Claims Adjudication Tune-Up (CAT-U)
April 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 (L&I) shares best practices and information, as well as highlight opportunities for improvement. The focus of this month’s edition of CAT-U is communicating with workers.
Legal Corner
Washington Administrative Code (WAC) 296-15-420
(7) “How long does a self-insurer have to provide a copy of the claim file to the
worker or worker’s representative?”
“A self-insurer must provide a copy of the claim file within fifteen days of
receiving a written request from the worker or worker's representative. Unless
the worker or representative requests a particular portion of the file, the self-
insurer must provide a copy of the entire file.”
(8) “When may a self-insurer charge a worker or his/her representative for a
copy of the claim file?
A self-insurer must provide the first copy of a claim file free of charge. Upon
receipt of a subsequent written request, the self-insurer must provide any
material not previously supplied free of charge. The self-insurer may charge the
worker or any representative a reasonable fee for any material previously
supplied.”
Take away: Careful attention to deadlines is critical. For example, when calculating time, do not include the day you receive the request. Claim Adjudication Guidelines (CAG), Miscellaneous chapter, “Computation of Time,” gives direction on how to count days from significant events and deadlines.
WAC 296-15-350
(5) Establish procedures to answer questions and address concerns raised by
workers, providers, or the department.
(7) Include the department's claim number in all claim-related communications
with workers, providers, and the department.
(9) Ensure a means of communicating with all injured workers.
Take away: Communication to workers includes translating documents into their language of choice. Note that many forms and publications on the L&I website are available in several languages. The WAC requires timely handling of all written requests, phone calls and emails.
News You Can Use
Revised Code of Washington (RCW) 51.52.050(1)
“Whenever the department has made any order it shall promptly serve the worker, beneficiary, employer, or other person affected thereby, with a copy thereof …. Such … order, decision, or award shall become final within sixty days from the date the order is communicated to the parties….”
Take away: This requirement applies also to orders issued by the self-insured employer. Communication of an order generally means the date the party receives it. However, any question of whether an order was communicated should be handled on a case-by-case basis. A mailed document received but not read by the worker could still be considered communicated. See In re Mario Malarchick, BIIA Dec., 18 30609 (2019) for an example.
Trainer Trivia
What year was the oldest known complaint letter written from one person to another?
Answer to March 2025’s question, “What was the first anti-smoking medication and when was it approved for use in the U.S.?” Nicotine gum was approved for use in 1984 as an anti-smoking aid, according to the American Lung Association.
More reading/resources:
WAC 296-15-550(2) Telephone calls must be returned within three business days,
written correspondence within fifteen business days.
Claim Adjudication Guidelines (CAG), Miscellaneous chapter, “Computation of Time.”
Nafus v. Department of Labor and Industries (1927): case law addressing whether an
order was communicated to a worker.
Questions? Comments? Please email: SITrainerQuestions@Lni.wa.gov
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