Get Our E- Newsletter

Fresh News, Hot Topics, CompTalk! Radio and Video and More.

Sign Up!


Washington Workers' Compensation Legal Library

Washington Home Page   >   Washington Regulations
WAC 296-15-360 Qualifications of personnel-Certified claims administrators.

(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) Have a minimum of
three years of experience, at least twenty hours per week, in the
administration or oversight 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;and(b) Take and pass the department's
"self-insurance claims administrator" test.After passing the test,
you are designated a certified claims administrator. The initial
certification is valid for five years.(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
data base 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.(4) What happens if I fail the test? You may
retest six months 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) 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 (2) and (3) of this section; or(b)
Remaining employed for a minimum of three of the last five years in
the administration or oversight of claims under Title 51
RCW;andEarning the required continuing education credits as outlined
in subsection (6) of this section;andApplying to the department for
renewal.(6) 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 and submit your renewal application 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, defined as:Instruction on any complex claim
adjudication activity that is geared to an experienced adjudicator,
containing information that goes beyond known, common everyday
practices, including instruction on complex medical issues related to
the adjudication of claims under Title 51 RCW;andThat is not specific
to the legal category.(ii) Twenty legal credits, defined
as:Instruction on any recent changes to: Title 51 RCW, the Washington
Administrative Code, significant board decisions, and case law.
"Recent" will generally be considered decisions and changes that
occurred within the eighteen-month period prior to course
submittal.(iii) Fifteen general claims education credits, defined
as:Instruction on common everyday claims and related practices such
as refresher classes, industry specific training, safety, and injury
prevention courses. For this category only, credit will be awarded
one credit for every hour of instruction.Excess claims management or
legal credits may be applied toward the general claims education
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 curriculum
review committee as follows: A maximum of one credit per hour of
training will be awarded if all of the material submitted meets the
definition of that category. Credit will be assigned based on 0.5
increments; no credit will be awarded for increments less than 0.5.
The curriculum review committee's decision will be final.(c) Courses
approved for elective credits prior to the effective date of this
rule change will be applied as general claims education credits.(d)
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.(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 data base.
[Statutory Authority: RCW 51.04.020, 51.14.030. WSR 14-02-121, § 296-
15-360, filed 1/2/14, effective 2/2/14; WSR 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. WSR 07-17-162, § 296-
15-360, filed 8/22/07, effective 10/1/07; WSR 06-06-066, § 296-15-
360, filed 2/28/06, effective 4/1/06.]

Save Time & Effort! Our Premium Members Get:
Searchable Rules & Statutes, Compliance Information,
Benefits Calculators, Case Law, & Reference

Washington Compliance Information
Washington Case Law Summaries And Court Opinions
Washington Type And Save Forms
State Comparison Tables
Benefits Calculators
Reference Desk
Email Notification Services