Last week L&I published self-insured rule changes that will take effect July 1, 2019 and will affect injured workers and workers’ compensation claims in Washington State. One of the most important changes relates to closing self-insured workers compensation claims. According to L&I, self-insurers are “empowered to close claims” consistent with RCW 51.32.055 and under WAC 296-15-450.
Workers’ compensation claim closure in Washington State
So what does this change mean? When a claim closes, the injured worker no longer has access to benefits. In other words, all existing benefits under a claim come to an end. Therefore, claim closure is a very important issue for my clients. While the L&I bulletin states that self-insurers are empowered to close claims, they don’t have absolute power to close claims. Under WAC 296-15-450, it is important to note that L&I always has the authority to close self-insured claims. However, self-insurers only have authority to close some claims.
Self-insurers may only close claims that fit within the following parameters:
1) Medical only claims;
2) Time-loss claims without any disputes resolved by L&I, and only if the injured worker returns to work with the employer of injury at the job of injury or another job with comparable wages and benefits; or
3) Medical only, time-loss and permanent partial disability claims filed after August 1, 1997 where:
(i) no disputes have been resolved by L&I;
(ii) the injured worker returned to work with the employer of injury at the job of injury or another job with comparable wages and benefits; and
(iii) the closing medical report was sent to the attending or treating provider with fourteen days allowed for the provider to respond.
Restrictions and requirements
Even if a self-insurer closes an injured workers’ claim, they must meet certain requirements regarding the closing medical report. On top, they must satisfy rules relating to the notice they provide to the injured worker and the attending provider, and the information submitted to L&I regarding the closure. In addition, the Department has two years to find mistakes made by the self-insurer. If L&I discovers errors in benefits or violation of claim closure conditions, L&I can require self-insurers to pay additional benefits on the claim.
In summary, effective July 1, 2019, L&I is empowering self-insurers to close claims. However, self-insurers’ authority to close claims is not absolute. Only certain kinds of claims can be closed by a self-insurer. Moreover, specific closure requirements must be met. If issues are found, L&I can require self-insurers to pay additional benefits up to two years following claim closure.