WAC 296-15-360
Qualifications of personnel. (1) How
does an individual initially become a department-approved
claims administrator?
In order to become a department-approved claims
administrator, an individual 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 the filing of the
application.
An individual must then take and pass the department's
"self-insurance claims administrator" test. After passing the
test, an individual is designated a department-approved claims
administrator. The initial designation of department-approved
claims administrator is valid for five years.
(2) How does an applicant receive approval to take the
test? To be approved to take the "self-insurance claims
administration" test, an applicant must submit a completed
application form to the department (Form F207-177-000). The
application must be received by the department no less than
forty-five days prior to the scheduled test date.
The department will review the application and determine
if the applicant meets the minimum requirements to take the
test. Notification of approval to take the test will be
mailed to the applicant no less than fourteen days prior to
the scheduled test date.
(3) What happens when an applicant fails the test? When
an applicant fails the test, the applicant must reapply to
take the test again. An applicant will not be permitted to
retake the test until six months have passed after the failed
result.
The most recent test results will determine an
individual's status as a claims administrator.
(4) How does a department-approved administrator maintain
their approved status beyond the initial five-year
designation? An administrator may maintain approved status
by:
(a) Retaking and passing the "self-insurance claims
administrator" test as outlined in subsection (1) of this
section; or
(b) Providing documentation to the department that the
individual has remained 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 meeting the continuing
education criteria.
To meet continuing education criteria, the administrator
must submit verification to the department that a minimum of
seventy-five credits have been obtained prior to lapse of the
approved status. Extensions will not be granted.
Credits must be earned in the following categories:
(i) Twenty claims process/procedure credits;
(ii) Twenty legal credits;
(iii) Twenty medical credits;
(iv) Two ethics credits; and
(v) Thirteen elective credits (e.g., industry-specific
training).
The seventy-five credits must include any training
designated as mandatory by the department. If an
administrator fails to complete sufficient continuing
education credits, he or she will be required to retake the
written test.
Assignment of course credit will be determined by the
department review committee.
(c) Individuals whose department-approved status expires
between October 1, 2008, 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) 10/1/2008 - 3/31/2009: Earn a minimum of thirty
credits (eight process/procedure credits, eight legal credits,
eight medical credits, one ethics credit, and five elective
credits);
(ii) 4/1/2009 - 9/30/2009: Earn a minimum of thirty-five
credits (ten process/procedure credits, ten legal credits, ten
medical credits, one ethics credit, and four elective
credits);
(iii) 10/1/2009 - 3/31/2010: Earn a minimum of forty
credits (eleven process/procedure credits, eleven legal
credits, eleven medical credits, one ethics credit, and six
elective credits);
(iv) 4/1/2010 - 9/30/2010: Earn a minimum of forty-five
credits (twelve process/procedure credits, twelve legal
credits, twelve medical credits, two ethics credits, and seven
elective credits);
(v) 10/1/2010 - 3/31/2011: Earn a minimum of fifty
credits (fourteen process/procedure credits, fourteen legal
credits, thirteen medical credits, two ethics credits, and
seven elective credits);
(vi) 4/1/2011 - 9/30/2011: Earn a minimum of fifty-five
credits (fifteen process/procedure credits, fifteen legal
credits, fifteen medical credits, two ethics credits, and
eight elective credits);
(vii) 10/1/2011 - 3/31/2012: Earn a minimum of sixty
credits (sixteen process/procedure credits, sixteen legal
credits, sixteen medical credits, two ethics credits, and ten
elective credits);
(viii) 4/1/2012 - 9/30/2012: Earn a minimum of
sixty-five credits (eighteen process/procedure credits,
eighteen legal credits, eighteen medical credits, two ethics
credits, and nine elective credits).
(5) How does an approved administrator report earned
continuing education credit to the department? Each
department-approved administrator must track and report earned
credits at the department's online data base. The approved
administrator must obtain and retain signed verification of
courses attended. Verification of earned credits must be
received by the department by the date the approved
administrator's certification expires. Extensions will not be
granted.
The department may audit the reported credits of any
approved administrator at random, or "for cause."
Falsification of reported credits will result in revocation of
the individual's approved administrator status, and may result
in the department's refusal of future applications to take the
self-insurance claims administrator test.
(6) The department-approved claims administrator must
notify the department within thirty calendar days of the
effective date of a change in mailing address, work location,
or name.
[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.]