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Adjuster CertificationCore BenefitsClaims HandlingLegal ProcessesResources
Adjuster Certification & Training
- Certification Required: Minimum standards set by California Insurance Commissioner.
- Experience Requirements:
- 5 years of experience in the last 8 years adjusting CA workers' comp claims, or
- Pass the self-insurance exam and meet continuous work criteria.
- Training Requirements: 160 hours of training (120 classroom hours) if not experienced.
- Continuing Education: 30 hours every 2 years.
Core Benefits Overview
| Benefit Type | Key Details |
|---|---|
| Medical Care | Must be reasonably necessary to cure or relieve injury. Governed by MTUS. |
| Temporary Disability (TD) | Paid when worker can't work temporarily. Subject to time limits. |
| Permanent Disability (PD) | Based on impairment ratings. Includes COLA adjustments. |
| Supplemental Job Displacement Benefit (SJDB) | Voucher for retraining if worker can't return to former job. |
| Death Benefits | Paid to dependents. Amount varies by number and type of dependents. |
Claims Handling Essentials
- Notice of Injury: Must be reported within 30 days.
- Claim Filing Deadline: 1 year from injury or last benefit payment.
- Utilization Review (UR):
- Must respond within 5 business days.
- Expedited UR required for serious health threats.
- Independent Medical Review (IMR): Must be requested within 10–30 days of UR denial.
Legal & Administrative Processes
| Process | Details |
|---|---|
| Medical-Legal Evaluations | Triggered by disputes over treatment or disability. |
| Panel QME Process | Initiated under Labor Code §§ 4060–4062.2. |
| WCAB Hearings & Appeals | Governed by Labor Code § 5950 and Rule 8.500. |
| Sanctions for Bad Faith | Labor Code § 5813; penalties for delays or misconduct. |
Tools & Resources
- Sullivan on Comp: Comprehensive digital treatise with calculators, webinars, and legal updates.
- DWC Guidebook for Injured Workers: Useful for understanding worker rights and procedures.
- EDG Handbook: Practical roadmap for navigating claims and legal obligations.
Read Also
About The Author
About The Author
-
Frank Ferreri
Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.
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