Licensed caregivers:

1. (1) Must:

   1. (a) Contact the caregiver claims manager to request the claim appeal form for the third party damages, personal injuries, or emergency medical expenses;
   2. (b) Include the justification and alternatives explored when requesting exceptions to the terms, limitations, and exclusions; and
   3. (c) Submit the claim appeal forms to the caregiver claims manager within 30 calendar days of the notification of the final claim decisions from the department. If appeal requests are not received within 30 calendar days, the department will not review them;
2. (2) Cannot appeal the use of a private or public insurance policy available to them when the item is covered and reimbursable by their insurance policy. The department will not require them to use their insurance policy, but the reimbursement amounts will be determined as if they did, per WAC 110-50-0960; and
3. (3) Do not have the right to administrative hearings to challenge the denial of the appeals. The department will notify the licensed caregivers of the appeal decisions within 90 calendar days of receipt of the claim appeal.

[Statutory Authority: RCW 74.13.031 and 74.14B.080. WSR 26-09-128, s 110-50-0990, filed 4/21/26, effective 5/22/26.]