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Workers’ comp news: Fraud prevention, structured settlements, medical network

Fraud prevention: L&I recently made several announcements about peopled arrested or convicted for workers’ comp fraud. For example three defendants from Tacoma East Wenatchee and Idaho in three unrelated cases pleaded guilty to felony theft for stealing workers’ compensation benefits. Each was receiving wage-replacement payments and other benefits after officially declaring they could not work because their on-the-job injuries were so severe.

L&I reminds employers about its fraud webpage (L&I Fraud Prevention and Compliance) through which employers can learn the signs of fraud and report fraudulent activity:

Structured settlements: Because of changes made through the AGC-backed workers’ comp reforms passed in 2011 injured workers have been choosing whether to take a cash settlement in compensation for their injuries instead of a lifetime pension. But a state board has blocked some of those settlements when it believes they are not in the best interest of the worker. A court put a halt to that for workers with attorneys saying the board cant intervene to protect the workers from themselves. When state lawmakers created the option for settlements in installments they intended the Board of Industrial Insurance Appeals to step in only to protect the interests of workers without attorneys the Court of Appeals Division II ruled.

This approach assigns the determination of one’s own interest to those arguably best positioned to make that determination workers with legal counsel Judge Thomas Bjorgen wrote in a unanimous decision joined by Judges Bradley Maxa and Jill Johanson.  

Business groups including AGC feel there are too many restrictions as it is on the settlements which it says are working in other states. They have been lobbying to allow younger workers to choose the settlements which are now limited to people 55 and older. But this court decision is a positive step.

Medical network: Injured workers in Washington can now choose from more than 20000 health-care providers in L&I’s medical network a doubling of the size of the network since 2013. The medical provider network is part of the AGC-backed 2011 workers’ compensation reforms designed to improve outcomes for injured workers reduce disability and cut costs for the state’s workers’ compensation program. The standards for providers to be admitted to the L&I network are similar to those of other health networks in Washington state and around the country. Requirements include proof of medical liability insurance and professional licenses that are free of restrictions.

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