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(Effective until January 1, 2023)

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, § 296-15-560, filed 5/18/21, effective 7/1/21.]
(Effective January 1, 2023)

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. Beginning July 1, 2023, as authorized by RCW 51.48.095, this penalty will be adjusted for inflation every three years based on the consumer price index (Seattle, Washington area for urban wage earners and clerical workers, all items compiled by the Bureau of Labor Statistics of the United States Department of Labor) and posted to the L&I website.
(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 $1,000 or 25 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 and 51.16.035. WSR 22-21-117, § 296-15-560, filed 10/18/22, effective 1/1/23. Statutory Authority: RCW 51.04.020, 51.32.190 and 2020 c 277. WSR 21-11-083, § 296-15-560, filed 5/18/21, effective 7/1/21.]
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