Frequently Asked Questions

New questions and answers will be added as they are received from our website visitors. Don’t hesitate to Contact Us if you have additional questions.

1. What does the Washington Hospitals Services Workers’ Compensation Program do?
2. What are the benefits to my hospital of joining either trust?
3. How do I know if my hospital can join either of these Trusts?
4. How are services assessed?
5. What is the 3-day waiting period?
6. What’s the best way to go about investigating a claim and what do we need to include in our investigation? (See Root Cause injury information for investigation for safety prevention.)
7. When do we need to provide a wage history and why?
8. Is a wage history always required?
9. Why do we need to provide health benefit information?
10. Retirement or separation: Do we need to let you know?
11. What are the consequences of late claim filing and incomplete forms?
12. What is a Physician’s Initial Report (PIR) and what should we do if we get one?
13. What is my role as the designated contact here at the hospital for Washington Hospitals Self-Insured Workers’ Compensation Program?
14. What can we expect from our claims adjudicator at Washington Hospitals Self-Insured Workers’ Compensation Program?
15. Sometimes it seems that an injury can’t possibly have resulted from the work an employee has done at the hospital. How do we determine if a claim is valid and what happens while a determination is being made?
16. How and when can a claim be reopened once it has closed?
17. What are the requirements for a "modified/transitional" return to work offer?
18. Why do we need a Safety Committee and what are the requirements?
19. How will the successful repeal of the ergonomics regulation through I-841 change what the Washington Hospitals Workers’ Compensation Trusts are doing?
    

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What does the Washington Hospitals Services Workers’ Compensation Program do?

It provides group self-insurance Workers’ Compensation Services to hospitals in the Public Hospital District Workers’ Compensation Trust and the Washington Hospitals Workers’ Compensation Trust. These services are mainly claims management and safety services, but also include filing of quarterly and annual reports to the Department of Labor and Industries. Claims and safety services include education on workers’ compensation and best practices for optimum outcomes for both injury prevention and claims management. Each employer works with a specific claims and safety representative.

What are the benefits to my hospital of joining either trust?

The services received through the Trusts’ programs are only for hospitals. We know hospitals. The focus is on hospitals and geared toward the needs of hospitals. Independent audits of the claims management services have received excellent ratings. Safety services are provided by staff, who have knowledge achieved through working in and with hospitals. The safety services are provided as a complement to your own staff and we focus on issues of relevance to hospitals. Our “ZERO LIFT” program is one example.

How do I know if my hospital can join either of these Trusts?

If your hospital is a public district hospital, your hospital is eligible to apply for membership in the Public Hospital District Workers’ Compensation Trust.

If your hospital is a not for profit or for profit hospital, your hospital is eligible to apply for membership in the Washington Hospitals Workers’ Compensation Trust.

In either case, you complete an application for membership and sign the membership agreement. The respective Board of Trustees will then review the application for membership eligibility.

How are services assessed?

We bill you monthly for your contribution (premium) that is actuarially determined and experienced rated. Accounting services provided through the Trusts file quarterly reports and annual reports to the Department of Labor & Industries for the hospitals. Included in the contribution is the reinsurance, actuarial, financial audits, claims management, safety services, and reports.

What is the 3-day waiting period?

The 3-day waiting period is the 3 calendar days immediately following the date of injury. If the injury occurs on the 1st, the 3-day waiting period becomes the 2nd, 3rd & 4th. Unless the employee is back to work on the 5th, time loss is due. This is the only time during the course of the claim that the waiting period applies; for instance, if the injury occurs on the 1st and the physician does not authorize time loss until the 8th, time loss becomes payable immediately because the 3-day waiting period is over. In the event of an occupational disease (or repetitive stress) claim. The 3-day waiting period becomes the 3 days immediately following the date the employee was first treated for the condition.

What’s the best way to go about investigating a claim and what do we need to include in our investigation? (See Root Cause injury information for investigation for safety prevention.)

Claims investigation needs to be completed as soon as reasonably possible after an injury has occurred. Talking to the injured worker and witnesses while things are fresh is vital. People forget, and details become fuzzy as time passes. Photographs are a great tool, especially if you believe the injury may have been due to a faulty piece of equipment. Investigation is imperative if you believe a third-party may be responsible for your employee’s injury. Your Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual is a great reference. Check out Chapter 3, starting on page 6 for a comprehensive explanation of how to go about investigating an employee injury. Chapter 9 includes our third party recover policy, on page 2; that’s where those photographs and diagrams can be vital in recovering expenses paid on a claim. Check out the “red flags” on page 39 of the same chapter for items associated with high exposure claims. One or more of these may alert you to the need for a more thorough investigation.

When do we need to provide a wage history and why?

A wage history is required when the worker and employer statement of wages and/or hours on the SIF-2 do not match, or the worker has a varied schedule with multiple shifts and rates of pay.

Time loss rates are based on the pattern of employment that most closely represents the employees work history. Hospitals have multiple shift differentials and wage variations based on assignment (i.e. and RN working in a supervisory role some of her shifts and not on others). The Department of Labor and Industries requires that our calculations be based on hours worked. When providing a wage history, please be sure the history includes hours worked as well as rates of pay. Payroll records must always be provided when requested by The Department of Labor and Industries, our office, or your claims adjudicator.

Is a wage history always required?

A wage history is not required on treatment only claims; when the worker and employers hours and rates of pay, including multiple shifts and shift differentials, match on the SIF-2 or when there is a signed agreement between the employer and the worker of average monthly earning for each shift and rate of pay. (How to complete wage info on SIF2 so a wage history is not needed)

Why do we need to provide health benefit information?

Calculating time loss became more complicated when the Supreme Court found in favor of the employee in Cockle vs. The Department of Labor and Industries. We are obligated to include the worth of health benefits (medical/dental/vision) paid by the employer when calculating time loss. If health benefits are terminated, whether by termination or by an employee being off work, or on time loss for an extended period of time, we must adjust the time loss rate to include the worth of the employer’s contribution to the worker’s benefits. This enables provides the worker extra funds to pay for COBRA benefits, should they chose to do so.

Retirement or separation: Do we need to let you know?

Please, yes! If a person voluntarily retires, is terminated, or quits, with an open workers’ compensation claim, we need to know. There is a form specifically for that purpose on page 34 of chapter 3 of the Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual. Just fax or mail it!

What are the consequences of late claim filing and incomplete forms?

Late filing of claims can is one of the major causes of difficulty in controlling claims and claims costs. It can also result in fines being assessed by The Department of Labor and Industries, if it causes a late time loss payment. Starting on page 10 of chapter 3 of the Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual, there is a wealth of information on this subject.

What is a Physician’s Initial Report (PIR) and what should we do if we get one?

The PIR is completed by the physician who first treats an injured worker for the effects of their work-related injury. It is considered to be notification of a claim, if the form is signed by the employee. A SIF2 should be completed immediately and the claim forwarded to Washington Hospitals Self-Insured Workers’ Compensation Program. Refer to your Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual, Chapter 3, page 15 for a more thorough explanation of the importance of this form and your role, should you get one on your desk!

What is my role as the designated contact here at the hospital for Washington Hospitals Self-Insured Workers’ Compensation Program?

You are the front-line through which all claim information flows. Communication and documentation are the keys to effective claims management. Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual has a detailed description of your role in Chapter 3, beginning on page 17. If you haven’t read it, you need to!

What can we expect from our claims adjudicator at Washington Hospitals Self-Insured Workers’ Compensation Program?

You can expect prompt, responsive communication and claims management. There’s a great outline on page 21, chapter 3 in the Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual, detailing our claims management procedures.

Sometimes it seems that an injury can’t possibly have resulted from the work an employee has done at the hospital. How do we determine if a claim is valid and what happens while a determination is being made?

The definition of an industrial injury as per RCW 51.08.100 is “a sudden and tangible happening of a traumatic nature, producing a prompt result, and occurring from without, and such physical conditions as result therefrom.” An occupational disease is defined as “such disease or infection as arises naturally and proximately out of employment under the mandatory or elective adoption provisions of this title,” as per RCW 51.08.140. If you believe that a claim is not valid you need to let us know as soon as possible. Investigation is the key. Review Chapter 3, starting on page 6, in the Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual. Claim validation is reviewed beginning on page 23 of the same chapter. While claim validation is being determined, if time loss is authorized by the attending physician, we must pay; albeit on a provisional basis. If the claim is found not to be valid and is ultimately denied, the employee is required to pay back all time loss benefits paid.

How and when can a claim be reopened once it has closed?

An employee and their physician can apply for the reopening of a claim within, seven (7) years of the date of closure. The request will be reviewed and a determination made by The Department of Labor and Industries, based on the individual facts of the claim. Reopening is allowed if there has been a natural worsening of the condition since claim closure. There is a blank reopening application in chapter 3, page 64, of the Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual.

What are the requirements for a "modified/transitional" return to work offer

Reference our Washington Hospitals Self-Insured Workers’ Compensation Program Training Manual (chapter 3 beginning on page 81).

Why do we need a Safety Committee and what are the requirements?

The goal of the Safety Committee is to create and maintain a non-adversarial partnership between employees and management in a cooperative effort to promote communication and evaluation of safety and health issues and to implement the necessary changes to reduce workplace injuries, illnesses, and incidents. WAC 296-800-130, Safety Committees/Safety Meetings, lists the specific Safety Committee membership, meeting, topic, and documentation requirements.

How will the successful repeal of the ergonomics regulation through I-841 change what the Washington Hospitals Workers’ Compensation Trusts are doing?

The successful passage of I-841 will have a minimal impact to the Workers’ Compensation Program. We have founded and based our programs upon the Boards’ Vision for the programs: “To lead our membership to create and maintain the safest work environment.” Our focus and objective for the ZERO LIFT Program was primarily, and continues to be, primarily injury prevention; not to meet a regulation. When we started our movement to ZERO LIFT in 1999, there was no ergonomic regulation. When Washington adopted the regulation in May 2000, we took the requirements of the state, incorporated those elements into our program implementation and structured them to help the members meet the requirements. Now that there is no longer a regulation, we can revise the paperwork and process to reduce any unnecessary steps and still obtain our original objective of injury prevention within the membership.

Before the ergonomic regulation, employers were required to provide a safe workplace for their employees. If a complaint is filed, or an employer site is inspected through some other process, that employer is still subject to rules and regulations for maintaining a safe workplace and can still be cited and/or fined through the already existing rules and regulations.