Translated Documents Are Now Available for Self-Insured Employers’ Use

Washington State Department of Labor & Industries sent this bulletin at 02/21/2023 10:29 AM PST

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washington state department of labor and industries - claims and insurance

Self-Insurance

Translated documents are now available for self-insured employers’ use

Limited English Proficient (LEP) customers have limited ability to read, speak, write or understand English, and are entitled to language assistance to apply for workers’ compensation benefits.

L&I’s core values support language access for these customers. Self-insured employers and third-party administrators (TPAs) are required to ensure they are effectively communicating with “all injured workers” under WAC 296-15-350. This includes communicating in their preferred language. To aid in this effort, L&I has translated some of the most used vital claims documents to some of the most common languages.

More information on this subject will be included in Forms and Templates training. Please join us on February 22, 2023. Registration is required.

The Forms & Publications listed below are available in Cambodian, Chinese Simplified, Chinese Traditional, Korean, Russian, Somali, Spanish, and Vietnamese.

  • F207-020-111 Self-Insured Employers’ Medical Only Claim Closure Order and Notice
  • F207-070-000 Self-Insured Employers’ Time-Loss Claim Closure and Notice
  • F207-114-000 Transfer of Attending Provider Form for Self-Insured Workers
  • F207-155-000 Workers’ Compensation Filing Information
  • F207-162-000 Schedule of Future Payments for the Balance of PPD
  • F207-164-000 Self-Insured Employers' Permanent Partial Disability Closure Order and Notice (PPD - Time-Loss)
  • F207-165-000 Self-Insured Employers' PPD Closure Order and Notice (PPD-NTL)
  • F207-220-000 Letter - Accept Newly Contended Condition
  • F207-221-000 Letter - Deny Newly Contended Condition
  • F207-222-000 Letter - Assessment of Overpayment
  • F207-223-000 Letter - Notice of Underpayment
  • F207-224-000 Letter - Provisional Compensation Benefits
  • F207-225-000 Letter - Start, Stop, or Deny Compensation Benefits
  • F207-226-000 Letter - Treatment Decision
  • F207-227-000 Letter - Calculation of Monthly Wage as a Basis for Time-Loss Compensation
  • F207-236-000 Self-Insurer Beneficiary Application Letter
  • F207-238-000 Self-Insurance IME Assignment Letter

The self-insured employer and TPA are responsible for using the provided translations or translating these documents into other languages including free text and fillable sections of orders, letters, and applications. Failure to use translated documents may result in penalties.

Questions? Email: SITrainerQuestions@Lni.wa.gov