Category: LNI News (Page 15 of 22)

Have you ever heard of the term Retrospective Rating? It is an incentive program that the Department of Labor and Industries (L&I) created for employers. Any employer with industrial insurance and in good standing can participate in Retrospective Ratings. Employers can do this individually or by joining a “Retro Group“. Through Retrospective Rating, employers can earn a partial refund of their workers’ compensation premiums by reducing workplace injuries and lowering the associated claim costs.

 

What is a Retrospective Rating Group?

Very simply, Retrospective Rating is a new way of calculating employer premiums for workers’ compensation. Here, premiums are calculated retrospectively after the fact. Coverage periods last for twelve months and may begin any calendar quarter. Roughly ten months after a coverage period ends, L&I reviews the actual experience and calculates a retrospective premium.

 

If the claims cost for the coverage year are below expectations, the employer or retro group earns a partial refund. The refund is the difference between the retro premium and the regular premium. If costs are higher than the regular premium, the employer or retro group may be penalized with an additional assessment.

 

Theory versus reality

This seems like a fair and equitable incentive program. After all, shouldn’t employers be rewarded for increasing safety and reducing work injuries and occupational diseases? If that is how this program really worked, it would have my full and most ardent support. Unfortunately, I think more effort is spent “lowering associated claim costs” than “reducing workplace injuries”.

 

Since Retrospective Rating came into existence, I have seen an increase in contentious relations between retrospective rating employers and groups, and work injury claimants. This often results in tension with return to work options, breakdowns in effective communication, contentiousness throughout claim administration, and increased litigation.

 

Personal notes and takeaways

I’m not opposed to incentivizing employers. Far from it. But, I think the Retrospective Rating program needs to be thoroughly re-evaluated to determine if it is accomplishing what it should. Reducing claim costs is important. But at what expense? Some food for thought…

Last month I posted about a food worker that L&I  said wrongfully obtained over $11,000 in workers’ compensation benefits. Today L&I announced that it has accused a Washington State woman with stealing over $11,000 in workers’ comp benefits. L&I has been investigating this case since 2015. Now, she has been charged criminally with first degree theft. Revised Code of Washington, Title 9A, is the relevant criminal statute. The statute allows a business or individual to be charged for theft against L&I.

 

What is willful misrepresentation in an L&I claim?

Here again, this story illustrates how seriously L&I takes fraud allegations. Under the Industrial Insurance Act, fraud is called willful misrepresentation. It means obtaining workman’s compensation benefits you are not entitled too. It includes intentional, conscious, or deliberate false statements and misrepresentations, omissions, or concealment of fact to obtain or increase benefits. L&I has a detailed checklist it provides self-insured administrators that outlines reporting requirements for willful misrepresentation. Simply put, in L&I’s view, it is willful misrepresentation for a person to intentionally obtain benefits they are not entitled to by willfully misrepresenting or omitting material facts.

 

The impact on L&I work injury claims in Washington State

According to L&I, this type of fraudulent behavior costs the system millions of dollars each year. Employers, employees, insurance carriers and Washington consumers pay the cost of fraud. These costs include lost jobs and profit, and lower wages and benefits. On top, there are increased costs for services and premiums. Fraud can be committed by employees, employers, health care providers, attorneys and others. To this end, RCW 51.48.020 allows felony (class C) charges to be filed against any employer that knowingly misrepresents to L&I the amount of payroll or worker hours. The employer is liable for up to ten times the difference in premiums due. Furthermore, the employer is liable for any reasonable expenses of auditing the employer’s books.

If interested, more information about L&I’s efforts to investigate and prosecute fraudulent behavior can be found on the L&I website.