Outline • Legal basis for WISHA • Background of WISHA • Structure and organization of L&I and WISHA
Section 1 The Legal Basis for WISHA
“The Pittsburgh Survey” • - the first industrial accident study was made in 1906 • It revealed an average of ten workers killed every week during the year • Records were kept on a calendar hung on the wall • Each X represents a worker fatality
This study showed that 500 workers were killed or maimed in Pittsburgh in one year. • Day by day count in Allegheny County alone shows 60 deaths in one month - - 2 2 1 1 4 1 5 4 2 2 - 1 2 3 4 1 5 - 1 1 2 4 - 4 - 1 3 3 1
The Effect of “Government Interference” Although there was concern by business about “government interference”, this chart shows the dramatic decline in fatalities after the enactment of the Federal Coal Mine Health & Safety Act of 1969.
The Williams-Steiger ActDecember 29, 1970 • Established OSHA & NIOSH The Occupational Safety & Health Agency (OSHA) adopts standards and enforces them through a system of inspections and fines and provides outreach to inform employers about regulations and how to comply with them. The National Institute for Occupational Safety and Health (NIOSH) is the Federal agency responsible for conducting research and making recommendations for the prevention of work-related disease and injury. The Institute is part of the Centers for Disease Control and Prevention.
OSHA 26 States State Plan 24 States Coverage Federal OSHA gave individual states an option for overseeing their own workplace safety. The states can elect to receive coverage by OSHA or establish their own plans. Currently 24 states including Washington as well as Puerto Rico and the Virgin Islands have their own programs.
Two Basic Elements • Federal OSHA authorized Washington to develop its own “State Plan” in lieu of having OSHA provide protection for Washington workers. • The Washington legislature enacted RCW 49.17, the WISH Act, authorizing L&I to draft safety and health rules which are subject to approval by the legislature as Washington Administrative Codes or WACs. LINK TO 49.17
WASHINGTONhas a “State Plan” • In 1973 Washington State Legislature enacted RCW 49.17, the WISH Act, giving L&I the authority over workplace safety and health regulations. • Under the act, employers must provide safe and healthful workplaces for their employees. L&I drafts the safety and health regulations for approval by the state legislature. State rules must be at least as effective as OSHA rules; but, in some cases, our laws are more stringent than OSHA’s. • WISHA Safety & Health Inspectors conduct inspections of workplaces to ensure that employers are in compliance with the laws. • The Revised Code of Washington (RCW) provides for right of entry during normal working hours for inspection purposes. • It also prohibits giving advance notice to employers of scheduled inspections.
Logging is one of the most hazardous industries in Washington State. In 1928, there was approximately one recorded logging fatality every three days. If you don’t believe that Worker Protection Laws save lives, just look at the comparison between then and now. Our goal is to reduce the number of fatalities and injuries to ZERO.
Excerpt from RCW 49.17 explaining the purpose of the RCW resulting from the Federal OSHA Mandate. RCW 49.17.010Purpose. The legislature finds that personal injuries and illnesses arising out of conditions of employment impose a substantial burden upon employers and employees in terms of lost production, wage loss, medical expenses, and payment of benefits under the industrial insurance act. Therefore, in the public interest for the welfare of the people of the state of Washington and in order to assure, insofar as may reasonably be possible, safe and healthful working conditions for every man and woman working in the state of Washington, the legislature in the exercise of its police power, and in keeping with the mandates of Article II, section 35 of the state Constitution, declares its purpose by the provisions of this chapter to create, maintain, continue, and enhance the industrial safety and health program of the state, which program shall equal or exceed the standards prescribed by the Occupational Safety and Health Act of 1970 (Public Law 91-596, 84 Stat. 1590).
How the law is put into effect:RCW 49.17.040 • “The director shall make, adopt, modify, and repeal rules and regulations governing safety and health standards for conditions of employment…” The term "director" means the director of the department of labor and industries, or his designated representative. Thus, whoever happens to be director at the time we need a new rule, need to change a rule, or need to remove a rule, is charged with that responsibility.
RCW 49.17.050Rules and regulations -- Guidelines -- Standards. This chapter provides a laundry list of the director’s responsibilities as the head of Labor and Industries. Click here to view the text of RCW 49.17.050
Section 2 How L&I Is Structured
Department of Labor and Industries Facts • Service locations throughout the state • 2,500 employees • Washington’s 3rd largest agency • 22 offices across the State • Services to 180,000 employers • Covers 2.1 million workers
Primary Responsibilities • Industrial Insurance, more commonly known as the Workers Compensation system or “Workers Comp.”, is the insurance system that covers workers who are injured while on the job. You’ll learn more about this later. • Specialty Compliance ensures public and worker safety, a qualified workforce through the apprenticeship program and a variety of consumer and worker economic protections. • Compliance, consultation and risk management promote occupational safety and health using standards and tools developed by different sections of the department.
Department of Labor and Industries Director Trades & Licensing Field Services Insurance Services WISHA Operations 5 divisions This is how the agency is broken down. There are five main divisions shown here under the Director and each will be discussed in the following slides.
Department of Labor and Industries Director Field Services Insurance Services Trades & Licensing Operations WISHA • Claims Administration • Employer Services • Self Insurance • Retrospective Rating • Actuarial Services • Crime Victims • Medical Director • Health Services • SHARP Let’s start with Insurance Services, the driving force of Labor and Industries. The following programs are under the jurisdiction of Insurance Services. A brief summary of each program follows.
Insurance Services • Insurances Services directs the seventh largest industrial insurance company in the United States. 70% - 75% of L&I’s employees are in this section.
Insurance Services • There are two separate programs that provide medical coverage for workers that are injured on the job. • The first and largest is the State Fund. Approximately 1.8 million Washington workers are covered by this fund. It works the way any insurance company does: employers and workers each pay money in the form of premiums. The premium rates are based on the type of work and the injury history of the employer. Under the State Fund, claims are managed by state employees using a pot of money from the premiums paid in. • The second program, Self-Insurance, covers approximately 600,000 workers. Self-Insured employers hire their own claims managers to manage their work related injury & illness claims. Their rates are determined by the employer. L & I monitors the Self-Insured company to ensure compliance with Washington laws and regulations.
Insurance Services Claims Administration • Think of this as the equivalent in all respects to a private insurance company. Claims Administration adjudicate approximately 180,000 claims annually. When a worker covered under Washington State Industrial Insurance suffers a job-related injury or illness -- or experiences permanent disability resulting from such injury or illness -- and files a claim, Claims Administration manages all aspects of the claim. • The claims manager coordinates with the injured worker’s attending physician and other providers to determine how bad the injuries or illnesses are, how those injuries or illness affects the worker’s ability to do their job, and the type and amount of care required. Based on that information, the claims managers compensate the providers and the workers for medical expenses, time loss and disability. • There are 26 separate units that adjudicate Industrial Insurance claims.
Insurance Services Employer Services • While Claims administration works primarily with workers, Employer services works primarily with the employers. • They generate the income needed to sustain the State Fund by assigning risk classifications and auditing employers to verify the correct reporting of worker hours for the various risk classification. • For example, they may audit a construction company’s payroll records to ensure they are reporting the correct risk classification for the number of workers engaged in high risk jobs. The premiums paid for the construction worker are higher than one of the company’s clerical workers.
Insurance Services Self-Insurance • Self-Insurance is a unique program in which the employer provides any and all appropriate benefits to the injured worker. It is a long-term obligation. The employer is responsible for the payment of benefits during the time a claim is open and remains liable for benefits during a lengthy reopening period provided in industrial insurance law. This remains the employer's responsibility whether the self-insurance certification is continued or surrendered. • Labor and Industries oversees the provision of benefits to ensure compliance with its rules and regulations and reviews the financial strength of the self-insurer to ensure that workers' compensation obligations can be met. • Approximately 400 of the State’s 180,000 employers roughly, (0.2%) with Approximately 30% of the workforce are self-insured. Some of the self-insured employers are Boeing, Safeway, Weyerhaeuser, Simpson Timber, School Districts, Nalley’s Fine Foods, etc.
Insurance Services Retrospective Rating (Retro) • An optional financial incentive program offered by the Department of Labor and Industries which rewards employers who minimize their industrial insurance losses. Qualifying employers can enroll on their own, or in group plans sponsored by various trade and professional organizations • Enrolling in Retro doesn't change an employer's quarterly premium payments to the department. There's no special "up-front discount". Rates and experience factors are determined just as they normally would be. You can think of Retro as simply an alternate way of calculating your premium-- after the fact.
Insurance Services Actuarial Services These are the money people. They determine the premium rates and predict future needs based on statistical information and historical data.
Insurance Services Crime Victims • Crime Victims is a secondary insurance program that provides financial, medical and mental health benefits to victims who suffer injuries or are killed during acts of criminal activities. • The fund pays the victims medical bills and provides monetary funds to the victims if they are unable to work because of their injuries. They also provide funds for retraining victims if they are unable to return to the type of job they were doing prior to their injuries. • If the victim dies as a result of their injuries, the victim’s beneficiaries may be entitled to compensation from the fund.
Insurance Services Office of the Medical Director • Their charter is to ensure that the medical care received by occupationally injured and ill workers is of the highest quality and meets national and community standards for safety and efficacy. • They are also tasked to address safety and quality of care issues crucial to the prevention and treatment of occupational injury, disease, and long-term disability by conducting research, providing medical consultation and education, and promoting guidelines and policy development and implementation. Health Services Analysis • Set fee schedules to determine how much providers can charge for treating injured workers. They also assure quality of health care provided to injured workers through worker’s compensation.
Insurance Services Safety & Health Assessment and Research for Prevention (SHARP) SHARP conducts research, monitoring, and demonstration projects that promote healthy work environments and the prevention of workplace injuries and illnesses. The remainder of L & I Department and Functions is in Part 2.