WSR 12-03-088

PERMANENT RULES

DEPARTMENT OF

LABOR AND INDUSTRIES

[ Filed January 17, 2012, 8:27 a.m. , effective February 17, 2012 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The rule currently requires that a department-approved claims administrator choosing to renew their status via continuing education earn a total of seventy-five credits, including a minimum number of credits in five different categories. This rule making reduces the number of credit categories to three, simplifying the continuing education requirements. Department-approved claims administrators will still need to earn seventy-five credits.

Other changes in the rule have been made for clarity.

Citation of Existing Rules Affected by this Order: Amending WAC 296-15-360 Qualifications of personnel.

Statutory Authority for Adoption: RCW 51.04.020, 51.14.030.

Adopted under notice filed as WSR 11-22-079 on November 1, 2011.

A final cost-benefit analysis is available by contacting Yuanlong Ge, P.O. Box 44320, Olympia, WA 98504-4320, phone (360) 902-5139, fax (360) 902-4249, e-mail Yuanlong.Ge@Lni.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 1, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

Date Adopted: January 17, 2012.

Judy Schurke

Director

OTS-4290.1


AMENDATORY SECTION(Amending WSR 07-17-162, filed 8/22/07, effective 10/1/07)

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

In order to become a ((department-approved)) certified claims administrator, ((an individual)) you 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)) your filing of the application to take the "self-insurance claims administrator" test.

((An individual)) You must then take and pass the department's "self-insurance claims administrator" test. After passing the test, ((an individual is)) you are designated a ((department-approved)) certified claims administrator. The initial designation of ((department-approved)) certified claims administrator is valid for five years.

(2) How ((does an applicant)) do I receive approval to take the test? To be approved to take the "self-insurance claims ((administration)) administrator" test, ((an applicant)) you must ((submit a completed application form)) apply to the department (((Form F207-177-000). The application must be received by the department)) no less than forty-five days prior to the next scheduled test date.

The department will review ((the)) your application and determine if ((the applicant)) you meet((s)) the minimum requirements to take the test. ((Notification of approval to take the test will be mailed to the applicant)) We will respond to your application no less than fourteen days prior to the next scheduled test date.

(3) What happens ((when an applicant)) if I fail((s)) the test? ((When an applicant)) If you are not currently a certified claims administrator and you fail((s)) the test, ((the applicant)) you must reapply to take the test again. ((An applicant)) You 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.)) If you are a certified claims administrator and you fail the test, your approval will be revoked. You must then reapply to take the test again. You will not be permitted to retake the test until six months have passed after the failed result.

(4) How does a ((department-approved)) certified claims administrator maintain their ((approved)) certified status beyond the initial five-year designation? ((An)) A certified claims administrator may maintain ((approved)) certified status by:

(a) Retaking and passing the "self-insurance claims administrator" test as outlined in subsections (1) and (2) of this section; or

(b) ((Providing documentation to the department that the individual has remained)) Remaining 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)) earning the required continuing education ((criteria.

To meet continuing education criteria, the administrator)) credits as outlined in subsection (5) of this section.

(5) What is required if I choose to maintain my certified status using continuing education credits?

(a) You must ((submit verification to the department that)) earn a minimum of seventy-five credits ((have been obtained)) prior to lapse of the ((approved)) certified status. Extensions will not be granted.

Credits must be earned in the following categories:

(i) ((Twenty)) Forty claims ((process/procedure)) management credits;

(ii) Twenty legal credits;

(iii) ((Twenty medical credits;

(iv) Two ethics credits; and

(v) Thirteen)) Fifteen elective credits (e.g., industry-specific training). Excess claims management or legal credits may be applied toward the elective credit requirement.

The seventy-five credits must include any training designated as mandatory by the department. If ((an administrator)) you fail((s)) to ((complete)) earn sufficient continuing education credits, ((he or she)) you will be required to retake the written test to maintain your certified status.

(b) Assignment of course credit will be determined by the department review committee.

(c) Courses approved prior to the effective date of this rule change that were assigned different credit categories will be applied as follows:

(i) Claims process/procedure credits will apply toward claims management credits.

(ii) Medical credits will apply toward claims management credits.

(iii) Ethics credits will apply toward elective credits.

(d) Individuals whose ((department-approved)) certified status expires between October 1, ((2008)) 2011, 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)) thirty-two claims management credits, sixteen legal credits, ((sixteen medical credits, two ethics credits,)) and ((ten)) twelve elective credits);

(((viii))) (ii) 4/1/2012 - 9/30/2012: Earn a minimum of sixty-five credits (((eighteen process/procedure)) thirty-six claims management credits, eighteen legal credits, ((eighteen medical credits, two ethics credits,)) and ((nine)) eleven elective credits).

(((5) How does an approved administrator report earned continuing education credit to the department? Each department-approved administrator)) (e) You must track and report earned credits at the department's ((online)) on-line data base. ((The approved administrator)) You must obtain and retain signed verification of courses attended. Verification of earned credits must be received by the department by the date the ((approved)) certified claims administrator's certification expires. Extensions will not be granted.

(f) The department may audit the reported credits of any ((approved)) certified claims administrator at random, or "for cause." Falsification of reported credits will result in revocation of the individual's ((approved)) certified claims 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)) How often must certified claims administrators notify the department of changes to their contact information? Certified claims administrators must notify the department within thirty calendar days of the effective date of a change in mailing address, work location, or name. Changes must be reported using the department's on-line data base.

[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.]

Washington State Code Reviser's Office