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Washington Administrative Code (Last Updated: November 23, 2016) |
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Title 296. Labor and Industries, Department of |
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Chapter 296-15. Workers' compensation self-insurance rules and regulations. |
Section 296-15-420. After a self-insured claim is filed.
Latest version.
- (1) What must a self-insurer do when beginning time loss (TL) benefits on a claim?1The SIF-5 is the Self-Insurer's Report on Occupational Injury or Disease. Use a form substantially similar to L&I form F 207-005-000.2The SIF-5A is the Time Loss Calculation Rate Notice. Use a form substantially similar to L&I form F 207-156-000.3If the worker is kept on salary, report the amount of time loss the worker would have been entitled to on the SIF-5.(2) How must a self-insurer request an interlocutory1 order?When requesting an interlocutory order from the department, a self-insurer must:1An interlocutory order places a claim in provisional status while the self-insurer investigates the validity of the claim.2When not specified, time is in calendar days.(3) How must a self-insurer request claim denial from the department?When requesting claim denial from the department, a self-insurer must:1The SIF-4 is the Self-Insured Employer's Notice of Denial of Claim. Use a form substantially similar to L&I form F 207-163-000.(4) What if a self-insurer does not request allowance, denial, or an interlocutory order for a claim within sixty days?If a self-insurer does not request allowance, denial, or an interlocutory order within sixty days, the department will intervene and adjudicate the claim. The department may obtain additional medical information to make the determination. The claim remains in provisional status until the department makes the determination.The exception to this requirement is the allowance of medical only claims. Self-insurers are not required to request allowance for medical only claims.(5) Must a self-insurer submit an SIF-5 each time the department requests one?Yes. A self-insurer must submit a complete and accurate SIF-5 within ten working days of receipt of a written request from the department.(6) What must a self-insurer do when the department requests information on a claim by certified mail?A self-insurer must submit all requested information concerning the claim within ten working days of receipt of the department's request by certified mail.(7) How long does a self-insurer have to provide a copy of the claim file to the worker or worker's representative?A self-insurer must provide a copy of the claim file within fifteen days of receiving a written request from the worker or worker's representative. Unless the worker or representative requests a particular portion of the file, the self-insurer must provide a copy of the entire file.(8) When may a self-insurer charge a worker or his/her representative for a copy of the claim file?A self-insurer must provide the first copy of a claim file free of charge. Upon receipt of a subsequent written request, the self-insurer must provide any material not previously supplied free of charge. The self-insurer may charge the worker or any representative a reasonable fee for any material previously supplied.(9) What must a self-insurer do when it terminates time loss?No later than the date of time loss termination, a self-insurer must notify the worker in writing of the reasons for time loss termination. If termination is based on a release to work not received directly from the worker, attach a copy of the release to the notice.
Rules
207-005-000,207-156-000,207-163-000,