September 19, 2021

Volume XI, Number 262

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New TPA Law Governing Workers Compensation in Washington State

Washington has recently adopted legislation (Substitute House Bill 2409 that established Revised Code of Washington 51.14.179) that will impose new licensing and other regulatory requirements on workers compensation Third Party Administrators (“TPAs”) that contract with one or more self-insured employers to handle their claims.  Specifically, effective July 1, 2021, all TPAs administering workers compensation business for self-insured employers must be licensed by the Washington State Department of Labor and Industries (“Washington DLI”). Per the Washington DLI, such self-insured employers have used TPAs for a long time in Washington, but this is the first time there will be a requirement to obtain a TPA license.

To become eligible for a TPA license with the Washington DLI, a business entity must:

  • Be licensed to conduct business in Washington by holding a business license from the Washington Department of Revenue.

  • Demonstrate to the Washington DLI’s satisfaction that it can meet the requirement for handling claims under Washington’s laws.

  • Comply with the reporting requirements for TPAs under Washington law.

  • Provide a list of the self-insured employers in Washington for which the TPA is under contract to handle claims.

  • Provide a list of the TPA’s certified claims administrators. Claims administrators are the individuals managing the claims for the self-insured employers.

    • Historically in Washington, only one claims administrator at each location was required to be certified by the Washington DLI. Effective July 1, 2021, all claims administrators will need to be certified or in the process of becoming certified.

    • The process to become certified as a claims administrator is outlined in the Washington Administrative Code and includes having a certain amount of experience in the administration or oversight of workers compensation claims or completion of a training program or curriculum and also includes taking a certification test with the Washington DLI.

The Washington DLI is finalizing the TPA license application materials and expects to distribute them soon.  According to the Washington DLI, if a TPA does not obtain a TPA license by July 1, 2021, it will not be authorized to manage workers compensation claims for self-insured employers in the state of Washington.

Click here to view the PDF. 

© Polsinelli PC, Polsinelli LLP in CaliforniaNational Law Review, Volume XI, Number 126
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About this Author

Steven L. Imber, Polsinelli PC, Insurance Regulatory Attorney, Enforcement Actions Lawyer,
Shareholder

Steve Imber chairs Polsinelli's Insurance Business and Regulatory group.  As a former General Counsel at a state insurance department, Steve Imber has the knowledge and experience to provide quality counsel to insurers, third party administrators, insurance agencies, medical discount plans and other insurance regulated entities. His practice includes representing and assisting clients on multi-state and national licensing projects, research projects, enforcement actions, market conduct examinations, audits and compliance programs and various other regulatory and...

913.234.7469
Counsel

Jennifer Osborn Nix works diligently for insurance companies, third-party administrators, and other regulated entities to further their goals and help them remain compliant within the 50-state regulatory scheme. She focuses on insurance regulatory and compliance issues, with a primary emphasis on life and health insurance matters.

Jennifer works with many regulated entities, including many in the health care sector, who rely on her for research, advice, strategic counsel, and licensing.

913.234.7472
Shareholder

Justin Liby has a talent for organizing and managing large national and multi-state licensure and research projects. This knack provides him with a solid foundation for crafting and implementing sound, efficient strategies that achieve success for his clients. Justin concentrates his efforts on helping the insurance industry navigate the formidable federal and state regulatory maze to achieve the industry’s business needs. He stays current in the insurance industry's evolution, as well as the legislation and regulatory activity impacting the industry.

...
913-234-7427
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