Claims Adjudication Tune-Up (CAT-U)
October 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 newsletter is provider types.
Legal Corner
Washington Administrative Code (WAC) 296-20-015 Who may treat.
(1) A provider must:
(a) Apply and be enrolled in the provider network per WAC 296-20-01010; or
(b) If the provider network scope in WAC 296-20-01010 is not applicable, apply and
obtain a provider account number per WAC 296-20-12401.
(2) If the provider or service is within the scope of the provider network under
WAC 296-20-01010:
WAC 296-20-01002 Definitions
Attending provider: For these rules, means a person who is a member of the health
care provider network established under Revised Code of Washington (RCW)
51.36.010, is treating injured workers within their scope of practice, and is licensed
under Title 18 RCW as one of the following: Physician, osteopathic physician,
chiropractor, naturopath, podiatric physician, dentist, optometrist, advanced registered
nurse practitioner, psychologist in the case of claims solely for mental health
conditions, and physician assistant.
RCW 51.28.020 Worker’s application for compensation-Attending provider to aid in.
(b) physician assistant, or psychologist in claims solely for mental health conditions…
Take away:
As of July 1, 2025:
• Physician assistants and psychologists can serve as attending providers.
Psychologists can be an attending provider on mental health-only workers
compensation cases.
• Psychologists who do not join the L&I Medical Provider Network will be limited to
performing initial visits on mental-health only cases. Psychologists will not be able to
conduct an initial visit if any physical conditions are contended. A psychologist who
has applied for the MPN may still treat workers while their application is being
processed.
• WAC 296-20-01010 requires providers caring for workers in Washington to be part of
the network. If a provider is caring for a worker outside of Washington, they are not
required to be part of the L&I MPN.
News You Can Use
Case Law / Significant decision - In re Maria Gonzalez, BIIA Dec., 97 0261 (1998)
Summary: Ms. Gonzalez’s attending provider found her to be able to work full duty and at maximum medical improvement. Following this, she sought transfer to a new attending provider.
Claim impact: Ordinarily a transfer of care should be approved unless there is a legitimate reason for denial. Denial should not be a casual decision. In this case, the board found that “the mere fact that the worker is unhappy with the physician does not warrant a transfer.”
Trainer Trivia
Last month’s question, “We always see the same face of the moon. Does the moon
rotate?”
Answer: Yes, the moon does rotate on its axis. However, the rotation is synchronized with its orbit around the Earth, meaning the same side of the moon always faces us. This phenomenon is called tidal locking.
October Question:
What is the fear of Halloween called?
More reading/resources:
MARFS Chapter 2: Information for All Providers
MARFS Chapter 3: Attending Providers
Self-Insurance Claim Adjudication Guidelines Medical Treatment
WAC 296-20-01010 Scope of health care provider network.
Reminders/tips from the SI teams:
A provider does not need to be in the L&I Medical Provider Network to complete a Provider’s Initial Report or Reopening application. (WAC 296-20-01010 and RCW 51.36.010)
Find a Doctor – Find a Doctor or Provider that’s in the L&I Medical Network
For more information, email: SITrainerQuestions@Lni.wa.gov
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