Compliance with the New Training Requirements
Saturday, April 23, 2005 | 0
Mandatory education is now required for all California workers compensation insurance companies, TPAs, self-insureds, and bill review companies. Regulations proposed in CA SB899 and outlined in Insurance Code 11761 require medical only, junior, experienced claims examiners, and medical bill review specialists to be certified and maintain specific continuing education requirements in order to handle workers compensation claims in California.
The new regulations require training as follows:
| Occupation | Training Hours Required |
| Medical Only Adjuster | * 80 hours of education within one year from 5/1/05 or date of hire, of which at least 50 hours must be conducted in a classroom with an instructor, and 30 hours may be on-the-job training. * Medical-only adjusters who complete 80 hours of training may be certified as a claims adjuster upon completion of 80 additional hours of training provided that such training is completed within six months of the date the adjuster begins to adjust indemnity claims. * Minimum of 20 hours of post-certification training every 2 years, which need not be in a classroom with an instructor. |
| Experienced Medical Only Adjuster | * Minimum of 20 hours of post-certification training every 2 years, which need not be in a classroom with an instructor. |
| Claims Adjuster | * 160 hours of education within one year from 5/1/05 or date of hire, of which at least 120 hours must be conducted in a classroom with an instructor, and 40 hours may be on-the-job training. On-the-job training shall be done under the supervision of an instructor or an experienced claims adjuster. * Minimum of 30 hours of post-certification training every 2 years, which need not be in a classroom with an instructor. |
| Experienced Claims Adjuster | * Minimum of 30 hours of post-certification training every 2 years, which need not be in a classroom with an instructor. |
* Retroactive credit is applicable in some cases for Medical Only Adjusters and Claims Adjusters.
The new regulations are substantive, generally requiring inexperienced or new adjusters to complete the training and receive their certificates within one year from the date of employment or date when the new regulations go into effect. Every insurer must certify to the commissioner that the personnel employed by the insurer to adjust workers compensation claims, or employed for that purpose by any medical billing entity with which the insurer contracts, meet the minimum standards adopted by the commissioner.
* Certified claims adjusters who then fail to fulfill the requirement for post-certification training every two years will no longer be considered certified claims adjusters.
An insurer may not authorize an untrained individual, or someone who is not an experienced claims adjuster, to act in the capacity of claims adjuster, unless that individual is undergoing training and adjusts claims under the direct supervision of an experienced claims adjuster.
Article by Byron Kerns of Acacia Pacific Education & Consulting, Inc. Byron can be reached at (866) 777-9330.
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