Self-Insurance SIF-2 Q&A

Having trouble viewing this email? View it as a Web page.

washington state department of labor and industries - claims and insurance

Self-Insurance

SIF2 Q&A


L&I has received a number of questions related to the communication sent out on Nov. 8, 2022 regarding SIF2 submission. Most of the questions were about the requirement that the employer name/address be provided in the top left field on the SIF2. Below are questions and answers that try to address this issue:

Q:  We use a stamp in the employer name/address field that includes the third-party administrator (TPA) name and mailing address. We’re concerned changing this will result in confusion for medical providers and workers on who to contact/mail bills, chart notes to, etc.

A:  L&I does not recommend using the employer name/address field as a primary source of information for providers or workers. However, we also understand the concern that this could present a significant change for self-insurers, groups, or TPAs. Effective January 3, 2023, L&I will not return SIF2 forms that are pre-stamped with the employer name, TPA name and mailing address if the “business name and address where injury or exposure occurred” field is complete with the employer name and address. This will help ensure that our data is accurate when assigning the appropriate employer address to claims. Use your discretion to determine whether you want the corporate address or the local address to be attached to the claim.

Q:  Does “employer name/address” mean the local location or the employer’s headquarters/corporate office?

A:  The top left field titled “business name of self-insured employer,” is meant for the employer’s headquarters/corporate office. The field titled “business name and address where injury or exposure occurred” is meant for the local location.

Q:  What should a self-insured employer (SIE) do if they are having difficulty getting the SIF2 completed by the worker?

A:  The SIE can complete the mandatory fields on the worker’s behalf and note on the SIF2 that it was completed by the SIE. Please do not use the term “dummy.” Find an appropriate blank space on the SIF2 to note, “completed by the employer/TPA”.

Q:  If an SIE enters the injury description on the SIF2 does that mean they agree that the injury occurred?

A:  No. The SIE can add language to the description such as “according to the worker” or “the worker reported” to further reflect the employer is merely reporting what the employer was told.

If you have questions, please contact LaNae Lien at lanae.lien@lni.wa.gov