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PDFWAC 296-20-020

Acceptance of rules and fees.

The filing of an accident report or the rendering of treatment to a worker who comes under the department's or self-insurer's jurisdiction, as the case may be, constitutes acceptance of the department's medical aid rules and compliance with its rules and fees.
In accordance with RCW 51.28.020 of the industrial insurance law, when a doctor renders treatment to a worker entitled to benefits under the law, "it shall be the duty of the physician to inform the worker of his rights under this title and to lend all necessary assistance in making the application for compensation and such proof of other matters as required by the rules of the department without charge to the worker," a worker shall not be billed for treatment rendered for his accepted industrial injury or occupational disease.
The department or self-insurer must be notified immediately, when an unrelated condition is being treated concurrently with an industrial injury. See WAC 296-20-055 for specific information required.
When there is questionable eligibility, (i.e., service is not usually allowed for industrial injuries or investigation is pending, etc.) the provider may require the worker to pay for the treatment rendered.
In cases of questionable eligibility where the provider has billed the worker or other insurance, and the claim is subsequently allowed, the provider shall refund the worker or insurer in full and bill the department or self-insurer for services rendered using billing instructions, codes, and policies as listed in the medical aid rules and fee schedules.
Cases in which there is a question of medical ethics or quality of medical care, will be referred to the Washington state medical association's medical advisory and utilization review committee to the department of labor and industries for recommendations.
[Statutory Authority: RCW 51.04.020, 51.04.030 and 1993 c 159. WSR 93-16-072, § 296-20-020, filed 8/1/93, effective 9/1/93. Statutory Authority: RCW 51.04.020(4) and 51.04.030. WSR 86-06-032 (Order 86-19), § 296-20-020, filed 2/28/86, effective 4/1/86. Statutory Authority: RCW 51.04.020(4), 51.04.030, and 51.16.120(3). WSR 81-01-100 (Order 80-29), § 296-20-020, filed 12/23/80, effective 3/1/81; Order 76-34, § 296-20-020, filed 11/24/76, effective 1/1/77; Order 75-39, § 296-20-020, filed 11/28/75, effective 1/1/76; Order 74-39, § 296-20-020, filed 11/22/74, effective 1/1/75; Order 71-6, § 296-20-020, filed 6/1/71; Order 70-12, § 296-20-020, filed 12/1/70, effective 1/1/71; Order 68-7, § 296-20-020, filed 11/27/68, effective 1/1/69.]
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