This chapter is intended to establish procedures to administer and define the Tribes’ self-administered workers’ compensation program, in a manner that is fair to both employees and the Tribes. All work-related injuries and deaths sustained by employees of the Tulalip Tribes and its enterprises are withdrawn from private controversy. To guarantee relief for employees killed or injured on the job and their families, regardless of questions of fault and to the exclusion of every other remedy, proceeding, or compensation, the following plan is adopted, which shall be known as the Tulalip Tribes workers’ compensation plan. The plan shall serve as the exclusive remedy for the injured employee, except as otherwise provided herein, and to that end all civil causes of action for such personal injuries or deaths and all jurisdictions of the Courts are hereby abolished.
(Ord. 108 § 108.1.1, 10-6-2006 (Res. 2006-312))
This chapter shall apply to the Tulalip Tribes, every entity of the Tribes that is an employer, and to all employees of the Tribes and its entities. For purposes of this chapter, “every entity of the Tribes” includes every political subdivision, subordinate organization, economic enterprise, commission, and authority organized under Tribal law, including but not limited to the Tulalip Utility Authority and the Tulalip Gaming Organization.
(Ord. 108 § 108.1.2, 10-6-2006 (Res. 2006-312))
Except as expressly provided in this chapter, the Tulalip Tribes shall be immune from all liability for compensation for injuries sustained by Tribal employees arising out of and in the course of their employment.
(1) 
Limited Waiver for Claims Under This Chapter. For those claims outlined herein, this chapter contains a strictly limited waiver for suit only and solely in Tribal Court. This limited waiver shall extend only to Tribal employees and other persons specifically entitled to benefits under this chapter, and shall not be construed to apply or extend to actions by any other party or actions beyond the scope of this chapter.
(2) 
No Modification to Existing Law. Except as specifically provided in this chapter, the provisions herein shall not be construed as modifying or restricting the immunity of the Tribes from tort liability as it existed on the date of enactment. Except as to claims that are wholly covered by the Tulalip Tribes workers’ compensation plan, nothing in this chapter, or in any State law incorporated herein by reference, shall in any way waive or diminish the sovereign immunity of the Tulalip Tribes.
(Ord. 108 § 108.1.3, 10-6-2006 (Res. 2006-312))
Any employee who has sustained an injury in the course of their employment shall immediately report the injury to the employer in accordance with TTC § 9.15.330. In the case of an occupational disease, the employee shall report the condition to the employer immediately after the employee learns of, or reasonably should have been aware of, the connection between their employment and the occupational disease. All reports of injury and occupational disease shall be made in writing, in accordance with TTC § 9.15.330.
(Ord. 108 § 108.1.4, 10-6-2006 (Res. 2006-312))
The right to receive compensation pursuant to this chapter for injuries sustained by a covered worker shall be the exclusive remedy against the Tribes and employees thereof, except as otherwise provided herein, and to that end, all civil causes of action against the Tribes and its employees for such personal injuries or death, all jurisdictions of the Courts, and all claims for contribution or indemnity asserted by third persons from whom damages are sought on account of such injuries, are hereby abolished.
(Ord. 108 § 108.1.5, 10-6-2006 (Res. 2006-312))
(1) 
Workers’ Compensation Committee.
(a) 
Membership. There is hereby established a Tulalip Workers’ Compensation Committee, whose responsibility it shall be to administer the plan and to act as the first level of review in the case of a disputed claim. The Committee shall be composed of six members, one of which shall serve as Chairperson of the Committee. The Committee shall include one representative from the Tribal government, one representative from Quil Ceda Village, one representative from the Legal Department, one representative from the Finance Department, and two representatives from the Tulalip Gaming and Hospitality Organization. The Committee Chairperson and members shall be appointed by the Tulalip Board of Directors for terms of three years. Vacancies occurring due to resignation, removal, or death shall also be filled by this method of appointment. The Board of Directors may remove any member of the Committee for cause. A majority of the Committee members shall constitute a quorum, and a majority of those members present and constituting a quorum must concur in order for any decision of the Committee to be valid.
(b) 
Functions, Duties, and Authority. The Workers’ Compensation Committee shall:
(i) 
Contract with a professional claims administration firm to handle the duties of the Claims Administrator, as provided in subsection (2) of this section. The Committee may review and approve key actions taken by the Claims Administrator to ensure compliance with this chapter.
(ii) 
Establish and promulgate rules governing the administration of this chapter.
(iii) 
Purchase stop loss insurance covering all claims arising under this chapter in excess of those covered by the Tribal fund.
(iv) 
Hear protests from decisions of the Claims Administrator as provided in Article V of this chapter.
(v) 
Consult with outside physicians having medical expertise related to the injury, when necessary.
(vi) 
Manage the Tribal fund as provided in Article VI of this chapter.
(vii) 
Submit annual reports to the Board of Directors as provided in Article VI of this chapter.
(2) 
Claims Administrator.
(a) 
Appointment. The Workers’ Compensation Committee shall contract with a third party administrator to serve as the Claims Administrator.
(b) 
Functions, Duties, and Authority. The Claims Administrator shall:
(i) 
Supervise medical, surgical, and hospital treatment for injured employees to ensure that it meets the required standards of modern medicine at the lowest possible cost.
(ii) 
Open claims, verify time loss and other aspects of disability, handle disbursement of funds for employees and beneficiaries on Tribal checks drawn on the Tribal fund, make claim evaluations and determinations with respect to each claim made.
(iii) 
Compile statistics as will afford the Workers’ Compensation Committee reliable information upon which to base its decisions.
(iv) 
Make, and from time to time update, a fee chart of maximum charges to be made by any physician, surgeon, hospital, druggist, or other agency or person rendering services to the injured employee.
(v) 
Make a record of the commencement of every disability and termination thereof, and when bills are rendered for the care and treatment of injured employees, approve and pay those which conform to the promulgated rules, regulations, and practices of the Workers’ Compensation Committee, and reject any bill or item thereof incurred in violation of the provisions of this chapter or the rules and regulations promulgated under it.
(Ord. 108 § 108.1.6, 10-6-2006 (Res. 2006-312); Res. 2010-41)
(1) 
“Accident”
means a specific occurrence, neither expected nor intended, which causes bodily injury to an employee.
(2) 
“Accredited school”
means a school approved by the Tribes or the State, or a school regulated, licensed, or recognized by the Tribes as having approved course content.
(3) 
“Average monthly wage”
means the average wage in the State of Washington, calculated by determining the total amount of wages paid by all employers in the State and dividing by 12 to derive the monthly average. RCW 51.08.018 defines “average monthly wage” as it is determined under RCW 50.04.355.
(4) 
“Award”
means the monetary compensation benefits that the Claims Administrator or Committee determines an injured employee is entitled to.
(5) 
“Beneficiary”
means a spouse, child, or dependent of an employee in whom shall vest a right to receive compensation under this plan.
(6) 
“Board of Directors”
means the Board of Directors of the Tulalip Tribes.
(7) 
“Child”
includes a posthumous child, a child legally adopted prior to the injury, a child toward whom the employee stands in the place of a parent, an illegitimate child, and a stepchild, if such stepchild was, at the time of the injury, a member of the employee’s family and substantially dependent upon the employee for support. A dependent physically or mentally incapacitated child is a child, for purposes of benefits, regardless of age, so long as the child was physically or mentally incapacitated at the time of the injury and thereafter remains incapacitated and substantially dependent on the employee for support. A child does not include any married children unless they are dependents. A person might also qualify as a child according to Tribal custom as determined by the Workers’ Compensation Committee.
(8) 
“Claim”
means a written request for compensation from an employee or someone on the employee’s behalf, or any compensable injury of which the employer has notice or knowledge.
(9) 
“Claims Administrator”
means the third party administrator appointed by the Tribes.
(10) 
“Committee”
means the Workers’ Compensation Committee.
(11) 
“Compensation”
means the compensation and benefits provided under this chapter and includes every benefit or payment conferred by this chapter upon an injured employee.
(12) 
“Compromise”
means an agreement between parties to settle any liability that is claimed to exist under this chapter on account of injury or death.
(13) 
“Dependent”
means any of the following named relatives of an employee whose death results from an injury and who leaves no surviving widow, widower, or child under the age of 18 years: father, mother, grandfather, grandmother, stepfather, stepmother, grandson, granddaughter, brother, sister, half-sister, half-brother, niece, nephew, or any other extended family member as approved by the Workers’ Compensation Committee, who at the time of the injury is actually and necessarily dependent in whole or in part upon the earnings of the employee.
(14) 
“Disability”
means incapacity because of injury to earn wages in the same or any other employment.
(15) 
“Earning power”
means actual wages. Loss of earning power is calculated with reference to an individual’s actual wages at the time of an injury compared to the employee’s wages, at any kind of work, after the injury.
(16) 
“Employee”
means any person employed by the Tribes and its entities entitled to benefits under the provisions of Chapter 9.10 TTC, Human Resources, and authorized variances, including, but not limited to, the Tulalip Police Department Manual, Quil Ceda Village and Tulalip Gaming Agency human resources ordinances and manuals. “Employee” shall not be construed to include a consultant or contract employee unless specifically provided for in their written contract.
(17) 
“Employer”
means the Tulalip Tribes and its enterprises.
(18) 
“Employer representative”
means that person designated by the employer to receive injury reports and updates.
(19) 
“Injury”
means the physical conditions resulting from a sudden and tangible happening of a traumatic nature, producing an immediate or prompt result. The term also encompasses the contraction of an occupational disease. (See Sault Ste. Marie and old Tulalip codes.)
(20) 
“Legal custody”
means having been legally vested with the power and responsibility to care for a child, and/or the child’s property, by a court of competent jurisdiction.
(21) 
“Light duty”
means any assignment, other than the employee’s usual job, designed to help the employee return to some sort of gainful employment.
(22) 
“Maximum medical improvement”
means an injured employee has reached a treatment plateau from which it is reasonably believed the condition will not change. It can mean either that the employee has fully recovered from the injury or that the employee’s medical condition has stabilized to the point that, based on the medical evidence, no material change can be expected.
(23) 
“Occupational disease”
means such disease or infection as arises naturally and proximately out of employment.
(24) 
“Permanent disability”
means that maximum medical improvement has been reached and there is still a loss of use or function. Permanent disabilities can be partial, where there is still some use or function, or total, where the employee is unable to return to any gainful employment.
(25) 
“Preexisting medical condition”
means any injury, disease, congenital abnormality, or medical condition that contributes or predisposes an employee to disability or the need for treatment and that precedes the injury or occupational disease that forms the basis for a claim under this chapter.
(26) 
“Spouse”
means a person who is married to an employee under the law or customs recognized by the Tulalip Tribes. “Spouse” does not include a person who is living separately and apart from an employee and who has filed, in Court, a petition for legal separation or dissolution of marriage.
(27) 
“Temporary disability”
means a physical incapacity that is expected to be completely curable or improved with proper medical attention. Temporary disabilities can be partial, where the employee can still perform some work though not necessarily their usual job, or total, where the employee is unable to perform at any gainful employment.
(28) 
“Travel expenses”
means the standard GSA reimbursement rate for mileage or expenses incurred utilizing public transportation. It does not include money spent on gas or costs of a rental car, unless specifically approved by the Claims Administrator.
(29) 
“Treating physician”
means a person licensed to independently practice one or more of the following professions: medicine and surgery; osteopathic medicine and surgery; chiropractic; naturopathic physician; podiatry; dentistry; and optometry. A treating physician actively treats an injured or ill worker.
(30) 
“Tribal Court”
means the Tulalip Tribal Court.
(31) 
“Tribal fund”
means the workers’ compensation fund established by the Tribes.
(32) 
“Tribes”
means the Tulalip Tribes.
(33) 
“Willfully and deliberately”
means intentionally, knowingly, or voluntarily acting in a particular manner. It is distinguished from accidental actions.
(Ord. 108 § 108.1.7, 10-6-2006 (Res. 2006-312); Res. 2010-41)