Washington WC Benefits

Department of Labor & Industries Issues New Checklist for Willful Misrepresentation

The Department of Labor & Industries recently amended the process and published an amended checklist for employers seeking Willful Misrepresentation orders. The Department’s new checklist for reporting Willful Misrepresentation available here. Pursuant to RCW 51.32.240(5), self-insured employers can demand repayment of any benefits induced by willful misrepresentation along with a 50% penalty payable to the Department’s supplemental pension fund so long as the repayment and recoupment of benefits is demanded within three years of the discovery of the worker’s willful misrepresentation. The statute goes on to explain that “willful misrepresentation” includes willful false statements, omissions, or concealment of any material fact. Additionally, Washington Administrative Code 296-14-4121 provides that the term “willful” means a “conscious or deliberate false statement, misrepresentation, omission,… Continue reading

New Washington Supreme Court “Innocent Misrepresentation” Overpayment Case

Ewing, Sarah_160x222The Washington Supreme Court issued a new case addressing whether the Department has authority to issue an overpayment order and an order modifying claimant’s compensation rate based on claimant’s innocent misrepresentation. Claimant was injured at work. He needed assistance to complete the SIF-2 and because of a language barrier and claimant coming in and out of consciousness, the SIF-2 stated claimant was married and had a dependent child at the time of injury. The listed persons were actually his sister and niece. The Department issued several wage orders, each basing the wage calculation on claimant having a spouse at the time of injury. Claimant was awarded a pension and when he filled out the pension paperwork, he indicated he was… Continue reading

WASHINGTON COLA INCREASES ON JULY 1ST

lee ann loweEffective Friday July 1, 2016 the annual cost of living adjustments (COLA) will take effect for the benefit period of July 1, 2016 through June 30, 2017. Washington’s statewide average wage increased from $54,829.00 in 2014 to $56,273.00 in 2015, an increase factor of 1.0263364278. As usual, there will be no COLA increase for dates of injury on or after July 1, 2011 until the second July after the date of injury, unless the time loss rate is set at the minimum or maximum rate, in which case the increase to the new minimum or maximum rate will apply. Effective July 1, 2016 the new maximum monthly time loss rate for dates of injury on or after July 1, 2016… Continue reading

Everything you’ve wanted to know about third-party recovery in Washington (but were afraid to ask.)

Whalen, Sam_167x222Recovering claims costs through third-party litigation in Washington can be complicated. If careless, self-insured employers (SIE) can walk away from third-party claims leaving money on the table. However, with forethought, third-party litigation can be an effective way for self-insured employers to recover the cost of processing a claim. The purpose of this post is to explain how entitlements to third-party recoveries are calculated, and what self-insured employers should think about to maximize their recovery. In Washington, where a work place injury is negligently caused by a third party, the SIE is entitled to recoup both the cost of benefits paid under the claim and future anticipated costs. Any settlement or jury verdict is subject to the SIE’s entitlement. If the… Continue reading

Lumbar Fusion – New Guidelines for DLI

Ewing, Sarah_160x222The Department has issued new stricter guidelines regarding when a proposed lumbar fusion is a medically necessity and clinically appropriate. These guidelines, effective March 7, 2016, deny lumbar fusion surgery coverage for patients with uncomplicated degenerative disc disease (“DDD”). An uncomplicated DDD is one where claimant has lower back pain without any evidence of: (1) radiculopathy, (2) functional neurologic deficits, (3) spondylolisthesis (greater than grade 1), isthmic spondylolysis, (4) primary neurogenic claudication associated with stenosis, (5) fracture, tumor, infection, inflammatory disease, or (6) degenerative disease associated with significant deformity. The current guidelines allowed a coverage for a lumbar fusion for a claimant who had no evidence of the above 6 conditions, as long as they completed three months… Continue reading

Washington Department of Labor and Industries Revises the Interlocutory Process

lee ann loweOn July 16, 2015 the Department issued a new set of guidelines for self-insured employers to obtain an interlocutory order. The 60-day period following the self-insured employer’s receipt of notice of a new claim, prior to when the claim is allowed or denied by the Department, is referred to as the interlocutory period. That period can be extended pursuant to a self-insured employer’s request to allow for additional time to investigate the claim and obtain additional information. Under the Department’s new interlocutory process, if an extension is requested there is a standard 30-day extension that will granted by a Department interlocutory order. The 30-day extension will begin from the date the initial 60-day period ends, regardless of… Continue reading

Washington Housekeeping Matters – COLA and Vocational Mileage Reimbursement

Ewing, Sarah_160x222COLA Effective July 1, 2015, cost of living adjustments (COLA) will take effect for the benefit period of July 1, 2015 through June 30, 2016. Washington’s statewide average wage increased from $52,635 in 2013 to $54,829 in 2014. The maximum monthly time-loss rate for dates of injury on or after July 1, 2015 is $5,482.90. Another adjustment on July 1, 2015 is minimum time-loss rates. 15% of the states average monthly wage is $685.37. For those eligible for that minimum time-loss rate, remember to add $10.00 for a spouse or registered domestic partner and $10.00 for each dependent child up to five dependents. Make sure to adjust your time-loss payment accordingly. You can access the Time-Loss Rates… Continue reading