(1)
What is a certified claims
administrator? An experienced adjudicator who has been certified by the
department to meet the requirements of WAC
296-15-350(2).
(2)
How do I become a certified claims
administrator for self-insured claims?
(a) Under the mentorship of a certified
claims administrator, have a minimum of one year of experience in the
administration or oversight of claims under Title 51 RCW. The experience must
have occurred within the five years immediately prior to your filing of the
application to take the "selfinsurance claims administrator" test.
(b) Have completed:
(i) A comprehensive goal-oriented curriculum
approved by the department and resulting in a worker's compensation
professional designation; or
(ii)
An approved training program within the department.
(c) Take and pass the department's
"self-insurance claims administrator" test. The department will provide annual
reports to stakeholders. The department will report the results, identify and
consider feasible alternative methods of test delivery, make any
recommendations for improvements if appropriate and seek comments from
stakeholders.
(i) If you have the requisite
experience under (a) of this subsection, you may take the test without
completing the training required under (b)(i) or (ii) of this subsection. The
provision to take the test for certification without completing the requisite
training will expire January 1, 2022.
(ii) If you have already passed the test and
are a certified claims administrator, you will maintain your certified claims
administrator designation without completing the training required under (b)(i)
or (ii) of this subsection, and you will need to fulfill the continuing
education credits under subsection (6) of this section.
After passing the test, you are designated a certified claims
administrator. This is a lifetime certification, provided that continuing
education requirements are met.
(3)
How do I receive approval to take
the test? To be approved to take the "self-insurance claims
administrator" test, you must apply using the department's online database.
The department will review your application and determine if
you meet the minimum requirements to take the test. The department will respond
to your application no less than fourteen days prior to the next scheduled test
date.
(4)
What
happens if I fail the test? You may retest after the failed test.
If you are a certified claims administrator and you fail the
test, your certification will be terminated until you retest and pass.
(5)
What must a
department-approved comprehensive goal-oriented curriculum for a worker's
compensation professional designation include? The curriculum must
include:
(a) All phases of basic,
intermediate, and advanced claim validity issues, including injury during the
course of employment, occupational exposure and illness or disease, causal
relationship of injury or illness, prima facie consideration, and submittal of
claims to department;
(b) All
phases of basic, intermediate, and advanced medical benefit management,
including treatment authorization, surgery approval, aggravation of conditions,
segregation of conditions, use of consultations and independent medical
examinations (IMEs), and department medical guidelines;
(c) All phases of basic, intermediate, and
advanced compensation management, including determining the wage as the basis
of compensation, payment of temporary total disability payments, permanent
partial disability payments, and loss of earning power compensation;
and
(d) All phases of basic,
intermediate, and advanced work disability prevention, including worker-centric
return to work practices, modified or light duty jobs, other vocational
recovery interventions, and medical provider collaboration on return to work,
activity prescription forms, and job analyses.
(e) Training must include at least
seventy-two credit hours as provided in subsection (6)(b) of this
section.
(f) Curriculum submitters
must provide their written core curriculum plan to the department with a table
of contents listing the courses in the curriculum, and a detailed description
of the content for each course. The curriculum advisory committee will review
the submitters' proposed curriculum content and advise of any recommended
adjustments, and the department will determine and provide notice of approval
or denial within ninety days, or extend the time for approval or denial of the
plan for another ninety days. The department may request additional materials,
and require adjustments in the core curriculum plan prior to approval, as it
deems necessary.
A department-approved curriculum must be reapproved every three
years.
(6)
How does a certified claims administrator maintain their certified
status? A certified claims administrator may maintain certified status
by earning the required continuing education credits as outlined in this
subsection.
(a) You must earn forty-five
credits every three years.
Credits earned within five years prior to the effective date of
this rule may be carried forward and applied toward meeting the required
continuing education credits for three years following the effective date of
this rule up to a maximum of forty-five credits.
Credits may be earned in the following areas:
(i) Instruction on relevant workers'
compensation subjects that help injured workers heal and return to work, and
focus on areas of recovery such as, but not limited to, medical benefit
management, payment of compensation, and vocational services;
(ii) Instruction on existing or historical
workers' compensation statutes, case law, rule, or departmental policy, which
may assist with managing claims, answering questions, and addressing concerns
in accordance with WAC 29615-350(5);
(iii) Instruction on new developments in
workers' compensation such as, but not limited to, changes in statute, case
law, rule, or departmental policy, which may assist claims management personnel
in remaining current in accordance with WAC
296-15-350(5);
or
(iv) Credits may also be earned
in injury prevention and safety, in addition to credits for injury recovery and
claims administration, but not to exceed five of the forty-five credits in
three years.
The forty-five credits must include any training designated as
mandatory by the department. All training must be specific to Washington law,
or describe in detail how the training is relevant to administering Washington
law. If you fail to earn sufficient continuing education credits, you will be
required to retake the written test to maintain your certified status.
(b) Continuing
education providers must submit a training plan with a detailed outline of each
area of training to the department when courses are offered. The curriculum
advisory committee will review the submitters' proposed training plan and
advise of any recommended adjustments, and assignment of course credit will be
determined by the department as follows: A maximum of one credit per hour of
training will be awarded. Credit will be assigned based on 0.5 increments; no
credit will be awarded for increments less than 0.5.
(c) Department-approved continuing education
courses must be reapproved biannually (every two years).
(d) You must track and report earned credits
at the department's online database. You must obtain and retain signed
verification of courses attended. Verification of earned credits must be
received by the department by the date the certified claims administrator's
certification expires. Extensions will not be granted. If your certification
lapses, you will not need to complete the comprehensive goal-oriented
curriculum if you apply for reinstatement within two years of the lapse, and
then take and pass the department's "self-insurance claims administrator"
test.
(e) The department may audit
the reported credits of any certified claims administrator at random, or "for
cause." Falsification of reported credits will result in revocation of the
individual's certified claims administrator status, and may result in the
department's refusal of future applications to take the self-insurance claims
administrator test.
(7)
How often must certified claims administrators notify the department of
changes to their contact information? Certified claims administrators
must notify the department within thirty calendar days of the effective date of
a change in mailing address, work location, or name. Changes must be reported
using the department's online database.
