in WC law

Washington Self-Insured Employers Face Increased Penalty Amounts Starting September 1

Self-insured employers in Washington should be aware that penalty amounts increase on September 1, 2020, as a result of HB 2409, passed earlier this year. The changes apply to several categories of penalties that the Department of Labor & Industries can impose, including penalties under RCW 51.48.017 for “unreasonably delaying or refusing to pay benefits” under a claim. Previously, penalties under this statute were capped at $500 or 25 percent of the benefits delayed, whichever is greater. Starting September 1, this amount increases to the greater of $1,000 or 25 percent. The new penalty amounts apply to new requests submitted on or after September 1, regardless of when the contended delay in benefits occurred. The penalty amount for a… Continue reading

Oregon Workers’ Compensation Mental Health Presumption of Compensability

Presumption—it’s a scary word in the world of Oregon workers’ compensation. Last year Oregon passed Senate Bill 507—now codified at ORS 656.802(7)—creating a presumption of compensability of certain mental health claims filed by first responders working for public entities. A careful look at the presumption created by ORS 656.802(7) reveals it actually applies in limited circumstances and may not be so scary after all. Covered Employees The presumption applies to limited group of employees employed by public employers. Only those employees that are full-time paid firefighters, emergency medical services providers, police officers, corrections officers or you corrections officers, parole or probation officer, or emergency dispatcher or 9-1-1 emergency operated are covered by the presumption. Further, the employee in question must… Continue reading

Trial Attorneys and Unions Pushing for COVID-19 Presumption Legislation

On June 23, 2020, Governor Brown directed the Management-Labor Advisory Committee (MLAC) to explore any gaps in our current workers’ compensation system related to COVID-19, including at looking to whether a presumption of compensability is needed to ensure workers are protected under the current system. The governor instructed the committee to provide a response by mid-July to prepare for an upcoming legislative session. MLAC held six meetings to take testimony from workers, attorneys, employers, insurers, administrators, and state officials discussing a list of potential issues. The issues were categorized into worker’s compensation issues MLAC could address and health/safety issues that MLAC could make recommendations, but ultimately would need to be addressed by other agencies. Ultimately, MLAC could not reach a… Continue reading

In the midst of COVID-19 pandemic, Oregon Court of Appeals issues troubling ruling for processing new/omitted condition claims

The Oregon Court of Appeals issued its decision in Coleman v. SAIF, 304 Or App 122 (2020) on May 13, 2020. Claimant filed a claim for a left knee injury on June 12, 2015. On June 29, 2015, claimant and his attending physician submitted an 827 form for a new/omitted condition claim for medial femoral chondral defect in the left knee. The carrier issued an initial notice of acceptance on August 11, 2015, accepting a left knee strain and contusion; there was no reference to the June 29, 2015 827 form. In a chart note dated October 15, 2015, claimant’s attending physician referenced the June 2015 827 form and indicated it needed to be addressed by the carrier. The carrier… Continue reading

Oregon Workers’ Compensation Rule Updates During COVID-19 Crisis

Needless to say, there have been a lot of changes recently, not just in our daily lives, but also in claim processing issues. The WCD has begun discussions to address a variety of issues that have arisen with Workers’ Compensation claims in light of COVID-19. Further, the WCD and WCB have continued forward with new rules. As SBH’s legislative liaison I have included some of the highlights below to help continue to process claims in a timely and proper manner during COVID-19. COVID-19 Potential Proposals I among others are working on identifying potential proposals to address many new issues arising from COVID-19 including: • Effect on claim processing deadlines due to lack of available IME and medical arbiter examiners. •… Continue reading

SBH Attorney Aaron Bass Testifies in Front of Washington State Senate

Attorney Aaron Bass testified on behalf of Washington Self-Insurers Association in opposition to SHB 2409. The bill not only increases the penalty amounts, it imposes a new vague “fair conduct” standard and includes a “per occurrence” multiplier on self-insurance penalties. Attorney Bass used his time to point out the grossly punitive and concerning language in Section 2 of the proposed bill. The bill would entitle claimants a penalty each time benefits were unreasonably delayed. Rather assessing a penalty of $500 or 25% of the aggregate amount of delayed or unpaid benefits, the proposed bill provides a maximum $1,700 penalty for each act of unreasonable delay. The consequence of a “per occurrence” penalty is catastrophic and extremely punitive. Attorney Bass outlined… Continue reading

Oregon Supreme Court rules that medical services for conditions caused in material part by the work injury incident, not just accepted conditions, are compensable

In a much-awaited decision, the Oregon Supreme Court recently ruled in Garcia-Solis v. Farmers Ins. Co., 365 Or 26 (2019) that medical services for conditions caused in material part by the work injury incident, not just accepted conditions, are compensable under ORS 656.245(1)(a). In relevant part, ORS 656.245(1)(a) states that “For every compensable injury, the insurer or the self-insured employer shall cause to be provided medical services for conditions caused in material part by the injury for such period as the nature of the injury or the process of the recovery requires.” This case involves a 2009 work injury, in which a food server sustained bodily injuries. Over the next two years, the insurer accepted numerous musculoskeletal conditions. In 2012,… Continue reading

New Average Weekly Wage Calculation Rules

The Workers’ Compensation Division recently issued new rules for calculating average weekly wage. The new rules will apply to claims with dates of injury on or after February 21, 2018. Under the new rule: When a worker is paid irregular wages and there is an increase or decrease in the worker’s pay rate in the previous 52 weeks before the injury/occupational disease, this will not constitute a “new wage earning agreement.” The insurer must calculate the worker’s average weekly hours worked at each pay rate since the last wage earning agreement (not to exceed 52 weeks). The average hours at each pay rate will then be multiplied by the pay rate at the time of injury/occupational disease. Any irregular… Continue reading

Worker’s Compensation Division Addresses House Bill 2338 Regarding Benefits to Surviving Children

The Workers’ Compensation Division issued an Addendum to Bulletin No. 377 on December 8, 2017. The Division issued the addendum to address House Bill 2338, which changed the computation of fatal benefits to children of deceased workers or “surviving children.” The addendum does not change the monthly benefit amounts for: Surviving children receiving benefits at 25 percent of the base or average weekly wage (whichever applies) before January 1, 2018; or Surviving children or dependents with no surviving parents who are completing secondary education, a GED, or a program of higher education. The addendum does change all monthly benefits being paid at the 10 percent level before January 1, 2018. Those benefits must be increased to 25 percent for benefits… Continue reading

Oregon Workers’ Compensation Division announces new administrative rules in response to Brown v. SAIF

On March 30, 2017, the Oregon Supreme Court issued a much-awaited decision in Brown v. SAIF Corporation, 361 Or 241 (2017), ruling that the term “compensable injury” shall be interpreted to mean only the medical conditions accepted by the insurer or self-insured employer. Since then, however, there has been some uncertainty regarding how and when the Workers’ Compensation Division (WCD) would permanently incorporate the Brown ruling into the Oregon Administrative Rules (OAR), Chapter 436. On September 8, 2017, the WCD announced and posted its final amendments to the following Divisions: OAR 436-010, Medical Services; OAR 436-030, Claim Closure and Reconsideration; and OAR 436-035, Disability Rating Standards. The permanent rules are effective October 8, 2017. As expected, the predominant change in… Continue reading