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New certification rules for out-of-state Washington claims administrators

The Washington Department of Labor and Industries adopted new rules on December 18, 2018, that require all administrators processing Washington claims and who are located outside of Washington be certified and maintain core business hours in the Pacific time zone. These changes to WAC 296-15-350 and 296-15-360 become effective July 1, 2019.

Existing non-certified claims administrators who have two years experience of at least 20 hours a week in the administration of claims since July 2014, and who handle claims outside of Washington State will be required to take and pass the Department’s certification test before July 1, 2020.

Existing and future claims administrators who are certified will be required to maintain their certification by earning 45 continuing education credits over three years; prior rules required 75 credits within five years. Credits earned since July 2014 may be carried forward and applied to the required continuing education credits for certification renewal due before July 1, 2021.

While the 45 renewal credits may include to-be-Department-determined mandatory training, the new rules specify that the rest of the credits may be earned in the following areas: subjects that help injured workers heal; historical workers’ compensation statutes, case law, rules or department policy; new developments in workers’ compensation; and, injury prevention and safety (the last area not to exceed five of the 45 credits.)

New claims administrators without any prior adjudication experience or experience less than 20 hours a week or less than two years will be required to meet new rules: work at least 20 hours per week for two years administering Washington claims; complete a Department-approved, 72-credit comprehensive and goal-oriented curriculum; and, take and pass the Department test.

The goal-oriented curriculum must include basic, intermediate and advanced elements for each of the following areas: claim validity issues, medical benefit management, compensation management and work disability prevention. Previously, the re-certification curriculum required 40 claims management credits, 20 legal credits and 15 general claims credits. All training must be specific to Washington law.

These rules apply to every claims administrator working outside the state of Washington who 1) manages Washington claims directly; 2) allows or denies Washington claims; 3) takes action relative to a Washington claim; or, 4) closes claims. Excluded are those who manage operations indirectly, such as support people, human resources, accounting or executive management.

For more information about the rule changes, click here.

Education is a cornerstone of Reinisch Wilson Weier PC. This firm will continue to offer accredited, timely and interesting continuing education courses for Washington claims administrators and for self-insured or state-fund-insured employers.

Click here to download a pdf.