WORKERS’ COMPENSATION CLAIM PROCESS FOR HANFORD SITE EMPLOYEES
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Workers’ Compensation (WC) claims are filed by the injured worker reporting their injury to their contractor, personal physician or Penser North America, Inc. (Penser)
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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
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Requests a Physicians Initial Report (PIR) if not already provided
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Investigates claim to determine validity
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Contacts worker for statement
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Verifies employment data and interviews witnesses, if any
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Obtains information from contractor’s WCR, if appropriate
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Requests additional medical documentation if needed
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Ensures claim details satisfy requirements of the law
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If an investigation does not support claim validity, claim is sent to WAL&I with a recommendation of claim denial
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Sends copy of denial recommendation to worker and WCR
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WAL&I reviews claim
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If WAL&I agrees with denial recommendation, WSL&I issues an Order of Denial to the worker (copy to Penser)
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worker has the right to appeal decision (see Workers Options)
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If claim is allowed, continues to administer the claim
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Maintains open communication with the worker, employer, attending physician, and HPMC
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Authorizes medical treatment and procedures, in accordance with WSL&I Laws
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Works with contractor’s WCR and HPMC to return the worker to the job of injury if the worker has been off work
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Determines the need for vocational counseling and/or retraining
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For certain claims, closes the claim when treatment is completed
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Physician determines whether worker is entitled to permanent partial disability
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For all claims, once a physician has determined 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:
- WSL&I issues Order
- Worker protests Order to WSL&I
- WSL&I reviews protest and issues new order
- Worker appeals to Washington State Board of Industrial Insurance Appeals
- Washington State Board of Industrial Insurance Appeals issues decision
- Worker appeals to higher court
- Higher court issues final decision
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