L&I claim administrative management come in two varieties. State Fund and Self Insured. State fund claims are managed by L&I. Self Insured claims are managed by the self insurer, with oversight by the L&I Self Insurance Section. In theory both types of claims should be handled the same. However it doesn’t work that way.
Employers with sufficient assets can self insure their L&I claims. These self insured employers manage their L&I claims in house or with the help of a service company such as, Sedgwick, Gallagher Bassett, Pinnacle Risk Management, Eberle Vivian, Penser North America or Matrix. Employers self insure to save money. One way they save money is by not paying it to injured workers. If you have a self insured claim and a serious injury, you are already at a disadvantage.
It is the job of L&I’s self insured section to oversee self insurers and make sure that they are following the law. However L&I is too busy to look at every self-insured decision. As a result self insured employers often do bad things and if you don’t complain with a protest or appeal, then they get away with their unfair claims management. Here is a guide to Workers’ Compensation Benefits For Employees of Self-Insured Businesses.
Don’t put up with bad treatment from your claims manager.
If you don’t like how your self insured employer is handling your claim, you need to take action. Become involved, get vocal, do something! Don’t let your self insured employer push you around. Here is what you can do:
• Talk to your self insured claims manager. Ask for an explanation of what they are doing. Tell them what you think. If they are wrong then tell them so and ask for what you want
• Communicate with the L&I Self Insured Section about your self insured employers behavior. You also have a claims manager at L&I, in the self insured section. It is the job of the L&I self insurance section to help you if you are being unfairly treated by your employer and their claims manager.
• Call them at 360-902-6901. Encourage them to do their job and help you with your claim.
•Penalty for delayed benefits If the Self Insured Employer unreasonably delays payment of benefits then you can write to L&I and request a penalty. Self Insured employers are subject to a penalty, RCW 51.48.017. Make them pay you for unreasonable delay of your benefits. Get legal help with this if you need it.
•Contact the Ombudsman. The office of the ombudsman is there to help you with unreasonable actions by Self Insured employers.
– Call 888-317-0493
– If your self insured employer is completely despicable and has repeatedly denied your access to the benefits you deserve then you can also ask for an audit of their compliance with self insured employer requirements.