WSR 07-09-095




[ Filed April 17, 2007, 6:24 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 06-13-080.

Title of Rule and Other Identifying Information: Workers' compensation self insurance rules and regulations, chapter 296-15 WAC. This chapter governs employers who are permitted to self-insure their workers' compensation obligation pursuant to Title 51 RCW. This filing includes modification to existing sections regarding requirements for department-approved claims administrators.

Hearing Location(s): Department of Labor and Industries, 7273 Linderson Way S.W., Tumwater, WA 98501-5414, on June 13, 2007, at 9:30 a.m.

Date of Intended Adoption: August 22, 2007.

Submit Written Comments to: Margaret Conley, P.O. Box 44890, Olympia, WA 98504-4890, e-mail, fax (360) 902-6977, by June 13, 2007, 5:00 p.m.

Assistance for Persons with Disabilities: Contact Margaret Conley by June 1, 2007, TTY (800) 833-6388 or (360) 902-6906.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed modifications will allow for certified claims administrators to choose a continuing education option in lieu of retaking and passing the claims administrator test to recertify every five years. The current rule is being modified to include the option.

Reasons Supporting Proposal: The rule revisions were developed in conjunction with self-insured community stakeholders, at their request. The department hopes that the addition of a continuing education option will result in better-informed claims administrators, which will also benefit injured workers' with self-insured industrial insurance claims.

Statutory Authority for Adoption: RCW 51.04.020, 51.14.020, 51.32.190, 51.14.090, and 51.14.095.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of labor and industries, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Jean Vanek, 243 Israel Road S.E., Tumwater, WA 98512, (360) 902-6907.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Chapter 296-15 WAC applies only to businesses that are certified to self-insure in Washington state. Per RCW 19.85.020(1), a business must have fifty or fewer employees to qualify as a small business under the Regulatory Fairness Act. The department reviewed the number of worker hours reported by each employer currently certified to self-insure, and no self-insured business has fewer than fifty employees. Therefore, no small business economic impact statement is required.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Melissa Shah, P.O. Box 44320, Olympia, WA 98504-4320, phone (360) 902-5122, fax (360) 902-4249, e-mail

April 17, 2007

Judy Schurke



AMENDATORY SECTION(Amending WSR 06-06-066, filed 2/28/06, effective 4/1/06)

WAC 296-15-360   Qualifications of personnel.   (1) How does an individual initially become a department-approved claims administrator?

(((1))) 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 ((to be accepted as a department-approved claims administrator. In order to be admitted to take this test, an individual must meet the following requirements:

(a))). 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 ((examination)) test date.

(((b) 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.))

The department will review the application and determine if the applicant meets the minimum requirements to take the ((examination)) test. Notification of approval to take the test will be mailed to the applicant no less than fourteen days prior to the scheduled ((examination)) test date.

((If)) (3) What happens when an applicant fails the test? When an applicant fails the ((examination, he or she must submit another completed application requesting)) test, the applicant must reapply to take the ((examination)) test again. An applicant ((must wait)) will not be permitted to retake the test until six months have passed after ((a)) the failed result ((before retaking the examination)).

(((2) The designation of department-approved claims administrator is valid for five years or until an individual retakes the examination, whichever occurs first.)) The most recent ((examination)) test results will ((always reflect)) determine an individual's status as a claims administrator. ((To maintain approved status, an individual must:

(a) Make application)) (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; ((and)) or

(b) ((Pass the "self-insurance claims administrator" examination again.)) 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 ((is responsible for notifying)) must notify the department within thirty calendar days of the effective date of ((any)) a change((s)) in ((his or her)) mailing address, work location, or ((employment status)) name.

[Statutory Authority: RCW 51.04.020, 51.14.020, 51.32.190, 51.14.090, and 51.14.095. 06-06-066, 296-15-360, filed 2/28/06, effective 4/1/06.]

Washington State Code Reviser's Office