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PDFWAC 296-15-560

Self-insured third-party administrator (TPA) penalties.

(1) A TPA may be penalized under RCW 51.48.080 for deficiencies involving, but not limited to:
(a) Failure to maintain the requirements under WAC 296-15-425, 296-15-520, or 296-15-550. The penalty for the initial violation is five hundred dollars. The department may increase the amount up to one thousand dollars if the violation is a reoccurring problem.
(b) The department will not assess additional penalties under RCW 51.48.017 when a TPA:
(i) Promptly self-assesses;
(ii) Correctly calculates the amount of the penalty;
(iii) Reports to the department; and
(iv) Pays to the worker a penalty not to exceed the greater of one thousand dollars or twenty-five percent upon discovery of the delayed payment, unless the department determines there is a reoccurring issue or establishes additional benefits have been delayed.
(2) A TPA may be directed to obtain training when reoccurring problems are identified. A TPA who refuses to obtain the training for their staff may be penalized when their failure to obtain training results in subsequent rule or statutory violations.
[Statutory Authority: RCW 51.04.020, 51.32.190 and 2020 c 277. WSR 21-11-083, ยง 296-15-560, filed 5/18/21, effective 7/1/21.]
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