April 16th 2024
Your LEOFF I Healthcare Benefits
What Are They And Who Decides
Joe Fischnaller | Published 10/27/2010 | Medical Benefits
BY J.E. FISCHNALLER
I think that we would all agree that Plan 1 of the Washington Law Enforcement Officers and Firefighters Benefit Act (LEOFF I) is a great benefit system. It provides LEOFF I members with a whole host of specific benefits which are unequaled, either in the private sector, or in other public employment.
After pensions, perhaps the most important aspect of your LEOFF I benefit package is the comprehensive medical benefit that the Act provides for members. The purpose of this article is to help you understand exactly what your healthcare benefits are, and how to be sure that you are receiving everything you are entitled to. Before we begin, however, let me just say that in recent years, your LEOFF I benefits have come under attack on a number of fronts. If it had not been for the and the generous financial support and assistance of the Retired Fire Fighters of Washington
(RFFOW) and similar organizations, you might well not have the same right to healthcare benefits that you enjoy today. RFFOW has, over many years, provided funding and much needed support for several important lawsuits which have served to defend and even strengthen your healthcare benefits under LEOFF I.
Many of these battles have been hard fought, and might not have won but for the assistance of RFFOW and its Officers. With that said, let's talk about how you can find out exactly what healthcare benefits you are entitled to and be certain that you are receiving all of the healthcare services to which you are entitled by virtue of your years of faithful service.
As a LEOFF I member, you are entitled to two broad kinds of medical services. I like to refer to these two general categories of medical services as Mandatory medical services and Optional medical services. RCW 41.26.030(19), a portion of the LEOFF Act, sets forth a detailed list of medical services which the statute says are the "minimum services" that must be provided for all LEOFF I members and paid for by their employers or former employers. These "minimum services" are what I call the Mandatory medical services, because you have an absolute right to any of these services that you need.
In addition to these Mandatory medical services, you are also entitled to certain additional medical services, over and above those set out in RCW 41.26.030(19). I call these additional healthcare services Optional because your Disability Board has the option of either allowing of denying your access to these additional services, and may choose to place various restrictions on your use of or access to such additional medical services. Your local Disability Board has the authority to control access to these additional medical services by virtue of RCW
41.26.150(1)(b), which gives these boards the power to "designate the medical services available" to a member. These Disability Boards do not have the power to refuse you any of the medical services listed in RCW
41.26.030(19) as long as you need the service in question. They may, however, designate additional medical services that are available to you.
Many Disability Boards provide comprehensive dental, vision, hearing, and other healthcare programs that might not be available without the Board's exercise of its discretion to make such services available to the members under their jurisdiction. So, how do you insure that you are getting all of the healthcare benefits to which you are entitled? It is very simple. First, you should obtain a copy of RCW
41.26.030(19), and read it to familiarize yourself with exactly which medical services are Mandatory and must be provided to you and paid for by your present or previous LEOFF I employer. Then contact your Disability Board, and ask that they provide you with a copy of the Board's Rules and Regulations. Note that your Board may call this document by another name; but it is the document that contains the policies and procedures of the Board.
With only these two documents, RCW 41.26.030(19) and your Board's Rules and Regulations, you should be able to gain a very good understanding of the exact nature and extent of the healthcare benefits provided for you by the LEOFF Act. You should also be aware that, if your Disability Board approves a medical bill, and your employer fails or refuses to pay the bill or reimburse you for it, you have a right to sue the employer and recover not only the amount of the bill, but your attorney's fees, as well.
In the event that you have trouble obtaining a copy of RCW 41.26.030(19), you may want to call Dick Warbrouck, the President of the Retired Fire Fighters of Washington. I am sure that he can help you in this regard, and he is someone that you should get to know in any event. He has a great deal of knowledge about the system.
In the event that you have specific questions about any aspect of the LEOFF law, whether dealing with healthcare benefits or any other issue, you may call me, Joe Fischnaller
ABOUT THE AUTHOR: Joe Fischnaller is an attorney who has successfully handled literally thousands of LEOFF related cases, and is responsible for most of the favorable Court of Appeals and Supreme Court decisions in this area of the law. He is no doubt, the most experienced LEOFF I attorney in Washington. He can beat (206-930-1818), and I will be glad to answer any questions you may have.