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Answers to frequently asked questions about workers' compensation for claims administrators

In addition to the FAQs below,claims administrators may call 1-800-736-7401 to hear recorded information on a variety of workers' compensation topics 24 hours a day.

Claims administrators may call a local office of the state Division of Workers' Compensation (DWC) and speak to the Information and Assistance (I&A) Unit for help during regular business hours.

Fact sheets and guides for injured workers on a variety of topics, which claims administrators may find useful, can be found on the I&A Unit's Web page.

Topics covered in this FAQ include:
The basics
New regulations for medical provider network
Utilization review

About the basics

Q. Do my claim adjusters need to be certified?

A. Yes. All insurers must certify that their claims adjusters meet the minimum standards of training and experience required by the insurance commissioner. Insurers maintain a record on the “Designation” and “Post-Designation” forms available at the Department of Insurance.

Q. What is the criterion to be a certified workers’ compensation adjuster?

A. An experienced claim adjuster must meet one of the following experience requirements:

  • Have five years in the last eight years of on the job experience adjusting California workers’ compensation claims or supervising claims adjusters handling workers’ compensation claims; or
  • Successfully complete the self-insurance exam written examination and have either (1) worked as a claims adjuster or supervisor of workers’ compensation claims continuously since passing the exam, or (2) passed the exam within the previous five years.

Q. What if the claim adjuster does not meet the mandatory experience requirement?

A. If a claim adjuster does not meet the experience requirements, he or she is required to have at least 160 hours of training with 120 hours in a classroom with an instructor.

Q. What are an adjuster’s continuing educational unit requirements?

A. A claim adjuster must complete 30 hours of training every two years.

For complete information, please go to the Department of Insurance Web site at www.insurance.ca.gov.

November 2010