View
216
Download
2
Category
Tags:
Preview:
Citation preview
Commonly Seen Errors In Department Audits
And How To Fix Them.
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
Recommendations– Form available on L & I website– Add to orientation checklist
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
Recommendations
– Booklet available on Department website or can be ordered from Department
– Provide with SIF-2
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
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
Recommendations
– Form available on Department website
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
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.
Treatment log for medical only claims with treatment exclusively at employer’s medical facility.
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
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
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
Recommendations– Review process of filing claims– Communication, communication, communication– Training employees
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
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
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
C.O.L.A. – July 1
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
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
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
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
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
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
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
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
Recommended