Claims Adjudication Tune-Up (CAT-U)
May 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 CAT-U is Effective Use of Department Forms.
Legal Corner
Washington Administrative Code (WAC) 296-15-420:“Requesting allowance or denial, or interlocutory order from the department—Providing claim file.
This WAC says that within 60 days of notice of claim, a self-insurer must:
Under subsection (1), send an L&I-developed form requesting claim allowance, with
copies of the SIF-2 and SIF-5A.
Under subsection (2), send an L&I-developed form requesting an interlocutory order,
with a complete copy of the claim file excluding medical bills, with copies of the SIF-2
and SIF-5A.
Under subsection (3), send an L&I-developed form requesting claim denial, with a
complete copy of the claim file excluding medical bills, and the SIF-2.
These are minimum requirements listed in the WAC, but additional information may be needed. For example, allowance requests for occupational disease claims should also include documentation to establish the date of manifestation.
Washington Administrative Code (WAC) 296-15-350(8):
“What elements must a self-insurer or third-party administrator (TPA) have in place to
ensure appropriate handling of claims? Every self-insurer or TPA must:
(8) Legibly date stamp or produce an imprint on incoming correspondence, identifying
both the date received and the location or entity that received it.”
These are formats acceptable to the department:
- MM/DD/YYYY: 04/17/2025
- MM/DD/YY: 04/17/25
- MMDDYYYY: 04172025
- YYYYMMDD: 20250417
- YYYYMMDD and other numbers: 20250417123567
The date stamp needs to be legible, per the WAC. The best practice is to ensure the date is easily recognizable. If it is not separated out, the date could easily be overlooked and cause unnecessary requests for more information. It could also lead to possible rule violation penalties if the number is not in the acceptable format or is not legible.
News You Can Use
Revised Forms: Several forms have been updated. They’re available now on the department’s Forms & Publications search page, and must be used starting July 1, 2025:
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Interlocutory Request: Extensions can be granted up to a maximum of 120 days from notice of claim.
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Claim Denial Request: Denials for “no application” must show the worker’s date of birth. Denials for “no medical” must be indicated in a checkbox. Documentation of attempts to get medical must be attached.
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Claim Closure: “Kept on Salary” has been added as an option for compensation reporting. The formatting for requesting closure from the department or reporting your own closure has been updated to make it clearer.
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Overpayment Request: There is now space in the form to enter dates of overpaid benefits, as well as amounts already recovered. There is a documentation checklist on the second page, in case a wage order is needed.
Additionally, several other Self-Insurance forms have been updated, including the Suspension Request Coversheet, No-Show Fee Request Checklist, Pension Review Coversheet, and the Post Pension Treatment Request
These changes were made as part of the Claims Process Project (CPP). To learn more about these and other CPP changes, plan to attend an L&I training webinar on either
June 5 or June 10. Watch our website and GovDelivery for registration announcements!
Trainer Trivia
Last month’s question was:
Q: What year was the oldest known complaint letter written from one person to
another?
A: About 1750 BC! 3700 years ago, a person named Nanni wrote to Ea-Nasir about
the poor quality of the metal ingots he received. He also complained that his servant
had been treated rudely.
Even though Star Wars day is behind us, here’s a Star Wars trivia question:
Q: How old was Yoda when he began training Luke in Episode V: The Empire
Strikes Back?
May the Fourth be with you!
More reading/resources:
Claim Adjudication Guidelines (CAG): Several chapters address department
communication.
Forms & Publications: Self-Insurance: Documents here are more specific to Self-
Insurance claim management than forms on the main department site.
Reminders/tips from the SI teams:
When responding to L&I documentation requests that ask for the entire file plus specific documents, put requested documents in front, or otherwise indicate where they are. When you receive a request to send specific documents or information rather than the file, please submit only that specific requested information. Being able to find documents quickly can help resolve requests and disputes more efficiently.
Be sure to complete the worker’s preferred language checkboxes on department forms. Orders issued that are not in the worker’s preferred language won’t become final since they would not be considered communicated.
For more information, email: SITrainerQuestions@Lni.wa.gov
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