Washington State L&I vs. Self-Insured Workers’ Comp Claims

By Benjamin McCay, DC, CCSP

Published October 24, 2026

If you are injured at work in Washington, your workers’ compensation claim may be handled directly by Washington State L&I or by a self-insured employer and its claims administrator. Self-insured employers often use third-party administrators such as Sedgwick, CorVel, or TRISTAR to manage their workers’ compensation claims.

Both types of claims are part of Washington’s workers’ compensation system and are governed by the same basic state laws. The benefits available to an injured worker do not change simply because the employer is self-insured. What changes primarily is who manages the claim, where paperwork is sent, who makes many day-to-day claim decisions, and who pays the benefits.

Understanding which type of claim you have can make it much easier to know whom to contact when you need treatment authorized, have questions about time-loss compensation, want to change providers, or disagree with a decision.

What Is a State Fund L&I Claim?

Most Washington employers obtain workers’ compensation coverage through the Washington State Fund, which is administered by L&I. These employers pay workers’ compensation premiums into the State Fund, and L&I manages claims when their employees are injured.

When you have a State Fund claim, an L&I claim manager is assigned to the claim. L&I reviews medical information, makes decisions about benefits and treatment when authorization is required, issues formal claim orders, and pays approved workers’ compensation benefits.

A State Fund claim can be started online through L&I, by telephone, or through a health care provider. When the claim is filed through a provider, the worker and provider complete a Report of Industrial Injury or Occupational Disease, commonly called the Report of Accident (ROA).

What Is a Self-Insured L&I Claim?

Some employers have been approved by Washington State to provide workers’ compensation coverage themselves rather than purchasing coverage through the State Fund. These are called self-insured employers, and they are financially responsible for paying workers’ compensation benefits for their employees.

The employer may manage claims through its own claims department or hire an outside third-party administrator (TPA) to do the work.

A third-party administrator is a company hired by the employer to handle workers’ compensation claims. A TPA may communicate with the worker, provider, and employer and make many day-to-day decisions about the claim, but the claim is still subject to Washington workers’ compensation law and L&I oversight.

A self-insured claim is not outside the L&I system. L&I does not routinely manage the claim from day to day, but it oversees self-insured employers and can become involved when certain decisions or disputes require its involvement.

State Fund vs. Self-Insured Claims

Self-insured employers must follow the same Washington workers’ compensation medical rules and fee schedules used for State Fund claims. In other words, the basic L&I treatment rules do not change simply because your employer is self-insured.

How Do You File a Self-Insured Claim?

The filing process is one of the first noticeable differences between the two systems. With a State Fund claim, the worker can file directly with L&I or complete the Report of Accident through a health care provider.

With a self-insured claim, the worker reports the injury to the employer and completes a Self-Insurer Accident Report (SIF-2) provided by the employer. The medical provider completes a Provider's Initial Report (PIR) and sends it to the employer or its third-party administrator.

The same filing deadlines apply to State Fund and self-insured claims. An injury claim must usually be filed within one year of the injury. For most occupational disease claims, the two-year filing period begins when a physician or nurse practitioner gives the worker written notice that they have an occupational disease and may file a claim for disability benefits. That notice must also explain the two-year filing deadline.

Because a self-insured claim is filed through the employer rather than directly through L&I, it is especially important to tell both your employer and your health care provider that the condition occurred at work. Doing so helps make sure the correct claim paperwork is started and sent to the right place.

Do Self-Insured Workers Have Different Benefits?

Employees of self-insured businesses have the same basic workers’ compensation rights and responsibilities as other Washington workers. Depending on the circumstances of the claim, benefits may include medically necessary treatment for the accepted work injury, wage-replacement benefits when an injury prevents or limits work, permanent partial disability benefits when applicable, vocational services, and other benefits provided under Washington workers’ compensation law.

The basic claim process is often very similar to a State Fund claim. Medical records, Activity Prescription Forms, treatment authorization requests, and other documents are still sent to a claim manager. The main difference is that the claim manager works for the self-insured employer or its third-party administrator rather than for L&I.

Who Makes Decisions on a Self-Insured Claim?

With a self-insured claim, the employer or its third-party administrator handles most of the day-to-day claim decisions. This includes deciding which medical conditions it recognizes as related to the work injury, authorizing treatment, and paying benefits.

If the claim involves medical treatment only and no wage-replacement benefits, the self-insured employer can accept and manage the claim without L&I issuing a separate allowance order. These are often referred to as medical-only claims.

L&I becomes more directly involved in certain situations. If the employer wants the entire claim denied, it must ask L&I to review the claim and decide whether denial is appropriate. For an accepted claim, the self-insurer must request an allowance order from L&I when time-loss or loss-of-earning-power benefits are paid. This requirement also applies when the employer continues paying salary instead of time-loss benefits.

L&I can also become involved when a worker or medical provider disagrees with a decision made by the self-insured employer or TPA. For example, if there is a dispute over whether a medical condition should be included in the claim, the worker or provider can ask L&I to review the issue.

What Changed for Self-Insured Claims in 2026?

Effective January 1, 2026, Washington expanded its good faith and fair dealing requirements to all self-insured employers and the third-party administrators handling their claims. These specific protections previously applied only to certain groups of workers. The expanded protections apply to claims regardless of when the injury occurred.

The expansion followed concerns raised in legislative testimony about delayed medical treatment, delayed benefit payments, misleading communications, and workers struggling to obtain benefits they were entitled to. Under RCW 51.14.180, employers and TPAs must give equal consideration to the worker’s interests when handling a claim. They cannot pressure a worker to accept less compensation than the law provides. The statute excludes errors or delays that are inadvertent or minor from being considered violations of this duty.

Workers who believe an employer or TPA has violated this duty can submit a written complaint to L&I. L&I must investigate the alleged violation and determine whether the law was violated. A finding of a violation requires a financial penalty for the worker’s benefit. The Office of the Ombuds can help workers understand their rights and raise concerns about how their claim is being handled.

Repeated violations can also lead to corrective action and, under specified circumstances, loss of the employer’s permission to remain self-insured. TPAs can face suspension or revocation of their license to administer self-insured claims in Washington. Under existing state licensing rules, those consequences may follow continued noncompliance and failure to correct deficiencies within the time required by L&I.

What If You Disagree With a Self-Insured Employer or TPA?

It is usually best to first try to resolve the issue with the employer or its third-party administrator. Sometimes a problem results from missing medical records, an unanswered request, or information that has not yet reached the claim manager.

If the problem cannot be resolved, the worker or medical provider can ask L&I to intervene. This may be appropriate when you disagree with a claim-related decision or believe the self-insured employer is delaying or failing to take required action.

If you ask L&I to review the issue, the dispute should be submitted in writing and should include the worker's name, claim number, the decision or delay being disputed, and any records or other information that support your position. L&I can review the dispute and issue a formal decision when appropriate.

Do Deadlines Still Apply?

Yes. Workers should pay close attention to letters about their claim, whether they come from L&I, the employer, or a third-party administrator.

Certain notices from a self-insured employer or TPA instruct the worker to ask L&I to review a disputed action in writing within 60 days. These notices may address treatment, accepted conditions, or wage-replacement benefits. Follow the instructions in the notice if you disagree.

Formal L&I orders and self-insurer claim closure orders have specific protest or appeal requirements. Most L&I orders have a 60-day deadline, but some decisions have shorter deadlines. A self-insurer's closure order can also become final if it is not protested within the required time.

Read the instructions on the particular letter or order, including where to send your response and when it must be received. Contact the claim manager or L&I promptly if you need help understanding it. A phone call does not replace a required written protest or appeal, and discussing the problem with the claim manager does not extend the deadline.

Can You Still Choose Your Own Doctor?

Being employed by a self-insured employer does not eliminate your right to choose your health care provider. The same general provider-choice rules apply whether the claim is State Fund or self-insured.

For ongoing care in Washington, your attending provider must participate in the L&I Medical Provider Network and must be qualified to treat the work-related condition. Medical Provider Network requirements apply to self-insured claims as well.

An employer may recommend an occupational medicine clinic or another provider, but self-insured status does not give the employer the right to select your treating provider for you. Provider choice and transfer-of-care rules are discussed more fully in our article on choosing or changing your doctor after a Washington work injury.

Does a Self-Insured Employer Follow Different Medical Treatment Rules?

Self-insured employers are required to follow Washington's workers’ compensation medical rules. The same general L&I treatment rules apply whether your claim is State Fund or self-insured.

For a State Fund claim, medical bills go to L&I. Depending on the service, treatment authorization requests may go to L&I or its utilization review contractor, Comagine. For a self-insured claim, providers send bills to the employer or TPA and follow its process for requesting treatment authorization.

Services such as certain MRIs and surgeries require prior authorization. Your provider can help identify where the request should be sent and what medical information is needed to support it.

How Can You Tell Whether Your Employer Is Self-Insured?

Your employer should be able to tell you whether it is self-insured. L&I also maintains a searchable list of Washington self-insured employers and their claims contacts.

If your work is covered by Washington's workers’ compensation system and your employer is not self-insured, the claim falls under the Washington State Fund. If the employer is self-insured, L&I's listing can help identify the appropriate employer or third-party administrator contact information.

Knowing this at the beginning of the claim can prevent paperwork from being sent to the wrong place. It can also help you know whom to contact when you have questions about treatment, benefits, or claim paperwork.

Where Can You Get Help With a Self-Insured Claim?

For day-to-day questions, your first contact will usually be the self-insured employer's claim manager or TPA. If a problem cannot be resolved with the claims administrator, workers can contact the L&I Self-Insurance Program at 360-902-6901 and ask for the L&I claim adjudicator assigned to the claim.

A claim adjudicator is the L&I staff member who handles questions and disputes involving the self-insured claim. That person may be able to explain L&I's role, review a disputed issue, or tell you what additional information is needed.

Washington also has an Office of the Ombuds for Injured Workers of Self-Insured Employers, which operates independently of L&I and advocates for injured workers employed by self-insured companies. The Ombuds office can provide information, explain workers’ rights, help workers navigate the claim process, and investigate complaints about how a claim is being handled.

What This Means for Your Claim

State Fund and self-insured claims provide workers with the same basic workers’ compensation protections, but they are managed differently. With a State Fund claim, L&I directly manages the claim and pays the benefits, while with a self-insured claim, the employer or its third-party administrator handles most day-to-day claim management and the employer pays the benefits.

Self-insured does not mean the employer operates its own separate workers’ compensation system. Self-insured employers must still follow Washington workers’ compensation law and L&I medical rules, and L&I can become involved when certain formal decisions or disputes require it.

Knowing who is responsible for each part of the process can make a complicated workers’ compensation claim easier to navigate. It also helps you know where to turn when you have questions or disagree with a decision.