(1) How do I initially become a certified claims administrator for self-insured claims?
In order to become a certified claims administrator, you must first have a minimum of three years of experience in the administration of time loss 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 "self-insurance claims administrator" test.
You must then take and pass the department's "self-insurance claims administrator" test. After passing the test, you are designated a certified claims administrator. The initial designation of certified claims administrator is valid for five years.
(2) How do I receive approval to take the test?
To be approved to take the "self-insurance claims administrator" test, you must apply to the department no less than forty-five days prior to the next scheduled test date.
The department will review your application and determine if you meet the minimum requirements to take the test. We will respond to your application no less than fourteen days prior to the next scheduled test date.
(3) What happens if I fail the test?
If you are not currently a certified claims administrator and you fail the test, you must reapply to take the test again. You will not be permitted to retake the test until six months have passed after the failed result.
If you are a certified claims administrator and you fail the test, your approval will be revoked. You must then reapply to take the test again. You will not be permitted to retake the test until six months have passed after the failed result.
(4) How does a certified claims administrator maintain their certified status beyond the initial five-year designation?
A certified claims administrator may maintain certified status by:
(a) Retaking and passing the "self-insurance claims administrator" test as outlined in subsections (1) and (2) of this section; or
(b) Remaining employed for a minimum of three of the last five years in the administration of, or the oversight of, claims under Title 51
RCW, and earning the required continuing education credits as outlined in subsection (5) of this section.
(5) What is required if I choose to maintain my certified status using continuing education credits?
(a) You must earn a minimum of seventy-five credits prior to lapse of the certified status. Extensions will not be granted.
Credits must be earned in the following categories:
(i) Forty claims management credits;
(ii) Twenty legal credits;
(iii) Fifteen elective credits (e.g., industry-specific training). Excess claims management or legal credits may be applied toward the elective credit requirement.
The seventy-five credits must include any training designated as mandatory by the department. If you fail to earn sufficient continuing education credits, you will be required to retake the written test to maintain your certified status.
(b) Assignment of course credit will be determined by the department review committee.
(c) Courses approved prior to the effective date of this rule change that were assigned different credit categories will be applied as follows:
(i) Claims process/procedure credits will apply toward claims management credits.
(ii) Medical credits will apply toward claims management credits.
(iii) Ethics credits will apply toward elective credits.
(d) Individuals whose certified status expires between October 1, 2011, and September 30, 2012, and who exercise the continuing education option in lieu of retaking the test, must meet the following modified requirements. If the individual's certification expiration date falls between:
(i) 10/1/2011 - 3/31/2012: Earn a minimum of sixty credits (thirty-two claims management credits, sixteen legal credits, and twelve elective credits);
(ii) 4/1/2012 - 9/30/2012: Earn a minimum of sixty-five credits (thirty-six claims management credits, eighteen legal credits, and eleven elective credits).
(e) You must track and report earned credits at the department's online data base. 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.
(f) 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.
(6) 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 data base.
[Statutory Authority: RCW 51.04.020 and 51.14.030. 12-03-088, § 296-15-360, filed 1/17/12, effective 2/17/12. Statutory Authority: RCW 51.04.020, 51.14.020, 51.32.190, 51.14.090, and 51.14.095. 07-17-162, § 296-15-360, filed 8/22/07, effective 10/1/07; 06-06-066, § 296-15-360, filed 2/28/06, effective 4/1/06.]