Self-Insured Claims in Washington State: How to Get Your Claim File and Updates?

If you have an?L&I Claim , you can easily find the status of your claim. You can just log onto?Claims and Account Center ?(CAC). It’s available on the?L&I website . There, you can find everything about your claim. From reports, to orders, claim file notes, and more. However, if you have a?self-insured claim , then things are not that simple. In fact, it can be very difficult to find the status of your claim.

Self-insured Employer Claims

Self-insured workers’ compensation claims are generally not available on CAC. Therefore, work injury claimants don’t have on-demand access to claim files. Consequently, it makes it very difficult to keep track of self-insured claims. Yet, there are ways to track the developments in these claims. More specifically, you can request your claim file and updates.

Self-insured employer claim file

First, you must request (in writing) a copy of your claim file. Then, under?RCW 51.32.195 ?and?WAC 296-15-420 ,?self-insured employers ?have 15 working days to provide a complete copy of the claim file. Interestingly, either you or your representative can make the request.

Generally, the employer maintains the worker’s claim file. Sometimes, it can be the claim administrator. Either way, the claim file should include:

1) Information that L&I received or prepared for the claim;

2) All the info that the employer produced or received;

3) All data and information from the?third-party claim administrator ?(TPA).

What information is in my worker’s comp claim file?

When you ask for the claim file, you can specify the information you need. Alternatively, you can submit a non-specific request. With non-specific requests, the employer must include the following:

(1) Information to evaluate the claim. For example, evaluating for?claim allowance ?or to provide?claim related benefits . The information may include forms and?incident reports . It can also include worker statements, witness interviews, and so on.

(2)?Medical records ?and reports. This includes: (a) all records related to?independent medical examinations ?(IMEs) or consultations; (b) nurse case management notes and reports; (c) the records from the employer’s on-site medical facility; and (d) all records and reports from?treating and consulting providers .

(3)?Vocational ?and?return to work ?activities. These activities may include vocational provider reports,?vocational plans , and more.

(4) Records of all activities completed on the claim.

(5) Records of claim communications. Specifically, records contain electronic, phone notes, logs, or other media.

(6) Incoming and outgoing claim correspondence.

(7)?Orders and decisions ?issued in the claim.

(8) Employer payroll records and worker earnings. Furthermore, any other documents used to?determine wages ?under?RCW 51.08.178 .

(9) Records of payments. In detail, this includes?time-loss compensation ?payments and?loss of earning power ?benefit. On top, it includes?kept-on-salary ?payments. Furthermore, it’ll have you’re?PPD rating ?and?permanent partial disability ?calculations and payments, as applicable.

(10) Bills on the claim and actions regarding each bill: Whether a bill was paid, denied, adjusted, and when. Note, however, that the self-insured employer doesn’t have to provide bills information. For bills, you have to specifically request them.

Complete work injury claim file vs claim file updates

Self-insured employers provide a first complete copy of the claim file for free. Then, after the initial copy, the self-insured employer may charge a fee for additional?complete?files. Therefore, it’s always good to request an initial complete file. After that, I recommend requesting claim file updates only. The updates contain new documents since the last request. You can request them on a regular interval. Usually, workers ask for claim file updates every 30 days.

Attorney-client materials in a workers’ compensation claim file

Often, self-insured employers and claim administrators work closely with their legal representatives. In turn, employers may decline to provide some claim file material. That’s because it may contain attorney-client privileged material. In addition, it may include attorney work product. It is a valid basis for withholding certain materials. However, it’s not a reason to withhold all information. Therefore, if a self-insured employer is working with attorneys, you may want to retain your own legal representative.

Conclusions

To summarize, it’s very important to know what’s happening in your workers’ compensation claim. Yet, self-insured claims can be difficult to follow. But it doesn’t mean it’s impossible. Work injury claimants can regularly request copies of claim file materials. Finally, when you write a request to receive your claim file, the self-insured employer must provide all claim materials within 15 days. That is, 15 days from receiving your request.

This article was first published on: https://tarareck.com/claim-file-update/

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Ms. Tara Reck is the managing L&I attorney at Reck Law — Workers’ Compensation Attorneys in Washington State. If you would like more information, please contact Ms. Reck through the following:

* Seattle | Bellevue | Mercer Island office: (206) 395–6141

* Tacoma office: (253) 999–9828

* Renton office: (425) 800–8195

* Port Orchard office: (360) 876–4123

* Email:?[email protected]

* Her Workers’ Compensation blog at https://tarareck.com/contact/ ?or her company website at https://recklaw.com/contact/