Chapter 14.04
WORKERS’ COMPENSATION ORDINANCE
Sections:
14.04.100 Insurer’s obligation.
14.04.110 Extra-territorial coverage.
14.04.130 Appeal to Tribal Court.
14.04.010 Purpose.
This chapter establishes a workers’ compensation program for employees of the Tribe. Its purpose is to provide coverage for employees of the Tribe who are injured on the job, to the exclusion of the program adopted and administered by the State of Washington. This chapter is adopted in order to provide, regardless of fault, medical treatment for injured workers, and income to them and their dependents; to restore injured workers physically and economically to a self-sufficient status; and to provide a system to administer the program and resolve any disputed claims that arise under it. [Res. 301297 (12/30/97); prior code § 14.01.010]
14.04.020 Coverage.
This chapter is applicable to and covers all employees and all parts of the Tribal government, including all departments, divisions, and programs of the Tribe, governmental corporations created by the Tribe, and the Tribe’s business enterprises. The coverage of this chapter includes, but is not limited to: all of the departments of Tribal government; administrative offices and staff; Chief Leschi Schools; the Puyallup Nation Health Authority; the Permanent Trust Fund Board; Chinook Landing Marina; Emerald Queen Casino; the Puyallup Nation Housing Authority; Marine View Ventures, Incorporated (MVV) and its business enterprises. This chapter does not apply to lessees or sublessees of the Tribe or MVV. [Amended during 2010 recodification; Res. 301297 (12/30/97); prior code § 14.01.020]
14.04.030 Exclusive remedy.
The right to receive compensation under this chapter for injuries sustained by a covered employee shall be the exclusive remedy available to the employee, and to anyone claiming through the employee, against the Tribe, all of its departments and programs, and the employees thereof, except as otherwise provided herein. To that end, all civil causes of action against the Tribe and its employees arising from such personal injuries or death and the jurisdiction of all courts over such causes of action are hereby abolished and barred, except as provided by this chapter. [Res. 301297 (12/30/97); prior code § 14.01.030]
14.04.040 Jurisdiction.
In order to provide substantive law on which the workers’ compensation program will be based, this chapter adopts by reference certain provisions of the Revised Code of Washington and the Washington Administrative Code. The sole purpose for adopting those provisions is to provide substantive standards of Tribal law on which basis the Tribe, its insurer, and the Tribe’s decision-making bodies shall determine the eligibility of employees, appropriate levels of compensation, and other related issues. Nothing in this chapter, including the adoption of certain provisions of Washington law, shall create, provide, or recognize any jurisdiction of any state agency or official. Jurisdiction to administer and enforce this chapter lies exclusively with the Tribe, including the Puyallup Tribal Court, as indicated in this chapter. [Res. 301297 (12/30/97); prior code § 14.01.040]
14.04.050 Sovereign immunity.
Nothing in this chapter and nothing in the Tribe’s adoption of certain provisions of Washington law shall in any manner work as a waiver of the Tribe’s sovereign immunity or of the protection from suit provided by that immunity, except that this chapter shall operate as a limited consent by the Tribe to the enforcement of the rights created by this chapter, but only to the extent and under the procedures provided by this chapter. [Res. 301297 (12/30/97); prior code § 14.01.050]
14.04.060 Definitions.
(a) “Claimant” shall mean a person who has applied for benefits under this chapter.
(b) “Employee” shall mean every person in the service of the Puyallup Tribe, elected, appointed, or hired, and carried on the payroll of the Tribe, including all employees of the entities of the Tribe described in PTC 14.04.020.
(c) “Insurance policy” shall mean the policy of insurance provided by contract between the Tribe and the insurer for the provision of workers’ compensation benefits.
(d) “Insurer” shall mean the insurance company with whom the Tribe has contracted to furnish the coverage provided in this chapter.
(e) “Tribe” shall mean the government of the Puyallup Tribe of Indians, including all entities of the Tribe as described in PTC 14.04.020.
(f) “Worker” shall have the same meaning as “employee” when the context so indicates. [Res. 301297 (12/30/97); prior code § 14.01.060]
14.04.070 Notification.
(a) Any employee who suffers an injury on the job shall notify his/her supervisor and shall send, on the form provided by the Tribe’s Human Resources Office, notification to the insurer. The Human Resources Office shall also send notification to the insurer. As between a claimant and the insurer, the insurer shall be deemed to have notice of the claim when the employee gives notice to her/his supervisor.
(b) As provided in RCW 51.28.050 and 51.28.055, respectively, no application shall be valid or claim enforceable, for benefits under this chapter, unless filed within one year after the date following the date upon which the injury occurred or within two years following the date the employee had written notice from a physician of an occupational disease or infection. [Res. 301297 (12/30/97); prior code § 14.01.070]
14.04.080 Substantive law.
There is hereby adopted, as substantive law of the Tribe, the provisions of the following sections of the Revised Code of Washington, with the modifications indicated, and as they may be modified in the future by the Washington Legislature; provided, however, that any modification to any of these provisions made in the future by the Washington Legislature shall become a part of this chapter only after review and approval by the Puyallup Tribal Council. Interpretations of those sections issued by the courts of the state of Washington or by the Washington Department of Labor and Industries shall be followed by the insurer and by the Tribal Court except in cases where significant Tribal policy considerations call for a different conclusion.
(a) RCW 51.04.070.
(b) The following sections of Chapter 51.08 RCW: 51.08.013, 51.08.015, 51.08.018, 51.08.020, 51.08.030, 51.08.050, 51.08.095, 51.08.100, 51.08.110, 51.08.140, 51.08.150, 51.08.160, and 51.08.178.
(c) The following provisions of Chapter 51.24 RCW; provided, that the term “department,” wherever it appears, shall be deleted and placed with the words “Tribe and/or its insurer”: 51.24.020, 51.24.030, 51.24.040, 51.24.050, 51.24.060, 51.24.070, 51.24.080, 51.24.090, and 51.24.100.
(d) The following sections of Chapter 51.28 RCW; provided, that the term “department,” wherever it appears, shall be deleted and replaced with the word “insurer”: 51.28.010, 51.28.020, 51.28.025, 51.28.030, 51.28.040, 51.28.050, 51.28.055, 51.28.060, and 51.28.070.
(e) The provisions of Chapter 51.32 RCW, with the exception noted below; provided, that the term “employer,” wherever it appears, shall be deleted and replaced with the word “Tribe,” and the terms “department” and “director,” wherever they appear, shall be deleted and replaced by the word “insurer”; and further provided, that the following provisions of Chapter 51.32 RCW are not adopted: 51.32.030, 51.32.073, 51.32.075(1) and (2), 51.32.140, 51.32.185, 51.32.190, 51.32.195, 51.32.200, 51.32.210, 51.32.242, 51.32.300, 51.32.360, 51.32.370 and 51.32.380; and provided further, that in RCW 51.32.215, the words, “in a state fund claim” are deleted; and provided further, that the regulations referred to in RCW 51.32.350 are adopted herein.
(f) The following sections of Chapter 51.36 RCW; provided, that the terms, “department” and “director,” wherever they appear, shall be deleted and replaced by the word, “insurer”: 51.36.010, 51.36.015, 51.36.030, 51.36.040, 51.36.060, 51.36.070, and 51.36.080. [Amended during 2010 recodification; Res. 301297 (12/30/97); prior code § 14.01.080]
14.04.090 Employment records.
The Tribe will provide to the insurer such records of employment as are necessary for the insurer to determine the eligibility of employees and to compute entitlements to compensation under this chapter. [Res. 301297 (12/30/97); prior code § 14.01.090]
14.04.100 Insurer’s obligation.
(a) The insurer shall pay the benefits provided by this chapter notwithstanding the Tribe’s sovereign immunity from suit.
(b) In return for the payment of benefits as provided in this chapter, the insurer shall be subrogated to the claimant’s right to recover from any third party who caused or contributed to the injury that resulted in the payment of benefits.
(c) The insurer shall be subject to the jurisdiction of the Tribe, including the Puyallup Tribal Court, for the purpose of enforcing the insurer’s obligations under the insurance policy. The insurer shall be bound by decisions made by the Puyallup Tribal Court and by other agencies of Tribal government exercising their lawful authority pursuant to Tribal law.
(d) The default, bankruptcy, or insolvency of the Tribe shall not relieve the insurer of its duties under this chapter or its duties under the insurance policy.
(e) The insurer is directly and primarily liable to any person entitled to benefits payable under the insurance policy. Those persons and/or the Tribe may enforce the duties of the insurer under the insurance policy.
(f) Terms of the insurance policy that conflict with this chapter are deemed modified to conform to and comply with this chapter.
(g) The insurer’s right to cancel the insurance policy shall be deemed modified to provide that the insurer shall not cancel the insurance policy until reasonable time has been provided for the Tribe to make other arrangements for workers’ compensation coverage, either with another insurance provider or with the Department of Labor and Industries of the State of Washington.
(h) Any dispute between the Tribe and the insurer arising out of or in relation to the insurance policy shall be settled by arbitration, or as otherwise provided in the insurance policy, in the jurisdiction of the Tribe. [Res. 301297 (12/30/97); prior code § 14.01.100]
14.04.110 Extra-territorial coverage.
(a) If an employee, while working or traveling at a location off of the property of the Tribe, including locations outside the Puyallup Indian Reservation, suffers an injury on account of which he or she, or his or her beneficiaries, would have been entitled to compensation under this chapter had such injury occurred on property of the Tribe, such employee, or his or her beneficiaries, shall be entitled to compensation under this chapter.
(b) The payment or award of compensation or other recoveries, including settlement proceeds, under the workers’ compensation law of another jurisdiction to a claimant or his or her beneficiaries otherwise entitled on account of such injury to compensation under this chapter shall not be a bar to a claim for compensation under this chapter. If compensation is paid or awarded under this chapter, the total amount of compensation or other recoveries, including settlement proceeds, paid or awarded the claimant or beneficiary under such other workers’ compensation law shall be credited against the compensation due the claimant or beneficiary under this title.
(c) If the Tribe shall enter into an agreement with the State of Washington concerning administration of workers’ compensation programs, including provisions with respect to conflicts of jurisdiction and the assumption of jurisdiction, it shall be binding on employees and on the insurer. [Res. 301297 (12/30/97); prior code § 14.01.110]
14.04.120 Initial appeal.
Any claimant aggrieved by a decision of the insurer denying eligibility or determining compensation to which the claimant is entitled shall have the right to appeal through the administrative process established by the insurer for that purpose. The insurer shall adopt, and provide to the Tribe and to each claimant, rules and procedures for the conduct of such appeals. [Res. 301297 (12/30/97); prior code § 14.01.120]
14.04.130 Appeal to Tribal Court.
Any claimant aggrieved by a decision of the insurer concerning eligibility for benefits, the amount of any compensation to which the claimant is entitled, reasonable attorneys’ fees or any other issue related to benefits under this chapter shall have the right to appeal any determination made by the insurer on an initial appeal to the Puyallup Tribal Court.
(a) Notice of an appeal to the Tribal Court shall be effective only if it is filed with the Clerk of the Court and a copy served on the insurer within 30 days after the final decision on the initial appeal is mailed to the claimant, and only if the claimant has first pursued to a determination an initial appeal as provided in PTC 14.04.120.
(b) The claimant shall include in his/her notice of appeal a short statement of the issues raised by the appeal or the grounds upon which the appeal is based.
(c) Upon receipt of a notice of appeal, the insurer shall provide to the Court, with a copy to the claimant, copies of all papers submitted by the claimant or considered by the insurer in the administrative appeal. Deadlines for further submissions by the insurer and the claimant shall be as provided in the Tribe’s Civil Procedures Code (Chapter 4.08 PTC), Judicial Code (Chapter 4.16 PTC), and other applicable law.
(d) On appeal, the Court will consider only those issues addressed during the initial appeal and included in the claimant’s notice of appeal. The hearing shall be de novo, but the Court shall not receive evidence or testimony other than that submitted during the initial appeal, except that the claimant may submit, and the insurer may rebut, evidence to support any claim or irregularity in the manner the initial appeal was conducted.
(e) The Court shall determine any of the following issues that were presented by the appeal: whether the claimant is or continues to be eligible for benefits or for additional benefits; whether the insurer’s determination of benefits for which the claimant is eligible was or still is correct; whether there was any irregularity in the manner the initial appeal was conducted; whether attorneys’ fees fixed by the insurer are reasonable and appropriate; any issue that arises under this chapter or under the provisions of the Revised Code of Washington incorporated into this chapter by PTC 14.04.080.
(f) In an appeal to Tribal Court under this section, the burden of proof shall be on the claimant. [Res. 301297 (12/30/97); prior code § 14.01.130]
14.04.140 Attorneys’ fees.
(a) It shall be unlawful for an attorney engaged in the representation of any claimant or beneficiary to charge for services related to benefits under this chapter any fee in excess of a reasonable fee, of not more than 30 percent of the increase in the award secured by the attorney’s services. Such reasonable fee shall be fixed by the insurer for services performed by an attorney for such claimant or beneficiary if written application therefor is made by the attorney, claimant or beneficiary within one year from the date the final decision of the insurer is communicated to the party making the application.
(b) If, on appeal to the Tribal Court from a decision of the insurer, said decision is reversed or modified and additional relief is granted to a claimant or beneficiary, a reasonable fee for the services of the attorney shall be fixed by the Court and paid by the insurer. [Res. 301297 (12/30/97); prior code § 14.01.140]