The Oregon Department answers certification questions

The following was provided to the firm in February 2018 by Fred Bruyns, policy analyst/rules coordinator, Department of Consumer and Business Services, Workers’ Compensation Division. If you have further questions, you may reach out to Fred at 503-947-7717; fax 503-947-7514; or, email fred.h.bruyns@oregon.gov.

We have prepared some Q&A to assist us in answering questions from claims examiners and prospective claims examiners. We think this information will also be helpful to those who provide claims examiner training. Please let me know if you have questions or concerns.

Question 1: May I be “certified” before being employed as a claims examiner?

Answer: Yes, but only an insurer* may certify a person or renew their certification, and claims examiners are usually certified after being employed by an insurer. Once a person is certified or renewed by an insurer, they remain certified, even if not employed as a claims examiner, until their certification expires. However, if a person provides an insurer documentation of certification issued by another insurer, the insurer receiving the documentation may require the person to recertify if they find that the person’s documentation is not sufficient to verify that the person meets the certification requirements.

Question 2: Several years ago, I successfully completed the claims examiner test and have kept up on ongoing training requirements, but I have never been certified by an insurer? May an insurer still certify me?

Answer: Yes. An insurer* may certify you if the insurer determines that you successfully completed the claims examiner test and satisfied all training requirements under the rules, regardless of the passage of time since the test.

Question 3: I have been certified by an insurer but never employed as an Oregon claims examiner. May an insurer still renew my certification?

Answer: Yes. An insurer* may renew your certification if the insurer determines you have sufficient documentation of initial certification and ongoing training under the rules, regardless of the passage of time since initial certification. However, the insurer receiving your documentation may require you to recertify if they find your documentation is not sufficient to verify that you meet the certification requirements.

Question 4: I have been certified by an insurer and employed as an Oregon claims examiner, but I have not worked as a claims examiner for several years. May an insurer still renew my certification?

Answer: Yes. An insurer* may renew your certification if the insurer determines you have sufficient documentation of initial certification and ongoing training under the rules, regardless of the passage of time since you were last employed as an Oregon claims examiner. However, the insurer receiving your documentation may require you to recertify if they find your documentation is not sufficient to verify that you meet the certification requirements.

*OAR 436-055-0005 (4) “Insurer” means the State Accident Insurance Fund Corporation; an insurer authorized under ORS chapter 731 to transact workers’ compensation insurance in this state ; an assigned claims agent selected by the director under ORS 656.054; an employer certified under ORS 656.430 that meets the qualifications of a self-insured employer under ORS 656.407; or a service company that processes claims for an insurer or self-insured employer under the conditions prescribed in ORS 731.475(3) and ORS 656.455(1).

Be sure to check the most recent rules online. You may click here to read the Oregon Administrative Rules concerning certification of examiners.