Reporting IW Healthcare Benefit Amounts

An injured worker’s time loss benefits are based on a percentage of their wages at the time of the injury.  Since 2001, the employer’s contribution to medical, dental, and vision benefits are to be factored in when calculating the injured worker’s monthly wage.  This is a result of the Washington Supreme Court ruling in Cockle vs. Department of Labor and Industries.  The court ruled that core, nonfringe benefits that are critical to protecting the worker’s basic health and survival at the time of injury must be included in the monthly wages.

Historically, the amount to be reported was the employer’s actual contribution to monthly healthcare benefits.  This changed with the implementation of the School Employees Benefits Board (SEBB) Program.  Effective January 1, 2020, standardized amounts for SEBB-covered employees were established, based on the benefits elected and family members covered.  Therefore, when reporting health care benefit amounts, rather than reporting the flat rate $1,000.00 per month that the employer pays into the program, it is important to report the amounts corresponding to coverages and family members elected.  This is because $1,000.00 per month is not a fair representation of the value of the benefits. 

A chart for use in reporting healthcare benefits for injured workers can be found here:  https://www.hca.wa.gov/sebb-benefits-admins/rates-information (Click on “Employer Payment for Heath Care Benefits – Cockle Rates”). 

Please report the amounts for the corresponding calendar year in which the injury occurred.  It is important to report the amounts for the coverage tier and family members elected by the employee.  (For example, if an employee waived medical benefits, you would report the appropriate dental and vision amounts only).  Additional examples for healthcare reporting can be found here:  https://www.hca.wa.gov/assets/perspay/SEBBCockleRateInstructions.pdf

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