Reminders regarding SIF2 submissions
November 08, 2022
L&I has recently engaged in conversations with the self-insured community regarding completion of SIF2s. Based on these conversations, we learned of difficulties employers often have with submitting a completed SIF2. Balancing the employers’ concerns, our need to complete our process in a timely and efficient manner, and ensuring an adherence to the law, we have reached a compromise. Although we prefer to receive SIF2s with all fields completed, here is the minimum information needed to avoid having the SIF2 returned:
- Worker’s first and last name.
- Worker’s mailing address.
- Worker’s date of birth.
- Employer name/address (Note: the employer name/address is not the third party administrator (TPA) name/address*)
- Description of injury (Note: Please provide details about the injury; “see PIR,” “see incident report,” or similar comments, are not considered complete injury description).
- Claim number.
- Date of injury/date of manifestation.
*Some self-insured employers (SIEs) or TPAs have pre-stamped blank SIF2s with the employer name/TPA mailing address. We are asking that those entities work on updating their process to ensure that the SIF2 has the employer’s address, not the TPA’s address by the end of 2022. To preserve claim numbers, SIEs are asked to update the forms they have (by placing correct address labels over existing addresses, etc.) by Jan. 3. Please avoid requesting new SIF2s if at all possible. After January 3, 2023, these SIF2s will be returned with a request for the correct address.
What to expect:
- Upon receipt of an incomplete SIF2, L&I will fax the form to the submitter noting the missing information and asking that a complete form be submitted.
- If no response is received within 14 calendar days, a letter will be sent requesting this information.
- If no response is received to our second request, L&I will send a pre-penalty letter again requesting the information.
- If no response is received, L&I may intervene to adjudicate the claim, per WAC 296-15-420(4). L&I may also issue a penalty for rule violation, per incident. Note, TPAs are subject to the same duties, obligations, and penalties, per WAC 296-15-550 and 560.
The legalities:
There has been some confusion between the employer’s duty regarding the SIF2 and the worker’s rights regarding filing a claim. The employer must provide a SIF2 to a worker upon request or upon knowledge of an injury or occupational disease, in accordance with WAC 296-15-320(1)(a). In addition, the employer must ensure timely delivery of a “completed” SIF2 to the claims management entity, per WAC 296-15-320(1)(b).
The employer’s duty regarding the SIF2 is separate from the worker’s rights regarding filing a claim. The employer has a duty to report injuries using the SIF2, per WAC 296-15-405(1). When the employer is requesting an allowance, denial, or interlocutory order, the employer must submit the department developed form and the SIF2, per WAC 296-15-420.
Additionally, employers have a responsibility to report an injury on forms prescribed by the department, which “shall include: (a) the name, address, and business of the employer; (b) the name, address, and occupation of the worker; (c) the date, time, cause, and nature of the injury or occupational disease; (d) whether the injury or occupational disease arose in the course of the injured worker’s employment; (e) all available information pertaining to the nature of the injury . . .; and (f) such other pertinent information as the department may prescribe by regulation,” in accordance with RCW 51.28.025.
If you have questions, please contact LaNae Lien at lanae.lien@lni.wa.gov.
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