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. 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 knowing that L&I is not looking. If you should get a bad decision do something. If you don’t complain, protest or appeal, then they get away with their unfair claims management.
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:
• Call them at 360-902-6901. Encourage them to do their job and help you with your claim.
Some employers are self-insured and manage their own workers compensation claims.
They choose to self insure because they wish to save money. Some self insurers will try to save money by not paying it to you. Don’t let them do this to you. Stand up for your rights and insist the self insurer treat you fairly. If they will not treat you fairly than request a penalty.
Penalties and the amount of the penalty for refusing to pay or delaying benefits are authorized by RCW 51.48.017. This law assesses a penalty of the greater of $500 or 25% of the amount due. Payment is to the injured worker.
These self-insured employers are required to pay workers compensation benefits on time. If the self insured employer delays benefits they can be penalized.
The department of Labor and Industries will consider assessing a penalty for unreasonable delay of benefits under the guidelines of WAC 296-15-266.
Delayed benefits subject to penalty include time loss, loss of earning power, coverage of medical conditions, payment of medical bills, authorization of emergency medical care and permanent partial disability.
It is Difficult to Get L&I to Order a Penalty.
Unfortunately in their administrative regulations, L&I allows the Self Insured employers to get away with delayed payment if there is any legal or medical doubt that payment is due. Said another way, if the self insured gets a bogus IME it is difficult to get a penalty. This isn’t right. The opinion of the attending doctor should prevail. See: Clark County v McManus
Some penalties are payable to the injured worker, others to L&I.
A penalty request is made by sending a written request to Labor and Industries. The director of L&I is required to issue an order within 30 days of your request. Some penalties are payable to the injured worker and some are payable to L&I.
Frequently asked questions about self insured penalties and more insight about how a court, the Board of Industrial Insurance Appeals, looks at penalties see : Penalties (RCW 51.48.17)
Injured workers of Self Insured employers can seek help from the Office of the Ombudsman at anytime during their claim. The Ombudsman can provide injured workers with many resources to address claims discrimination, claims suppression, unnecessary IME’s, delayed time loss payments and denied medical treatment.
Getting the Self Insured employer and their third party administrators to do the right thing is not easy. The Ombudsman’s knows this and is there to help you. It is their job to get involved and to make Self Insured Employers do the right thing.
The Office of the Ombudsman needs to hear from you if you have problems when dealing with these large self insured employers. They need you to report problems with the claims management companies hired by the employer so they can work directly with the employer and their third party claims administrators to resolve the issues delaying proper payment of benefits.
Sometimes a knowledgeable advocate is all you need to push the Self Insured Employer to do the right thing and authorize your benefits. Through the ombudsman, self-insured workers have access to knowledgeable and effective advocates who are able to work in partnership with self-insured personnel. The Ombudsman’s office is there to help you, the worker, receive appropriate benefits under the law.
The Ombudsman can be reached here, Office of the Ombudsman, or by calling 888-317-0493
Telephone – Call for information or a free strategy session – 206-343-1988