Claims Adjudication Tune-Up (CAT-U)
December 2024 Edition
Welcome to Self-Insurance’s (SI) Claims Adjudication Tune-Up (CAT-U) newsletter. This is where the Washington State Department of Labor & Industries (L&I) shares best practices and information, as well as highlight opportunities for improvement. The focus of this month’s CAT-U is Protests.
Revised Code of Washington (RCW) 51.52.050: Service of departmental
action…Reconsideration or appeal.
(1) Whenever the department has made any order, decision, or award, it shall
promptly serve the worker, beneficiary, employer, or other person affected
thereby, with a copy thereof by mail …such final order, decision, or award shall
become final within sixty days from the date the order is communicated to the
parties unless a written request for reconsideration is filed with the department
of labor and industries….
Take away:
Protests to orders must be received in writing by the department or employer from the protesting party. This is true for employer-issued closing orders, as well as L&I orders. Orders become final as written 60 days from communication. For unrepresented workers, an order must be in their preferred language to be considered communicated.
Other considerations:
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Who can protest? – The worker and the employer always have protest rights. Additionally, RCW 51.52.050(2)(a) allows any party ‘aggrieved’ by the order to also file a protest. This typically might include the attending provider, another provider, or a beneficiary. If you receive what looks like a protest, but are not sure the person qualifies as ‘aggrieved’, send it on to the department for review.
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What might be a protest? – A protest could be a medical bill, chart note, or treatment request. It may be from the worker, and say they disagree with a prior order. However, other things can be reasonably construed as a protest that are not so explicit. For example, if a new treatment request comes after a closing order is issued, it may be an assertion that the worker is not yet done with treatment, or that
not all contended conditions have been addressed. If the closing order is not yet final, that is reasonably considered a protest. That same request for treatment might also be a protest if it is for a condition that was previously denied by a department order that is not yet final. A protest to an order with appeal-only language is a misdirected appeal. It should still be forwarded to
the department within five days of receipt.
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What should I do with medical I receive on a closed claim? If the medical is from after the date of the closing order, it could be a protest, or possibly a reopening request. If the documentation asserts more treatment is needed, or that there is worsening of an accepted condition and the closing order is not yet final, it should be construed as a protest to the closing order. If the closing order is final, it may be considered an informal request for reopening of the claim.
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What should be done with a protest received by the employer? Washington Administrative Code (WAC) 296-15-480 says that a written protest received by the employer must be forwarded to the department within five working days from the date it was received by the employer. If you are not certain that what you’ve received is a protest to a non-final order, forward it to the department for
review, along with any documentation that is relevant (a closing order that has not been sent yet to the department, for example.) Failure to forward a protest within the allowable timeframe may result in a penalty.
Beverley Marley appealed an order issued by L&I that denied her survivor’s
benefits. She made her appeal six years after the order was issued. The appeals
court determined that since the department had jurisdiction to issue the order,
Ms. Marley’s only recourse had been to file a timely protest (within 60 days of
communication).
Effect: The Marley case supports that a protest to an order after the 60 days will not be timely: orders after that time are truly final and binding. This is true even if the content of the order is found to be incorrect or incomplete.
Claim Impact: Protests have to be filed in a timely way if a party to the order disagrees. For this reason, it is crucial that the received date of any protest is documented, and the protest routed to the department as soon as possible. Employers must stamp claim correspondence with the date and location received per WAC 296-15-350(8). In addition, WAC 296-15-480 requires that self-insurers submit written worker protests within five
working days to the department.
Reminders/tips from the SI teams:
- If a worker calls or emails disagreement with an order that has been issued, let them know that they need to file a written protest with L&I. You can refer them to the language on the letter, as well as giving them the department’s address. Workers can also use the online customer service portal to file a dispute or protest.
For questions or more information, email: SITrainerQuestions@lni.wa.gov
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