Today we’re going to talk about L&I penalizing self-insured employers such as King County Metro. There is more to the Department of Labor and Industries (L&I) than administering workers’ compensation cases. It is a very big administration charged with many other tasks including workplace safety issues. After all, safe workplaces are a first step towards reducing the number of industrial injuries that occur.
In today’s local news we learned that L&I has fined King County Metro $20,100 for safety violations involving employees working around high voltage. This isn’t the first time that King County Metro has been cited for safety violations by L&I. Approximately 2 years ago KIRO 7 news investigated incidents of Metro employees getting shocked while working on busses. Two years after a KIRO 7 investigation into employees getting shocked while working on buses in 2016, Metro was fined $10,800 for not implementing training programs for high voltage work and failing to periodically review and evaluate improper energy control procedures. Metro has also been fined for issues associated with bathrooms for bus drivers and assaults of Metro employees while working.
King County Metro is a self-insured employer. That means for injured Metro employees, Metro (or their third-party administrator insurance) handles claim paperwork and pays for the claim. According to WAC 296-15-310 Every employer certified to self-insure is obligated to comply with the provisions of the Industrial Insurance Act and the rules and regulations of L&I, and to have the necessary administrative processes in place to manage its self-insurance program. Each self-insurer is ultimately responsible for the sure and certain delivery of Industrial Insurance Act benefits to its injured workers and is accountable for all aspects of its workers’ compensation program. For an employer to be certified to be self-insured, the employer must meet the requirements set forth in WAC 296-15-001.
If an injured worker whose claim is being administered by a self-insured employer believes that the self-insured employer has unreasonably delayed benefits, the worker can ask L&I to penalize the self-insured employer according to WAC 296-15-266. If the self-insured employer’s actions are even more egregious than mere delay of benefits, under RCW 51.14.090 the Department may withdraw the self-insured employer’s certification. WAC 296-15-255 sets forth the hearing process for corrective action or withdrawal of a self-insured employer’s certification.
Did you know that the Department of Labor and Industries (L&I) has an acupuncture pilot project? Until very recently, acupuncture as a treatment was not covered on L&I claims. Recently L&I decided to launch a pilot program designed to collect information about the use of acupuncture to treat low back pain, including treatment provided by East Asian Medicine Practitioners (EAMPs). During the project L&I will pay qualified providers participating in the project to provide acupuncture treatment to injured workers with low back pain that is related to an accepted condition under their claim.
For treatment to be covered, it must focus on helping inured workers heal and return to work. Furthermore, the treatment must be ordered by the attending provider (AP) and documentation must show clinically meaningful improvement in pain and function with the acupuncture treatment. If these conditions are met, up to 10 acupuncture treatments over the lifetime of the claim may be authorized. As treatment progresses, participating providers are required to use the Oswestry Disability Index and 2-item Graded Chronic Pain Scale score to assess the improvement in pain and function and send reports to the Department continuing this data.
As an attorney representing Washington State injured workers, I am very excited that the Department is finally exploring acupuncture as a treatment option under L&I claims. For years, acupuncture has often been recommended to assist injured workers in overcoming painful conditions and dependence on pain medications like opioids. However, injured workers were often disappointed to learn the recommended treatment would not be covered by the Department. It was not uncommon for me to represent individuals so desperate for pain control they were willing to cover the cost of acupuncture treatment out of pocket. However, for struggling injured workers, paying out of pocket is often not possible. In my experience, many injured workers have had very positive results from acupuncture.
Are you an injured worker that has been able to take advantage of the L&I acupuncture pilot project? If so, I’d love to hear from you about your experience.
Vocational services in L&I claims
Continuing with vocational services articles for L&I workers’ compensation claims, yesterday I posted general information and thoughts about the Plan Development phase in vocational services. Today, I’d like to focus on disputing vocation decisions and Vocations Dispute Resolution (VDRO).
While vocational retraining can be a tremendous benefit under the right circumstances, I don’t believe enough emphasis is placed on a holistic analysis of the injured worker’s ultimate ability to become employed… Continue to read the full article.