Group Retrospective Rating Program Participation Agreement
RECITALS:
- The Washington State Dental Association, hereinafter referred to as the “Association”, has petitioned the Department of Labor and Industries, hereinafter referred to as “L&I”, for enrollment in L&I’s Industrial Insurance Group Retrospective Rating Program, hereinafter referred to as the “Program.”
- In conjunction with the petition for enrollment in the Program, the Association has engaged the services of Employer Resources Northwest, hereinafter referred to as “ERNW”, for the purpose of providing program administrative, limited loss control and claims management services.
- The purpose of the Program is to:
a) Reduce the frequency and severity of industrial injuries suffered by employees of Members
b) Provide a professional claims management system for Members
c) Provide financial support to Members in the Program to help employees of Members safely return to work - Under the terms of this Agreement and as a condition of program participation, each enrolled participant, hereinafter referred to as the “Member”, is bound by a contractual obligation with the Association for claims management services.
NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS AND PROMISES HEREIN, THE PARTIES HERETO AGREE AS FOLLOWS:
- Participation by the Member. The Member agrees to participate in the Association’s group retrospective rating program under the terms and conditions set forth hereinafter.
- Acceptance by the Association. The Association agrees to accept the Member as a participant in the Program if the Member meets the eligibility requirements set forth hereinafter at paragraph 3 of this Agreement, and is subject to the various terms, requirements and conditions attached to such participation.
- Eligibility. The Association, in its sole, absolute, and complete discretion, shall determine Member eligibility for the Program, in addition to other criteria, a member must:
a) Be determined to be eligible for retrospective rating and inclusion in the Program by L&I.
b) All owners of the practice have been disclosed and are members in “good standing” with the Association and L&I, having paid all premiums, fees, dues, penalties and assessments owed.
c) The Member’s workers’ compensation performance and L&I payment history meet the standards as set forth by the Association. - Obligations of the Member. The Member agrees to:
a) Cooperate fully with ERNW in all matters pertaining to claims administration, loss prevention, loss control, including but not limited to:
i) immediately notify ERNW of any occurrence which could result in a workers’ compensation claim;
ii) providing any and all information and evidence related to any said claim;
iii) meeting with ERNW or L&I representatives as necessary for the purpose of investigating, defending, or resolving any said claim;
iv) appearing at any official meetings or hearings of L&I related to any said claim; and
v) actively assisting ERNW in efforts to return an injured employee to work.
b) Make a good-faith effort to act upon and implement loss prevention and loss control measures suggested by the Association, L&I and/or ERNW including offering an injured employee a light duty alternative if said light duty is reasonable under the circumstances.
c) Maintain their industrial insurance account at L&I in “good standing” through the timely payment of any and all premiums, penalties, fees and assessments due L&I.
d) Maintain membership in “good standing” with the Association, including the prompt payment of all dues, assessment and fees due the Association or the Program.
e) Participate in at least one (1) workers’ compensation in-person training offered by the Association every three (3) years.
f) Assume financial responsibility for legal, expert witness, and/or surveillance costs in the event that the Member deems that such services are necessary.
g) Accept the decision of the Association if it is determined that the Member has failed to comply with the requirements of paragraph 4 of this Agreement.
i) Said Member shall be deemed in default hereunder and shall no longer be eligible for program participation until such time as the Association reinstates said Member.
ii) Any Member deemed “in default” shall forfeit the right to participate in any refund adjustments for any Program plan year in which they participated. - Claims Management Services. The Association agrees to provide the following services, and may elect to do so through the engagement of a professional claim management firm:
a) Maintain records on each assigned Washington State claim and regularly manage and review all workers’ compensation claims which adversely affect the plan year results of the Member and the Association;
b) Represent the Member’s interest and take appropriate action to minimize charges against the Member’s L&I industrial insurance account;
c) Verify the facts surrounding each time loss claim and arrange for medical, vocational or other expert review as necessary;
d) Conduct interviews, and/or take statements from, the claimant, witnesses, medical providers, vocational counselors, and other experts or representatives as necessary;
e) Monitor the treatment programs of claimants as necessary;
f) Assist the Member in arranging claimant rehabilitation, retraining, or light duty as appropriate;
g) Provide regular statistical and narrative reports concerning the status of industrial insurance claims which impact Program results;
h) Provide services that are in compliance with Washington statutes and administrative codes;
i) ERNW shall not provide services that are deemed to be the practice of law. - Duration of Agreement / Termination of Participation.
a) This Agreement shall be effective as of the date of program enrollment and will remain in effect until canceled by the member as discussed in paragraph 6(d), or upon removal from the program by the Association.
b) For the purposes of this agreement the programs plan year starts on April 1st and ends on March 31st of each year.
c) The member will be automatically reenrolled into the program at L&I for subsequent program plan years unless the member cancels participation, as described in 6(d), or is removed from the program by the Association.
d) This Agreement may only be canceled by the Member at the end of any given plan year. The Member agrees to notify ERNW and the Association in writing prior to March 15th of the start of the next plan year of their desire to discontinue Program participation. - Limitation of Liability and Indemnification.
a) The Member agrees to hold the Association, its Board of Directors, its Business Development Committee, other Members and ERNW harmless from and against any and all claims, demands, losses, liabilities, obligations, damages, costs, and expenses (including reasonable attorney’s fees) resulting from or arising out of participation or denial of participation in the Association Group Retrospective Rating Program.
b) The Association, its Board of Directors, its Business Development Committee and ERNW makes no guarantees, warranties or assurances regarding any projected future group or individual refunds. As a party to this Agreement the Member acknowledges and understands that due to numerous factors any Program refund projections may change. - Confidentiality. The Association, its Board of Directors, its Business Development Committee, other Members, and ERNW shall not use confidential information about the Members other than for the purposes of administering and managing the Program.
- Direct Medical Payment. The program and participants shall abide by the terms and conditions of WAC 296-17, which prohibits the direct payment to medical service providers for medical services related to an industrial injury or occupational disease. Violation of this WAC provision may cause a participant’s removal from the program, and may bar the participant from participation in all future retrospective rating programs supervised by L&I. Payment of monthly direct fees made on behalf of employees to qualifying direct primary care service providers as permitted by RCW 48.150.050 does not disqualify the program or participant from participating in the program.
- Attorney Fees. If legal action is instituted to enforce any of the terms or provisions of this Agreement, the prevailing party shall be entitled to reasonable attorney’s fees and costs to be awarded by the court. It is agreed that the venue of any such legal action, regardless of which party to this Agreement may commence the same, shall be in the Superior Court of the State of Washington for King County.
- Prior Agreements. This Agreement and any attachments contain the entire understanding of the parties relating to the subject matter hereof and shall supersede any prior written or oral agreements or communications between the parties pertaining to the subject matter of this Agreement.
- Amendment. This Agreement shall not be amended except by a writing duly executed by each of the parties.
- Governing Law. This agreement shall be governed by and construed and enforced in accordance with the laws of the State of Washington.
