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Commonly Seen Errors In Department Audits And How To Fix Them.

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Presentation on theme: "Commonly Seen Errors In Department Audits And How To Fix Them."— Presentation transcript:

1 Commonly Seen Errors In Department Audits And How To Fix Them.


3 Rights & Obligations  WAC 296-15-400  Within 30 days of Hire  Substantially Similar/WAC 296-15-001  Problems Found in Audits  Not using form  Modifying form  Not providing form to all new employees

4  Recommendations –Form available on L & I website – Add to orientation checklist

5  When Worker Files A Claim –Provide Department booklet –Names, address, phone number of person or organization handling claim Problems Found in Audits –Not providing booklet –Timely providing

6  Recommendations –Booklet available on Department website or can be ordered from Department –Provide with SIF-2

7 Claim Filing Procedure Errors  WAC 296-15-320  Problems Found in Audits –Providing Self-Insurer Accident Report (SIF-2) when notified of injury or illness –Timely delivery of completed (SIF-2s) to claim management entity –Only Department provided SIF-2s may be used

8 Notice of self-insurance RCW 51.14.100(1) Problems Found in Audits  Substantially identical form  Listing person or position on site  State Fund Notices  Reasonable number of notices

9  Recommendations –Form available on Department website

10 Claims Log  WAC 296-15-200  Designate location of official log in writing  Problems Found in Audits Date claim closed by Order and Notice Whether claim is time loss or medical only Unreported claims

11 Onsite Medical Treatment  Medical facilities and employers who treat their workers at their onsite medical facility  Treatment by physician, nurse practitioner, physician assistant, or registered nurse under doctors standing orders  Provide injured worker with opportunity to file claim form (SIF-2)  Documentation of refusal and notification of one-year filing statute.

12  Treatment log for medical only claims with treatment exclusively at employer’s medical facility.

13 Date stamping incoming correspondence  WAC 296-15-350(8)  Legibly date stamp with date received and where received  Includes doctor notes, activity prescription forms, state fund accident reports, physicians initial reports, and other reports received by employer or claims management entity  Punch dates are not legible

14 Failure to request allowance or denial within 60 days from date claim filed  RCW 51.14.130 and WAC 296-15-420  Check for allowance orders  Does not apply to medical only claims unless requesting denial or interlocutory order  Penalty per RCW 51.14.140 and RCW 51.48.080

15 Payment of first time loss within 14 days  RCW 51.32.190(3)  Payment within 14 days after notice of a claim  Notice of claim or claim arrival date –Injured worker makes application for benefits –Claim elements-description of injury, diagnosis of medical condition, treatment or treatment recommendation –Hospitals and employers with onsite medical facility

16  Recommendations –Review process of filing claims –Communication, communication, communication –Training employees

17 Benefits Not Paid as Entitled  RCW 51.32.010  Communication, communication, communication  Learn the employer’s payroll system  WAGES/ RCW 51.08.178 –Obtain & review daily payroll records to determine employment pattern –Averaging hours Use full weeks and full months

18  Multiple rates of pay –Substantial number of hours at different rates of pay, treat each as separate rate of pay –Rates of pay at time of injury –Change of circumstances Raises Change of jobs Change of shifts

19  Health Care Benefits (medical, dental, vision)  Bonuses  Loss of Earning Power Benefits –Communication, communication, communication –Determine if eligible any time return to work light or modified duty –Eight hours versus average daily hours –Updated date of injury wages –Bonuses

20  C.O.L.A. – July 1

21 Return to Modified or Light Duty Work  RCW 51.32.090(4)  Communication, communication, communication  Provide worker with copy of light duty job description when contacting physician for release to light duty  Document light duty offer and injured worker’s decision  Determine if LEP due

22 SIF-5 Information  WAC 296-15-420 and WAC 296-15-450  Required for Department to monitor claim and make determinations  Should report what has taken place at time of completion

23  Most common SIF-5 errors –Date of first payment –Release for work date –Return to work date Final report includes all dates- light duty, full duty

24 Employer Closures  RCW 51.32.055 (9) (a)  Jurisdictional errors –Did not return to work with employer of record –Null and Void Orders WAC 296-15-450(6) –Untimely filing of EC Order and Final SIF-5

25 Medical Only Claims  Communication, communication, communication  May become compensable claim  Determine if LEP due for return to work light duty  Verify return to work full duty

26 Worker Hours Salaried Employees  WAC 296-17-31021(2) –Report all salaried employees by same method –Actual hours worked or assumed 160 hours per month –Complete and accurate time records of all hours worked, whether paid or not

27  Personal Services Labor Contracts  RCW 51.08.180 and RCW 51.08.195  Independent contractor providing essentially personal labor for employer is a worker  Must meet ALL six parts of test described in RCW 51.08.195 to be exempt

28 Department Web Site  RCWs, WACs, Forms, Publications, Self- Insurance information   At web site, click on Business Links, then Self-Insurance



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