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Ruth and Rhonda from Stop ClaimsRuth and Rhonda from Stop Claims spoke to us about employee rights and avoiding the pitfalls of Labor and Industries Industrial Insurance.
In 2015 there were 174,000 employers in the State fund. Washington is a monopolistic state where every employer in the state fund is required to use L&I for their workers’ comp insurance. You have to become self-insured to be exempt. 109,000 new claims were accepted in 2015 and 300 claims were assigned to a case manager. $1.5 billion was paid in benefits and more pensions paid. Only 14 fraud claims were referred to the AG’s office for prosecution this was down from 24 the year before. Many more are likely fraud claims that are being overlooked. There are a lot of unworthy claims being paid. Care goes on too long, opiate abuse, depression, and PTSD are all associated with unworthy and fraud claims. Other things to be aware of are that occupational disease can be transferred to a new employer and sometimes the old employer does not have any liability. Many times, Pre-existing conditions are tacked on to the L&I claim that increases the cost of the claim.
The laws require that whatever the attending physician says the claims manager has to accept it. If there is a question, benefit of the doubt goes to the injured worker. Medical evidence is accepted until proven otherwise.
To ensure that a claim is not a runaway claim one needs to attempt to prevent a claim with an accident prevention plan and needs to manage the medical within the claim (medical care should only be had for 60-90 days unless it is a serious injury). IT is also wise to keep surveillance of the injured worker if there is a question about injuries. You can also, transition the worker back to work with light duty. To do this, use a vocational counselor to prepare a list of duties worker can take to physician. And remember that any legal decision from L&I can be protested within 60 days and then the decision is appealed.
Your experience rate and L&I premiums will go up if you have more compensable claims. Factors that will increase experience rate are time loss, a medical claim over $2,930, if there are any funds on reserve for the injured worker and permanent/partial disabilities. Remember that employers can review any claims online. It is important to monitor claims to ensure they do not become runaway claims that cost the company a lot.
The retrospective refund program is an incentive program through L&I that awards employers if they implement strong safety procedures. L&I will look back at claim performance. If they are good there is a refund, but if they are bad there is an assessment. Finally remember that, if you hire an injured worker you get a discount and benefits from L&I.
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