WAC Changes Effective July 1, 2019

Issued by the Washington State Department of Labor & Industries 12/20/2018

Thirteen Washington Administrative Codes (WACs) related to Self-Insurance are changing effective July 1, 2019.  Some of the changes are significant, while others align the WAC with current practices or statute.


Better communication to workers by:

  • Providing new communication templates for self-insured employers to more clearly inform workers of actions on their claims.
  • Ensuring self-insurers communicate key actions involving delivery of benefits to workers at specific points during a claim.
  • Explaining to injured workers what to do if they dispute an action taken by a self-insurer.

Greater certainty for employers by:

  • Encouraging injured workers to contact the self-insured employer with concerns at the time an action is taken.
  • Outlining a new approach to unreasonable delay of benefits penalties that arise from wage calculation errors; presumes it is reasonable if the new communication template is used.
  • Retiring the all-purpose SIF-5 form and replacing it with new purpose-driven forms, providing a streamlined way to request department allowance, denial, interlocutory, or closure of claims.

Reduced dependency on department adjudication by:

  • With the exception of statutory requirements for the department to allow, deny or close certain claims, clarifying that department intervention to adjudicate claims is required only when there are disputes.
  • Addressing Wage Orders and ensuring that the department only issues them when a dispute arises therefore reducing the department’s involvement in routine matters.
  • Creating a new comprehensive, goal-oriented, core curriculum for those interested in obtaining a professional workers’ compensation designation and becoming a certified claims administrator.

Next Steps

We will continue to forward regular updates with information, including available training dates and locations. The department-developed forms and templates will be available by April.

If you have questions, contact LaNae Lien, Self-Insurance Claims Operations Manager at 360-902-6968 or lanae.lien@lni.wa.gov

Summary of the WACs Changing Effective July 1, 2019

 WAC 296-15-266 – Penalties

Provides a new presumption that benefits won’t be considered unreasonably delayed and a penalty won’t be assessed if the self-insurer, when calculating the monthly wage for time-loss benefits, informs the worker by:

  • Providing a copy of the wage calculation.
  • Informing the worker they should contact the self-insurer with any questions.
  • Providing information on their right to dispute.

WAC 296-15-330 – Authorization of Medical Care

Requires written explanation to workers and providers for denied bills.

WAC 296-15-340 – Payment of Compensation

Requires a statement of benefits by provided with each time-loss and loss-of-earning power payment, the statement must include:

  • Type of benefit paid.
  • Period of time.
  • Statement of benefits for reimbursements.

WAC 296-15-420 – Requesting Allowance or Denial, or Interlocutory Order from the Department

Retires the SIF-5 and SIF-4 forms and requires the use of department-developed purpose driven forms on requests for:

  • Allowance
  • Interlocutory
  • Denial
  • Closure

WAC 296-15-425 – Communicating to Injured Workers During the Course of the Claim

This is a new WAC, it describes the purpose and definition of department-developed templates.

States department-developed templates must be completed and sent to the worker within 5 days of taking the following actions:

  • Calculation of a worker’s monthly wage.
  • Starting, stopping, or denying time-loss and loss of earning power.
  • Acceptance or denial of a contended condition.
  • Authorization or denial of treatment.
  • Assessment of underpayment or overpayment.

If no dispute to these actions is received then the department will not issue an order

 WAC 296-15-450 – Closure of Self-Insured Claims

Aligns the WAC with statute, limiting the 2-year look back on employer closures to:

  • Clerical error.
  • Benefits paid due to mistake of identity or innocent misrepresentation.
  • Violation of the conditions of claim closure.

 WAC 296-15-4316 – What Must the Self-Insurer do When the Worker Declines Further Vocational Rehabilitation Services and Elects Option 2 Benefits?

Aligns the WAC with statute by adding, “upon issuance of a department order confirming option 2 election terminate time-loss benefits effective the date of the department order with proper notification to the worker as required in WAC 296-15-425…”

 WAC 296-15-350 – Handling of Claims

Effective 7/1/2020 each person making claims decisions outside the state of Washington is required to be a certified claims administrator.  A six-month “waiver’ provision was added for those firms who have no certified administrators as a result of staffing changes.

WAC 296-15-360 – Qualifications of Personnel – Certified Claims Administrators

Changes in requirements to become and maintain a certified claims administrator certification, including:

  • Requirement that a comprehensive goal-oriented curriculum to be completed prior to taking the certification test.
  • Details on what a department-approved curriculum will include.
  • Changes in the continuing education credit requirements.

 WAC 296-15-200 – Claims Log Evaluation


WAC 296-15-320 – Reporting of Injuries

Since the Claims Log Evaluation WAC was deleted, the statement “Upon request, produce a report of all workers’ compensation claims filed in a format required by the department” was added to this WAC.

WAC 296-15-400 – Self-Insured Rights and Obligations

Modernizes the WAC, by allowing electronic access, if authorized by worker, to:

  • Workers’ Compensation Filing Information
  • A Guide to Workers’ Compensation Benefits for Employees of Self-Insured Businesses

WAC 296-15-405 – Filing a Self-Insured Claim

Changes in terminology:

  • Doctor to health care provider
  • Physician to provider

The rules can be viewed at:


Issued by the Washington State Department of Labor & Industries 12/20/2018