Category Archives: DLI

DLI

DLI News: Telehealth Visits

Temporary Telehealth Visits Payment Policy 

To help support containment of the COVID-19 outbreak, the Department of Labor and Industries has issued a new temporary telehealth visits policy. This temporary telehealth policy allows medical providers to use the worker’s home as an origination site in some instances to treat injured workers. This policy is effective 3/9/2020, and expires 7/3/2020. This is an emerging situation, and this policy may be updated as needed.

L&I’s current payment policy and fee schedule already covers phone calls between providers and workers, and telehealth visits when provided at a medical origination site. Please see the DLI Fact Sheet for more details of the current policy: LI Telehealth Fact Sheet AUG 2019.pdf

The new temporary policy will stipulate the following: 

  1. In addition to providing telehealth services under the current payment policy, providers who can normally provide telehealth services using video remote technologies may now bill the following CPT© evaluation and management codes with home as an origination site: 
    1. 99211
    2. 99212
    3. 99213
  2. The documentation requirements will follow the Department payment policy established in Medical Aid Rules and Fee Schedules (MARFS) Chapter 10: Evaluation and Management Services. Under this temporary measure, providers will be required to include a note about the emergency situation (limiting exposure to COVID-19, in this case) that prompted this encounter, as well as noting that the originating site of the worker is home.
  3. Providers are encouraged to implement their clinic’s emergency response plan.

On July 3, 2020, the temporary L&I emergency telehealth policy is scheduled to end, unless the Department decides an extension is needed. This is an emerging situation, and this policy may be updated as needed.

Policy Does Not Provide Equipment to Workers

Additionally, the temporary policy will state that L&I will not provide the worker with or reimburse the worker for equipment. If a worker doesn’t have access to high-speed internet via computer or a camera phone with reliable connectivity, the provider must work with the worker to identify an alternative.

Instructions to Claims Managers re: Time Loss Payments

Claims Administration has decided to instruct claim managers not to automatically stop time loss benefits if the restrictions on an APF expire because the worker was unable to be seen in person due to COVID-19 precautions. Claim managers will be advised to assess each case and staff with their supervisor and/or ONC to decide how best to manage the claim during the period of the forthcoming temporary policy.

Questions on the payment policy after it’s published? Contact us at HPPM@Lni.wa.gov.  

If you have questions or concerns about your claim, feel free to contact our firm for assistance. We provide a free case analysis and would be happy to discuss your circumstances with you.

Prior Post with Related Content

CONTACT AN ATTORNEY EARLY IN YOUR CASE FOR THE BEST CHANCE AT A FAIR OUTCOME

DLI

Pierce County, WA Landscaper Charged with Skipping Out on Workers’ Comp Coverage

          A Pierce County, WA landscaper has been charged with failing to pay workers’ compensation insurance after one of his employees was injured on the job.

           Kenneth Ivan Winters, 49, faces one count of doing business without workers’ comp insurance and seven counts of making false reports to the Department of Labor & Industries, according to charging papers. Each charge is a Class C felony with a maximum penalty of five years in prison and a $10,000 fine.

           The Lakewood man pleaded not guilty to the charges Wednesday, February 19, 2014 in Pierce County Superior Court. His trial was set for May 1.

           According to charging papers filed by the Washington Attorney General’s office, authorities were alerted to the case when an employee filed an on-the-job injury claim while working for Winters’ business, Executive Lawn Care, in October 2012.

           The worker told an L&I investigator that Winters, who was on site when the employee was hurt, threatened him and his family if he filed a claim with L&I, charging papers said. The employee said he had worked for Winters from 2002 until the day he was injured.

           Winters’ workers’ comp coverage had been revoked eight months earlier for failing to pay premiums. However, charging papers allege, he continued to employ the worker full time until the injury. Winters told an L&I investigator he started the business in 1990, and at one time had up to six employees. He said business slowed and his main employee was the worker who became injured, and occasionally the worker’s brother.

           As of Jan. 7, 2014, the employee’s claim has cost L&I more than $67,000 in medical expenses and lost wage payments, charging papers said.

           Businesses that don’t pay workers’ comp insurance gain an unfair advantage over companies that pay their fair share. A 2007 study found that an estimated 55,000 employers skipped out on paying $34.5 million in workers’ comp insurance in Washington state in 2006, causing legitimate employers to pay higher premiums.

         Washington state is one of the few states in the nation where employers and workers both pay a share of the workers’ compensation premiums.  The press release from the Department of Labor and Industries did not indicate whether this worker’s payroll deductions had continued even when his workers’ compensation coverage had lapsed.  If this was the case, this employer’s fraud would represent wage theft, as well.

         

DLI

Removing Age Threshold in Stuctured Settlements

So many options…

     The Washington State Senate adopted changes to the legislation governing structured settlements in workers’ compensation claims to remove the gradual implementation of the system via age-bands.  When initially implemented, CRSSAs (compromise and release structured settlement agreements) were available to injured workers aged 55 and over, with provisions for that age to slowly drop over a span of several years, down to age 50.  The Second Engrossed Substitute Senate Bill 5127, summarized here and adopted on January 29, 2014, would remove the age requirement, allowing any injured worker over the age of 18 to access CRSSAs as an alternative to receiving benefits typically available in a standard claim. This legislation should be watched as it makes it’s way through the system.

     The Washington Association for Justice and many claimant representatives are strongly opposed to this change.  Concerns include the inclination for an injured worker to grasp at a structured settlement in a time of dire financial need when, in the long-run, the benefits available in a claim would provide a fuller recovery – financially, physically and vocationally.  CRSSAs are seen to benefit the business community to a greater degree by decreasing claim costs.  The trend can also disproportionately impact workers of various income groups.  Those injured workers with strong financial standing – a working spouse, savings in the bank, alternate income such as a disability pension through a union or investment income – can more easily enter into a CRSSA, gaining easy approval by the Board of Industrial Insurance Appeals.  Such approvals are not readily available for injured workers in lower income brackets, with no alternate income or savings, and particularly those with heavy debt to income ratios.  They may lose more in the way of benefits if a CRSSA is approved, as they likely do not have equal access to healthcare (even if insured, co-pays can eat up meager savings) and are more likely to return to low-wage jobs after an injury, making it harder to recover financially after an injury.  Many injured workers who feel they need an influx of cash to avoid total financial devastation – those that were just getting by on their wages and whose debt begins to snowball quickly after an injury – may face disappointment when they attempt to settle via a CRSSA, only to be told by the Board that it is not in their best interest.  Can’t win for losing.

     My concern is not so focused on the age of the worker who wishes to seek a CRSSA, but the plight of those injured workers who do not have the benefit of legal counsel when making this decision.  I can envision a worker of younger years benefiting from the freedom to chose their future path with the assistance of a CRSSA, but I worry that, without full knowledge of what could be available under the claim if it were allowed to play out, unrepresented workers of all ages may make major decisions with short-sighted gains in mind, only to regret those decisions down the line. 

     I would encourage readers to review this legislation and participate in the process by contacting your representatives in Olympia to share your thoughts and concerns.

Photo credit: andybvrs / Foter / CC BY-NC-SA

DLI

Return To Work is a Program; Return To Function is a Philosophy

Title: “Expression of pain” – Chris JL

Today’s post comes from workerscompensation.com, one of the blogs that I follow.  I am taking Bob’s advice and sharing his article with our network.  His concepts are spot-on.

I wish I had thought of the two concepts reflected in the title of this article. Alas, I did not. I did, however, once again take two dynamite ideas, combine them into one cohesive concept, thereby saving the universe while still managing to create an enticing, killer headline in the process.

I swear, sometimes it’s exhausting being me.

I now serve on the Disability Management & Return to Work Committee of the International Association of Industrial Accident Boards and Commissions (IAIABC). We met Tuesday during the associations 99th Annual Convention in San Diego, CA. Committee Chair Peter Federko tasked the group with defining a working strategy that would encourage and promote successful disability management and return to work programs for both the industry and injured workers. This prompted what I can best describe as a passionate discussion among the members, each with their own take and view on where barriers exist, and what segments should be targeted in any RTW effort. 

Federko, who by day is CEO of the Saskatchewan Workers’ Compensation Board, did a masterful job of keeping the conversation focused as we rambled about with our various opinions. Personally I believe that there are many “moving parts” within workers’ compensation that all must be aligned and engaged to effectively deploy any respectable RTW program. It requires a team effort from all players. Unfortunately, our current trend in claims management is taking us towards a dehumanization of the process, and this is not conducive for the development of such initiatives. 

Two members of this group gave what I believe to be stunning insight, and not just because they dovetail nicely with my beliefs (ok, mostly because they dovetail nicely with my beliefs). Joachim (pronounced Yoke-em) Breuer, with the German workers’ comp system and Chair of the ISSA Technical Commission on Accident Insurance, provided tremendous insight when he stated that Return to Work was not a program, but rather a philosophy; a philosophy that needed to be ingrained throughout the workers’ compensation system. He was followed in short order by Ken Eichler, Director of Government & Insurance Services, Guidelines Division, for Reed Group. Eichler, who is also Committee Vice Chair, talked of suspicion and resistance on the side of the injured worker. He suggested that, to allay fears that RTW was merely a cleverly disguised cost control scheme, the committee instead develop criteria for a “Return to Function” program. He correctly pointed out that “function” is at the core of all life necessities, and that if we can focus on improving that for injured workers, return to work would be a natural extension of any successful effort. 

Brilliant observations from both of them. Federko immediately instructed each to take an extra thousand out of petty cash for their input (not really – I made that up. Ever the cost control maven, Federko wouldn’t even open the committee liquor cabinet). Still, this theory was not quite complete. We haven’t quite finished mixing all ingredients for our RTW stew. We still have one more to add.

As you may notice, both suggestions by Eichler and Breuer fit quite nicely with my (as yet unsuccessful) effort to reposition and rebrand the workers’ compensation industry into the Workers’ Recovery industry. We will therefore include that as a third element in the recipe. This concoction produces the following final scrumptious result:

Successful Return to Function must be driven as an overriding philosophy ingrained throughout the Workers’ Recovery system.

There. Not too shabby if I do say so myself. 

The philosophy maintains that we must return as many people as possible to functional capacity for as normal a life as possible. Severely injured workers almost without exception wish to have some normalcy in their life. They have children or grandchildren they hope to hold. They want to dress, walk or go to the bathroom without assistance. They want to be able to do their own shopping, and they literally would like to be able to take a moment, bend over, and smell the roses. An entire system that embraces that knowledge, from employers, TPA’s, brokers, carriers, doctors, regulators and the workers themselves, can improve both outcomes and individual lives. With that return to function we offer a return to normalcy, a return to life, and indeed, a return to work. 

I cannot speak for the committee nor do I even wish to reveal the path we ultimately chose. Suffice it to say we’re on the right track, and have an amazing amount of work ahead of us. But it will be worth it, as it needs to happen. The current trends are not sustainable. Disability rates are on a dramatic rise, being completely dependent on others is becoming socially normalized, and as workers we are getting older by the day. Our knees are wearing out. Our backs are starting to fail. Many of us have no appreciable skills beyond our current jobs. It is a recipe for disaster if we don’t act, and act quickly.

Restoring life and viability by returning to function via the process of workers’ recovery must be the wave of the future. The choice is simple. Embrace the philosophy today or pay for the reality tomorrow. 

What choice will we make?

Photo credit: Chris JL / Foter.com / CC BY-NC-ND

DLI

Student Safety and Health Video Wins First Place

School presentations have been made throughout the state.
School presentations have been made throughout the state.

Erik Soper, from Shelton, a student at the New Market Skills Center in Tumwater, took first place in a student safety and health video contest sponsored by the Department of Labor & Industries (L&I). Soper’s 60-second video, “The Teen Worker’s Survival Guide,” used computer generated graphics to highlight the hazards, responsibilities, and rights that teen workers have in the workplace. The first-place winner received a $500 gift card.

A second-place $300 gift card was awarded to Megan Bowlen, from Olympia, also from the New Market Skills Center, for her “Twitter Safety” video.  Her entry used social media in both humorous and serious ways to bring attention to workplace safety for young workers.

The video contest is part of L&I’s Injured Young Worker Speakers Program, a young worker safety campaign that reached over 3,000 students and young workers across Washington State this spring with important messages about workplace safety.

The video contest was one element of L&I’s program to raise workplace-safety awareness among young people by using a “peer-to-peer” approach in which young workers who have been seriously injured on the job talk to students and other young workers about their life-changing experiences.  Survey results have indicated that 70 percent of the students said their awareness of workplace safety significantly increased after listening to the presentations.

DLI

Klickitat County Lumber Company Fined

William Arthur Cooper: Lumber Industry, 1934

     The Washington State Department of Labor and Industries announced that a Klickitat County lumber company was fined nearly a quarter of a million dollars after worker gets caught in machinery.

     The SDS Lumber Company of Bingen, Wash., has been fined $244,600 for 69 workplace safety and health violations after a worker was seriously injured in March. The Department of Labor & Industries (L&I) cited the employer for one willful, 54 serious and 14 general violations of safety and health rules. A willful violation is cited when L&I alleges that the violation was committed with intentional disregard, plain indifference, or when employers substitute their own judgment for safety and health regulations.

     L&I determined that a lack of training and proper safety procedures left the lumber mill worker with severe injuries when his arms became entangled in machinery while trying to clear a jam. L&I began an investigation on March 9m 2013 after being notified that the worker had been hospitalized. By law, all employers are required to report to L&I within eight hours anytime a worker is hospitalized or dies due to work-related causes.

     “This incident shows the importance of Washington’s hospitalization reporting rule,” said Anne Soiza, assistant director for L&I’s Division of Occupational Safety and Health. “In most other states, a hospitalization involving only one worker does not have to be reported and the serious hazards could continue unabated. In our state, we are able to send inspectors right away to ensure the safety of the other workers.”

     The investigation found that managers and supervisors were aware that workers routinely bypassed machinery safety guards to try and clear jams while the machinery was still in motion.

     Consequently, the company was cited the maximum penalty allowed by law, $70,000, for a willful violation. Additionally, because the willful violation was associated with a worker’s serious injuries, the company will now be part of the Severe Violator Enforcement Program, an OSHA program that monitors severe safety violators.

     The injury incident prompted comprehensive safety and health inspections of the entire plant. In addition to the machinery violations, the department found serious hazards related to chemicals, hazardous and flammable substances, bloodborne pathogens, confined work spaces, electrical and fall protection. Many of the violations were corrected during the inspections. 

     The company has appealed the citations. 

 

Photo credit: americanartmuseum / Foter / CC BY-NC-ND

 

DLI

L&I Proposes 2.7 Percent Average Rise in Workers’ Comp Rates in 2014

Aside

Joel Sacks, Director

This will be L&I’s first rate increase in three years.

The Department of Labor & Industries (L&I) has proposed an average 2.7 percent rate increase for 2014 workers’ compensation premiums, an increase of less than 2 cents per hour worked. Over the past two years, workers’ compensation surveys have shown an increase in rates nationally. This will be L&I’s first rate increase in three years.

Cutting Workers’ Compensation Costs

“This proposal is part of a long-term plan to ensure steady and predictable rates, help injured workers heal and return to work, and reduce costs by improving operations,” said L&I Director Joel Sacks. “My goal is to reduce costs by an additional $35-70 million in 2014.” 

Work underway to cut costs includes:

  • Helping injured workers return to work as soon as they are medically able.
  • Improving L&I’s workers’ compensation claims processes.
  • Improving workplace safety.
  • Improving medical care and reducing long-term disability.
  • Making it easy to do business with L&I.

 

Keeping Rates Steady

“I want wage inflation to be our benchmark for steady and predictable rates,” said Sacks. “Wage inflation is a good benchmark because workers’ comp costs increase as wages increase.”  Washington’s most recent wage inflation number is 3.4 percent. However, because Washington’s rates are based on hours worked and not payroll like other states, Washington needs to raise rates to get the revenue that other states get automatically.

“We must also continue to restore the state’s workers’ comp reserves that were used to hold down rates during the Great Recession,” Sacks added.  The department’s Workers’ Compensation Advisory Committee, made up of business and labor representatives, agreed to a plan to restore reserves over the next several years.

Public hearings on the proposed rates will be held in: 

  • Tukwila, Oct. 22, 10 a.m., Tukwila Community Center
  • Bellingham, Oct. 23, 10 a.m., Central Library Lecture Room.
  • Spokane Valley, Oct. 24, 10 a.m., CenterPlace Event Center.
  • Richland, Oct. 25, 9 a.m., Community Center Activity Room.
  • Tumwater, Oct. 28, 10 a.m., L&I Auditorium.
  • Vancouver, Oct. 29, 10 a.m., Northwest Regional Training Center Rainier Auditorium.

Comments about the proposed rates can be made at the public hearings or in writing to Doug Stewart, Employer Services Program Manager, P. O. Box 44140, Olympia, WA 98504-4140, or email to Doug.Stewart@Lni.wa.gov.  More information regarding the rates proposal is available at www.Rates.Lni.wa.gov  Final rates will be adopted in early December and go into effect Jan. 1, 2014. 

Workers’ Comp Facts:

  • The proposed rate is an average. An individual employer’s actual rate change may be more or less depending on that employer’s industry and history of claims that result in wage replacement and/or disability benefits.
  • About 100,000 claims are filed each year through the Washington State Workers Compensation State Fund. 
  • Factsheet: L&I initiatives to improve outcomes and reduce costs

 

 

DLI

The High Price of Gas – Mileage Reimbursement for Injured Workers

Aside

     Injured workers who are are dependent on time loss compensation payments of only 60-75% of their wages unfortunately are well used to the enormous financial losses and constraints this wage loss puts on their family budgets.  With budget cuts being made by the Department of Labor & Industries which place additional burdens on workers by reducing reimbursements for the additional costs incurred as a result of an injury, it is important to be aware of what you can be reimbursed for, and what some relatively new regulations do not cover.  The current mileage reimbursement rate is now 56.5 cents per mile.

When money is tight, making sure you receive everything you are entitled to under your claim is important!

     Injured workers are always entitled to receive travel and/or wage reimbursement if they are asked to attend an IME (Independent Medical Exam).  However, we have noted that more recently both the Department and self-insured employers are failing to provide workers with the form necessary to be reimbursed gas mileage for what are often not insignificant distances.   Many workers are unaware they can have their wages reimbursed as well if they miss time from work.  The form can be found online here.  When self-insured employers do not provide our clients with a reimbursement form when sending out IME notices, we will send out the Department’s standard form.

     More difficult to decipher are the rules allowing for travel reimbursement for medical treatment or vocational services.  A different form must be filed to obtain reimbursement for these expenses.  At Causey Law Firm, we insure that our clients are reimbursed for travel for vocational meetings which take place in our office.  Parking is expensive in Seattle, and that cost can be reimbursed to you directly.  Some law firms charge a fee on travel reimbursement expenses, but we do not.

     While injured workers have the right to treat with their own preferred provider, travel reimbursement is only paid for regular treatment visits if there is no adequate treatment provider within 15 miles of their home AND if the claims manager has pre-authorized the travel.  Travel reimbursement is now limited for regular medical treatment visits by the so-called “15 mile rule”.  Thus, if your pre-authorized provider is 30 miles from your home, reimbursement will only be provided for the last 15 miles each way of that trip.  As with medical appointments, regular visits to meet with a vocational counselor are only covered after that 15 mile threshold has been reached.  If you are approved for a formal vocational retraining plan, however, mileage may be fully reimbursable through your plan with necessary signatures and paperwork submitted through a vocational rehabilitation counselor.

      Many workers are unaware of their right to apply for reimbursements, which can be submitted to the Department for a period up to one year of the date of travel.  The Department’s general guidelines can be seen here.  When money is tight, making sure you receive everything you are entitled to under your claim is important!

 Photo credit: Eric Fischer / Foter / CC BY

DLI

Spokane Restaurant Owner Charged with Theft of Nearly $250,000 in Workers’ Comp Payments

Aside

     The Washington State Department of Labor and Industries issued the following news bulletin with details of a recent fraud investigation:

A Spokane restaurant owner faces a felony theft charge alleging she defrauded the state of nearly $250,000 in workers’ compensation benefits over eight years while claiming she could not work.  In reality, a Department of Labor & Industries investigation found Wanitta Racicot, 69, was cooking, busing tables and performing other duties at a restaurant that she co-owns.

The Attorney General’s Office recently charged Racicot, of Spokane Valley, with one count of first-degree theft in Spokane County Superior Court. Racicot is scheduled to enter her plea to the charge on Sept. 4. According to court documents, Racicot filed for workers’ compensation with L&I in 2001, claiming she injured both of her arms while working at a restaurant. After opening her claim, she regularly signed official documents stating she was not employed and was unable to work due to her injury.

In August 2011, L&I launched an investigation after Racicot’s case raised red flags to a department employee, who was examining whether Racicot should be referred for a pension. During the investigation, Racicot told an investigator that her hands remained so damaged that she could not button shirts or put on earrings, court documents said. The same month, an investigator witnessed Racicot carrying groceries, busing heavy dishes, scrubbing the bar counter and doing other tasks at her Spokane business, Broadway Bar and Grill, on multiple days. In addition, Racicot’s current and former employees and business associates told the investigator that she had been working at the restaurant for more than five years, and one employee said she had been doing so since at least 2001.

The charge alleges Racicot fraudulently received $249,267 in time-loss benefits for replacement of lost wages from March 2003 until August 2011. First-degree theft carries a maximum penalty of 10 years in prison plus a $20,000 fine and costs.

     In addition to the criminal penalty and fines, I expect that an overpayment order with fraud penalties was also issued under the workers’ compensation claim, although this was not mentioned in the bulletin.  The Department is able to issue an order claiming an overpayment of the benefits paid incorrectly PLUS a penalty of up to 50% of the overpaid amount.  The criteria for meeting the legal burden of proof in a fraud case is pretty tough, for good reason, but when fraud is proven the penalties can be quite severe.

     The description of this case sounds like the Department has a solid case against the claimant.  However, not all fraud cases are as clear-cut.  If you find yourself facing an overpayment order, with or without allegations of fraud, contact an attorney for possible assistance with the fight to come.

 

Photo credit: Flavia_FF / Foter / CC BY-NC-ND

DLI

Spokane Restaurant Owner Charged with Theft of Nearly $250,000 in Workers’ Comp Payments

Aside

     The Washington State Department of Labor and Industries issued the following news bulletin with details of a recent fraud investigation:

A Spokane restaurant owner faces a felony theft charge alleging she defrauded the state of nearly $250,000 in workers’ compensation benefits over eight years while claiming she could not work.  In reality, a Department of Labor & Industries investigation found Wanitta Racicot, 69, was cooking, busing tables and performing other duties at a restaurant that she co-owns.

The Attorney General’s Office recently charged Racicot, of Spokane Valley, with one count of first-degree theft in Spokane County Superior Court. Racicot is scheduled to enter her plea to the charge on Sept. 4. According to court documents, Racicot filed for workers’ compensation with L&I in 2001, claiming she injured both of her arms while working at a restaurant. After opening her claim, she regularly signed official documents stating she was not employed and was unable to work due to her injury.

In August 2011, L&I launched an investigation after Racicot’s case raised red flags to a department employee, who was examining whether Racicot should be referred for a pension. During the investigation, Racicot told an investigator that her hands remained so damaged that she could not button shirts or put on earrings, court documents said. The same month, an investigator witnessed Racicot carrying groceries, busing heavy dishes, scrubbing the bar counter and doing other tasks at her Spokane business, Broadway Bar and Grill, on multiple days. In addition, Racicot’s current and former employees and business associates told the investigator that she had been working at the restaurant for more than five years, and one employee said she had been doing so since at least 2001.

The charge alleges Racicot fraudulently received $249,267 in time-loss benefits for replacement of lost wages from March 2003 until August 2011. First-degree theft carries a maximum penalty of 10 years in prison plus a $20,000 fine and costs.

     In addition to the criminal penalty and fines, I expect that an overpayment order with fraud penalties was also issued under the workers’ compensation claim, although this was not mentioned in the bulletin.  The Department is able to issue an order claiming an overpayment of the benefits paid incorrectly PLUS a penalty of up to 50% of the overpaid amount.  The criteria for meeting the legal burden of proof in a fraud case is pretty tough, for good reason, but when fraud is proven the penalties can be quite severe.

     The description of this case sounds like the Department has a solid case against the claimant.  However, not all fraud cases are as clear-cut.  If you find yourself facing an overpayment order, with or without allegations of fraud, contact an attorney for possible assistance with the fight to come.

 

Photo credit: Flavia_FF / Foter / CC BY-NC-ND