Category: LNI News (Page 19 of 22)

The New Automated 30-Day L&I Claim Cost Estimator for Employers

As an attorney representing injured workers in Washington States, I believe it is important to stay abreast of developments in workers compensation. Amongst other things, changes to the law, new cases that have been decided, and administrative developments can all have a dramatic impact on claims.

Background

One of my goals in representing injured workers is to address claim related issues as proactively as possible. Workers’ compensation is often quite reactive because we must often first wait for the Department of Labor and Industries (L&I) or third party administrator to make a claim related decision before we can take the appropriate steps to address any flawed portions of the decision being made. However, I believe it is important to be well versed in the facts to give us the best chance of foreseeing potential issues that might arise and to have an effective strategy for dealing with those issues before they become impediments to claim progress.

The same is true for administrative developments that may impact claims. It is important to be aware of the developments being made, to anticipate potential claim related issues that might arise as a result of the developments, and to formulate an effective strategy for managing any negative impact on claims as a result of the development. As a result, I am subscribed to several news updates from L&I.

The new Early Case Reserve (ECR) system

Today I received a news update from the Retrospective Rating Program announcing that effective April 18, 2019, L&I will be implementing a new predictive modeling system to estimate claim costs called “Early Case Reserve” or ECR. According to the news bulletin, ECR will provide employers and their representatives with an estimate of future claim costs much sooner than has historically been available. In fact, the estimate costs will now be available just 30 days following the filing of a claim with L&I and once the initial value is applied to the claim, the system will re-evaluate and update her projected costs on a monthly basis.

According to the news bulletin, the goal of the ECR is to help employers and their representative improve their ability to manage claims and to support better-informed decisions by employers about return-to-work options for injured workers. After all, according to L&I, better return to work outcomes mean lower costs for employers.

The impact on injured workers

As you can imagine, this raises a significant concern for me as I endeavor to best represent my clients. I believe in the underlying intent and purpose of the Industrial Insurance Act, to reduce to a minimum the suffering and economic impact on injured workers and their beneficiaries. While I do not deny the importance for employers to be able to asses and evaluate workers compensation costs exposures, I worry that using statistical data to project the costs of current claims so early in the process will have significant negative impacts on injured workers. In short, because the ECR will be available 30 days after a claim is filed, it will be available within the 60-day time frame for protesting and appealing a decision allowing a claim. Rather than the intended result of supporting better informed decisions about return-to-work options for injured workers, I believe these early cost estimates will be used as a deciding factor in whether to contest the allowance of a claim to begin with. I think this is a significant issue that representatives of injured workers are going to need to be prepared to address moving forward.

For more information

Frequently asked questions and additional information about ECR can be found on the L&I website.

Preferred Worker Program for Injured Workers in Washington State

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Have you ever heard the term Preferred Worker as it relates to injured workers and L&I or self-insured workers’ compensation claims? The preferred worker program is a return to work incentive program offered by L&I that benefits both employers and injured workers.

Preferred Workers Program in L&I workers’ compensation cases

Pursuant to WAC 296-16-110, under this program, L&I may certify an injured worker who has permanent medical restrictions as a “preferred worker“. This certification enables an employer to receive financial incentives when they hire the injured worker for a medically-approved, long-term job. Moreover, an injured worker certified as a “preferred worker” can use that status to make themselves a more competitive hire.

Benefits for employers

Employers who create a safe, long-term, medically appropriate job for a preferred worker become eligible for significant benefits including:
1) Reimbursements including 50% of the base wages paid to the preferred worker, for up to 66 days or up to $10,000 within a consecutive 24-month period;
2) Up to $2500 for tools and equipment; and
3) Up to $400 for worker clothing;
In addition to these reimbursements, the employer may become eligible for an additional incentive payment of 10% of the worker’s wages or $10,000 (whichever is less) after 12 months of continuous employment of the preferred worker. On top, hiring a preferred worker also comes with premium incentives: L&I will pay or reimburse the cost of a new claim filed within the certification period with no penalty on the business.

Preferred Worker Program: Tips for injured workers

If you are an injured worker trying to return to the workforce, be sure to ask your vocational counselor whether you qualify for “preferred worker” certification. If you are certified, the Department of Labor and Industries (L&I) will provide you with a letter confirming your certification. You will also receive a brochure you can present to prospective employers to educate them on all the benefits available when they hire a preferred worker.

If you are an employer interested in learning more about the incentives for hiring preferred workers, the L&I website has lots of information. L&I resources include informational webinar, the documents required to apply for the incentives, and an “apply here” link to apply online through the Secure Access Washington portal.

Conclusions and takeaways

Under the right circumstances, the preferred worker program can be very beneficial for injured workers returning to work and for accommodating employers. However, one significant shortcoming of the preferred worker program is that certification is only granted to injured workers who have a state funded claim. Injured workers of self-insured employers are not currently eligible for preferred worker certification. In my opinion this is a grave injustice to self-insured injured workers and I am currently exploring avenues for correcting this inequity.

LNI penalty against self insured employer king county metro

L&I Penalizes Self-Insured Employer King County Metro

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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.