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Compensation Claim Process

 

WORKERS’ COMPENSATION CLAIM PROCESS FOR HANFORD SITE EMPLOYEES

  • Workers’ Compensation (WC) claims are filed by the injured worker reporting their injury to their contractor, personal physician or Penser North America, Inc. (Penser)
  • The contractor’s WC Representative (WCR) assists the worker with completion of a Washington State Labor & Industries (WSL&I) claim form and forwards to Penser

PENSER and WAL&I

  • Requests a Physicians Initial Report (PIR) if not already provided
  • Investigates claim to determine validity
  • Contacts worker for statement
  • Verifies employment data and interviews witnesses, if any
  • Obtains information from contractor’s WCR, if appropriate
  • Requests additional medical documentation if needed
  • Ensures claim details satisfy requirements of the law
  • If an investigation does not support claim validity, claim is sent to WAL&I with a recommendation of claim denial
  • Sends copy of denial recommendation to worker and WCR
  • WAL&I reviews claim
    • If WAL&I agrees with denial recommendation, WSL&I issues an Order of Denial to the worker (copy to Penser)
    • worker has the right to appeal decision (see Workers Options)
  • If claim is allowed, continues to administer the claim
  • Maintains open communication with the worker, employer, attending physician, and HPMC
  • Authorizes medical treatment and procedures, in accordance with WSL&I Laws
  • Works with contractor’s WCR and HPMC to return the worker to the job of injury if the worker has been off work
  • Determines the need for vocational counseling and/or retraining
  • For certain claims, closes the claim when treatment is completed
  • Physician determines whether worker is entitled to permanent partial disability
  • For all claims, once a physician has determines permanent partial disability and the worker is capable of reasonably continuous gainful employment Penser submits request for closing order to WSL&I (see Workers Options)

WORKERS OPTIONS

Protest and Appeal Rights are provided under the Washington State Laws. The WSL&I makes a determination and issues a formal Order & Notice which includes a clear explanation of the workers rights, responsibilities, and time limits to protest or appeal a decision. The process is as follows:

1. WSL&I issues Order
2. Worker protests Order to WSL&I
3. WSL&I reviews protest and issues new order
4. Worker appeals to Washington State Board of Industrial Insurance Appeals
5. Washington State Board of Industrial Insurance Appeals issues decision
6. Worker appeals to higher court
7. Higher court issues final decision

 



 

 

 

Last Updated 12/06/2016 10:47 AM