On occasion, the Department of Labor and Industries (L&I) asks work injury claimants to fill a “Treating Provider List”. Usually, L&I sends a brief cover letter explaining why they it. Most commonly, it’s because L&I doesn’t know if they should cover a condition under your L&I claim.

 

Treating Provider List

Filling out the Treating Provider List can be stressful. And there are good reasons for the stress. Work injury claimants often worry that L&I will use past medical history to deny coverage. Also, they worry about the amount of information that L&I requests in the Treating Provider List. Furthermore, many are concerned about what will happen if they forget something. And then, some workers are unsure if they even must complete the form.

 

Will L&I use the Treating Provider List and the medical history to deny coverage? Maybe. Under the Industrial Insurance Act, L&I must cover conditions caused by the industrial injury or occupational disease. On top, it covers conditions aggravated by the workplace injury or illness. Therefore, just because you have prior treatment for a condition doesn’t mean L&I won’t cover it. In fact, sometimes prior treatment records is exactly what L&I needs to determine condition coverage.

 

Information L&I needs in the Treating Provider List

Does L&I really need all the information it asks for in the Treating Provider List? Probably. It can seem daunting when L&I asks for all that information. I mean, they ask for names, addresses, phone numbers, conditions treatments, and dates. And that’s for all treating providers. However, the truth is that this kind of detail is the best way to obtain the records.

 

First, medical records are very lengthy (especially since electronic records became mandatory). General and non-specific record request often lead to production of irrelevant and unnecessary records. Sorting through a ton of irrelevant records only increases L&I’s time to make a decision. Second, medical providers tend to change facilities. Yet, the records usually remain at the treatment facility. And third, many providers have the similar sounding names. It’s worth filling the forms right, even if it seems overwhelming. If you provide L&I an accurate and complete Treating Provider List, it’s the best way to get L&I the record it needs. It’s the quickest and most efficient way to help L&I reach a decision in your L&I claim.

 

Forgetting details in the Treating Provider List

What if I can’t remember or forget to include a treating provider? It happens. None of us are perfect. Most people don’t keep a journal of every medical provider they see. Not to mention remembering a provider name you saw at the ER or urgent care years ago. That’s ok. Do the best you can. Try to remember all the details or try to find them.  If you can’t, do your best to include as much detail as you can.

 

Must injured workers complete the list form?

Am I obligated to fill out the Treating Provider List? Probably. Work injury claimants have an obligation to cooperate with claim administration. This is true for L&I claims and self-insured employer claims. Personally, I’m not aware of specific rules about completing the list. But, in my opinion, it’s best for work injury claimants to almost always cooperate and fill the form.

 

I feel this way for several reasons. For one, not filling the form can suggest that you’re hiding something. Secondly, it can delay L&I in making coverage decisions. And third, you must share this information with your doctors and your workers’ compensation attorney. This information can’t catch them by surprise later. After all, if the issue escalates to litigation, you’ll have to provide it during discovery. Hence, it makes all the sense in the world to cooperate and fill the form. Do it as accurately and completely as possible when L&I asks for it.

 

Summary and notes

In conclusion, it can be scary and frustrating when L&I asks to complete a Treating Provider List. However, the general best practice is to return the form as quickly as possible. Don’t cut corners. Fill the form as completely and accurately as you can. The records in the provider list will be available in your workers’ compensation claim file. You can access it later. Similarly, your medical providers can access it as well. Furthermore, the same goes for vocational providers and your L&I attorney. They can all review the file and address things as appropriate.

 

Withholding information in the Treating Provider List rarely (if ever) benefits you. However, if you feel there are reasons to withhold information, then it’s best to speak with a workers’ compensation attorney. In such cases, you’ll have to handle the situation carefully.

 

If you have an L&I Claim, you can easily find the status of your claim. You can just log onto Claims and Account Center (CAC). It’s available on the L&I website. There, you can find everything about your claim. From reports, to orders, claim file notes, and more. However, if you have a self-insured claim, then things are not that simple. In fact, it can be very difficult to find the status of your claim.

 

Self-insured Employer Claims

Self-insured workers’ compensation claims are generally not available on CAC. Therefore, work injury claimants don’t have on-demand access to claim files. Consequently, it makes it very difficult to keep track of self-insured claims. Yet, there are ways to track the developments in these claims. More specifically, you can request your claim file and updates.

 

Self-insured employer claim file

First, you must request (in writing) a copy of your claim file. Then, under RCW 51.32.195 and WAC 296-15-420, self-insured employers have 15 working days to provide a complete copy of the claim file. Interestingly, either you or your representative can make the request.

 

Generally, the employer maintains the worker’s claim file. Sometimes, it can be the claim administrator. Either way, it should include:

1) Information that L&I received or prepared for the claim;

2) All the info that the employer produced or received;

3) All data and information from the third-party claim administrator (TPA).

 

What information is in my worker’s comp claim file?

When you ask for the claim file, you can specify the information you need. Alternatively, you can submit a non-specific request. With non-specific requests, the employer must include the following:

(1) Information to evaluate the claim. For example, evaluating for claim allowance or to provide claim related benefits. The information may include forms and incident reports. It can also include worker statements, witness interviews, and so on.

(2) Medical records and reports. This includes: (a) all records related to independent medical examinations (IMEs) or consultations; (b) nurse case management notes and reports; (c) the records from the employer’s on-site medical facility; and (d) all records and reports from treating and consulting providers.

(3) Vocational and return to work activities. These activities may include vocational provider reports, vocational plans, and more.

(4) Records of all activities completed on the claim.

(5) Records of claim communications. Specifically, records contain electronic, phone notes, logs, or other media.

(6) Incoming and outgoing claim correspondence.

(7) Orders and decisions issued in the claim.

(8) Employer payroll records and worker earnings. Furthermore, any other documents used to determine wages under RCW 51.08.178.

(9) Records of payments. In detail, this includes time-loss compensation payments and loss of earning power benefit. On top, it includes kept-on-salary payments. Furthermore, it’ll have you’re PPD rating and permanent partial disability calculations and payments, as applicable.

(10) Bills on the claim and actions regarding each bill: Whether a bill was paid, denied, adjusted, and when. Note, however, that the self-insured employer doesn’t have to provide bills information. For bills, you have to specifically request them.

 

Complete work injury claim file vs claim file updates

Self-insured employers provide a first complete copy of the claim file for free. Then, after the initial copy, the self-insured employer may charge a fee for additional complete files. Therefore, it’s always good to request an initial complete file. After that, I recommend requesting claim file updates only. The updates contain new documents since the last request. You can request them on a regular interval. Usually, workers ask for updates every 30 days.

 

Attorney-client materials in a workers’ compensation claim file

Often, self-insured employers and claim administrators work closely with their legal representatives. In turn, employers may decline to provide some claim file material. That’s because it may contain attorney-client privileged material. In addition, it may include attorney work product. It is a valid basis for withholding certain materials. However, it’s not a reason to withhold all information. Therefore, if a self-insured employer is working with attorneys, you may want to retain your own legal representative.

 

Conclusions

To summarize, it’s very important to know what’s happening in your workers’ compensation claim. Yet, self-insured claims can be difficult to follow. But it doesn’t mean it’s impossible. Work injury claimants can regularly request copies of claim file materials. Finally, when you write a request to receive your claim file, the self-insured employer must provide all claim materials within 15 days. That is, 15 days from receiving your request.