What elements must a
self-insurer have in place to ensure the reporting of injuries?
Every self-insurer must:
(1) Establish procedures to assist
injured workers in reporting and filing claims.
Immediately provide a Self-Insurer Accident Report (SIF-2) form
F207-002-000 to every worker who makes a request, or upon the
self-insurer's first knowledge of the existence of an industrial injury
or occupational disease, whichever occurs first. Only department
provided SIF-2 forms may be used. Copies or reproductions are not
(3) Establish procedures for ensuring the
timely delivery of completed SIF-2s to the claims management entity.
(4) Designate individuals as resources to address employee
questions. These resources must:
(a) Have sufficient
knowledge to answer routine questions; and
responsibility for seeking answers to more complex problems; and
(c) Have detailed knowledge of the self-insurer's claim filing
(d) Be reasonably accessible to employees at
every work location.
(5) Maintain a claims log of all
workers' compensation claims filed.
(a) For each claim, the
log must consist of only the following information:
The complete first and last name of the injured worker (no initials or
(ii) The date of injury, or for an
occupational disease, the date of manifestation.
claim number found on the department's Self-Insurer Accident Report
(SIF-2, form F207-002-000).
(iv) The date the claim is
(v) Whether the claim is a time loss claim or
(b) The self-insurer must designate the
location of the official claims log.
(i) The self-insurer
may maintain the log on its premises; or
self-insurer may elect to have its third-party administrator maintain
the claims log on its behalf. If this option is selected, there must be
a written agreement between the self-insurer and the third-party
administrator acknowledging that the official claims log is maintained
by the third-party administrator.
The self-insurer must
notify the department in writing of the location of their official
claims log. If the option in (b)(ii) of this subsection is selected, a
copy of the written agreement between the self-insurer and the
third-party administrator must be provided to the department.
[Statutory Authority: RCW 51.04.020,
06-06-066, § 296-15-320, filed 2/28/06, effective 4/1/06.]