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Death and Disability Ombudsman WSCFF Educational Seminar April 21-23, 2015.

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Presentation on theme: "Death and Disability Ombudsman WSCFF Educational Seminar April 21-23, 2015."— Presentation transcript:

1 Death and Disability Ombudsman WSCFF Educational Seminar April 21-23, 2015

2 What is an Ombudsman? Consultant Resource Center Advocate Educator 2WSCFF Educational Seminar | April 21-23, 2015

3 Who can call the Ombudsman? Members Family Union Reps Employers 3WSCFF Educational Seminar | April 21-23, 2015

4 What questions should I ask? Individual help on all types of disabilities and survivor benefits LEOFF LNI Social Security Other 4WSCFF Educational Seminar | April 21-23, 2015

5 What happens next? The Ombudsman will listen, ask questions and provide: Answers to your questions Collaboration between agencies Resources as needed 5WSCFF Educational Seminar | April 21-23, 2015

6 Frequently Asked Questions I got hurt on the job and this is what I’ve done so far…am I following the right process? I don’t think the doctor is going to let me go back to work, what now? What happens for my family if I die? Can you explain the procedure for applying for catastrophic disability? 6WSCFF Educational Seminar | April 21-23, 2015

7 Questions? Contact Us Tammy Harman Death & Disability Ombudsman (360) 586-2324 tammy.harman@leoff.wa.gov 7WSCFF Educational Seminar | April 21-23, 2015

8 Ombuds for Self-Insured Injured Workers  Purpose and Duties –Advocate for injured workers of self-insured employers –Provide info on industrial insurance rules and regulations –Identify, investigate and resolve complaints between multiple parties (Injured worker, Labor, Attorney, Employer, TPAs, Providers) –Maintain separate confidential records and toll-free # –Identify policy and practice process improvements –Annual Report to the Governor

9 Ombuds Self-Insured FAQs  Benefit Delays –Time loss –Medical treatment (surgery, MRIs, chiropractic)  Independent Medical Exams  Claim Suppression  Firefighter Presumption (RCW 51.32.185) –Presumes certain conditions are a covered occupational disease –Does not include EMTs and Volunteer Firefighters

10 Firefighter Presumption  Covered conditions, but not limited to: –Respiratory –Heart Problems Experienced within 72 hours of exposure to smoke, fumes, toxic substances Within 24 hours of strenuous physical exertion due to firefighting –Certain infectious diseases Hepatitis HIV/AIDS Meningococcal Meningitis Mycobacterium Tuberculosis

11 Firefighter Presumption  Covered conditions, but not limited to: –Cancers due to chemical exposure, asbestos, and firefighting Primary Brain Kidney, Ureter, Bladder Leukemia Malignant Melanoma Non-Hodgkin’s Lymphoma Prostate (before age 50) Colorectal Testicular Multiple Myeloma

12 Firefighter Presumption  Presumption extended following termination of service for 3 months for each year of service, but no more than 60 months following last day of employment  Cancers only apply to any active or former firefighter whose cancer develops after he/she has served at least 10 years and was given a qualifying medical exam upon becoming a firefighter that showed no evidence of cancer

13 Firefighter Presumption  May be rebutted by preponderance of evidence –Tobacco use –Physical fitness and weight –Lifestyle –Hereditary factors –Exposure from factors unrelated to work  Department L&I Additional Resource: –Wendy Devries 360-902-6773


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