Claims Adjudication Tune-Up (CAT-U)
January 2025 Edition
Welcome to Self-Insurance’s (SI) Claims Adjudication Tune-Up (CAT-U) newsletter. This is where the Washington State Department of Labor & Industries Self-Insurance Program shares best practices and information, as well as highlight opportunities for improvement. The focus of this month’s CAT-U is hearing loss claims.
Hearing loss claims are handled differently than other occupational disease claims and require special attention. In this edition, we will look at some of the differences: setting date of manifestation, paying for hearing aids after claim closure, and audiograms for validity.
Legal Corner
Case Law – Harry v. Buse Timber Sales, Inc. (2009)
Background: Donald Harry appealed the permanent partial disability (PPD) award at closure of his claim, citing an incorrect date of manifestation, which lowered his award amount. The Washington State Supreme Court concluded that:
…the Department erred in calculating Harry's permanent partial disability award
according to the 1974 schedule of benefits. RCW 51.32.180(b) is ambiguous as to
whether “the date ․ the disease ․ [i]s totally or partially disabling” refers to the first
date any compensable hearing loss first occurred, or the last date hazardous
workplace noise contributed to the disability for which a worker seeks compensation.
Applying the liberal construal mandate, we hold occupational hearing loss is “partially
disabling” within the meaning of RCW 51.32.180(b) as of the date a worker was last
exposed to hazardous occupational noise.
Claim impact: For occupational hearing loss claims, the date of manifestation is either the date the worker first sought treatment, or the last date of injurious exposure, whichever came first. Note that just getting an audiogram alone would not constitute treatment for purposes of date of manifestation.
Revised Code of Washington (RCW) 51.36.020(5)(a)
(5)(a) All mechanical appliances necessary in the treatment of an injured worker,
such as braces, belts, casts, and crutches, shall be provided and all mechanical
appliances required as permanent equipment after treatment has been completed
shall continue to be provided or replaced without regard to the date of injury or date
treatment was completed, notwithstanding any other provision of law.
Claim impact: The Self-Insured employer covers the cost of hearing aids when prescribed to address accepted hearing loss. After the initial purchase, the employer would remain responsible for the costs of repairs or replacement due to normal wear, replacement on request after five years, and battery replacements. The claim does not need to be reopened after closure to pay for these items. Travel costs for repair or replacement of hearing aids is not covered, unlike other prosthetics.
News You Can Use
Audiograms
The most common tool for measuring hearing loss is an audiogram. An audiogram tests the lowest volume the subject can hear at frequencies ranging from 250 Hertz (Hz) to 8000 Hz.
The vertical axis to the left measures the volume of the tone in decibels (dB) and the axis across the top measures frequency (Hz). In this example, the subject hears a 4000Hz tone at 50dB in their left ear, and 55dB in their right.
For an audiogram to be considered valid it must be:
- Preceded by at least 14 hours without exposure to high levels of noise (occupational or non-occupational).
- Performed by a licensed or certified audiologist, an otolaryngologist or other qualified physician, or by a certified technician responsible to one of the above.
- Performed in a sound-attenuated room.
- Obtained from equipment calibrated to current American National Standards Institute (ANSI) standards.
Only valid audiograms can be used for allowance of a claim, and for establishing any permanent partial disability at claim closure. If there is permanent partial disability, the rating provider should review a valid audiogram, and complete the Hearing Impairment Calculation Worksheet, which calculates the disability percentage for each ear.
Trainer's Trivia
Washington’s workers’ compensation program was established in 1911, but Self-Insurance was not part of the picture yet. What year did the Self-Insurance program get started?
(See next month’s edition for the answer, and a little history!)
More Reading and Resources
Self-Insurance Claim Adjudication Guidelines, Validity Chapter covers types of hearing loss, establishing date of manifestation, and what is needed for allowance.
RCW 51.28.055 “Time limitation for filing claim for occupational disease- Notice – Hearing loss claims - Rules.”
Reminders/tips from the SI teams
Some of a worker’s hearing loss claim can still be paid even if filed late. Occupational hearing loss claims need to be filed within two years of the last date of noise exposure for full benefits, including PPD. If a worker files their claim after that period, they are still eligible to have medical costs paid, including hearing aids. They would not be eligible for PPD, however, due to non-timely filing of the claim.
For more information, email: SITrainerQuestions@lni.wa.gov
|
