WA Changes to Claim Administration to Tighten Deadlines
In Washington, the workers’ compensation system is designed to provide prompt medical treatment to affected workers so that the worker can return to work as promptly as possible. As a result, while the employer has the right to investigate claims prior to accepting a claim, the employer is held to close deadlines. To make this process more streamlined, the Department of Labor and Industries has announced new claims handling processes and deadlines that are set to begin on July 1, 2025.
First, in the event the employer requires additional time to investigate the claim the employer must request an interlocutory order. The employer must give a reasonable explanation as to why they require additional time in their application of an initial interlocutory order. Now though the employer must cite good cause for any extensions of that interlocutory order. WAC 296-15-420(2)(c). This is done on the new interlocutory request form (F201-218-000).
As interlocutory orders are to provide the employer additional time to address claim validity, examples of sufficient good cause for an interlocutory order show why a determination cannot be made. This would include the need for pre-claim records in an occupational disease claim or should an independent medical exam be necessary to address causation where there is no clear injury. In the event that an exam is required the best practice would be to provide the date and reason for the exam as part of the good cause section.
However, should the reason for the interlocutory request not address claim validity the Department may issue an allowance order so long as there is prima facie evidence to support claim allowance. WAC 296-15-420(2)(c). An example would be to allow the employer to obtain pre-injury medical records when there is evidence of a specific injury, as these records would address aggravation of a pre-existing condition instead of claim validity.
The employer is still required to request an interlocutory order within 60 days of notice of the claim. The maximum amount of time the employer will be granted to either request allowance or denial of the claim would be 120 days for an industrial injury, and 150 days for an occupational disease. Once this period has expired, should the employer fail to timely request an interlocutory order or should the employer not give good cause for an interlocutory order; the Department may issue an order allowing or denying the claim on their own. WAC 296-15-420(4).
As can be seen, the Department intends to streamline the claim allowance process by requiring employers to justify their need for an interlocutory order. Should the interlocutory request not have a sufficient reason to justify an interlocutory order the Department may allow the claim.
Due to these changes, the best practice for an employer are to provide an explanation as to why they are unable to provide an opinion on claim validity. Moreover, the employer should also show what they are doing to get whatever information they are lacking, such as when an independent medical examination is scheduled or where they have sent records requests from.
If you have any questions, or want to discuss these new claim administration changes and how they may impact your claims, please feel free to contact me at or (971) 867-2730.
Posted by Brad Mielke.
