Third Party Administrator and Qualified Administrator
Third Party Administrator
TPA’s are companies that Self-Insured employers contract with to administer the claims administration process. The process of properly and effectively administering claims is very complex as there are numerous mandated deadlines where actions must be taken by, the reserving process is governed by a wide body of law and court cases, and effectively providing benefits and facilitating the injured worker to return to work has a direct effect on controlling the costs associated with a company’s workers compensation program. Some self-insured employers choose to handle this claims administration process in-house to have a tighter control over the process.
Title 8, Chapter 8, Subchapter 2, Article 12, Sections 15450-15463 provide information on the basic rules that govern claims administration.
Roster of third party administrators
The Application Process
- The Form A4-50 is a multiple usage form that can be used to become a new TPA, to add a new reporting location, or to renew an existing TPA certificate.
- The applicant may request the certificate be issued for a period of 1, 2, or 3 years. When the certificate is issued, you will receive an expiration date. OSIP will mail out the TPA renewals in the beginning of May.
- The minimum fee for a private TPA certificate with 1 adjusting location is $1,000 per year. There is an additional charge of $200 per year for each additional adjusting location. Payment must be submitted with the application.
- Public applicants are exempt from payment of a fee provided that all claims administered are for public self-insurers only.
Changing Third Party Administrators and Locations of Record
- To transfer your claims from one TPA to another or to a different adjusting location for the same TPA, the former TPA must:
- Submit a Transfer of Records by the transfer effective date to the Office of Self-Insurance Plans via mail or email.
- Submit a list of open and closed claims that are transferring.
- The Transfer of Records form and open/closed claims list detailed above should also be sent to the new TPA.
- If the transfer is to a new TPA, you are required to file an Interim Annual Report within 30 calendar days on the OSIP Online Portal.
- Failure to provide a Transfer of Records in a timely manner may be cause for revocation of a certificate to administer.
Please direct any other questions regarding Third Party Administrators to OSIP at (916) 464-7000 or send your inquiries to the OSIP Public Box
Pursuant to Title 8, California Code of Regulations, Section 15452, each self-insured employer or administrative agency is required to conduct the administration of self-insured workers' compensation claims through the services of a competent person or persons located in California. Competence may be demonstrated by passing the Self-Insurance Administrator's Examination, administered for this office by PSI Examination Services.
Prior to Examination
- You can apply online to take the examination at PSI Services.
- Click “I’m a Test Taker” and then search for “California Office of Self Insurance Plans: CA Self Insurance Examination”. Choose the test named as such and follow the instructions given.
- Make sure the information you input for your registration is current and correct. It will be validated at the exam site against your state issued picture ID and it will be the information the Office of Self-Insurance Plans uses for verification should you pass the exam.
- The Office of Self-Insurance Plans does not endorse study materials. However, a list of study materials is provided for those interested.
- Inquiries regarding the OSIP Self-Insurance Administrators examination program should be submitted to PSI Services.
- This exam may be taken anytime year-round.
- The test is 100 questions and a passing score is 70.
- This written exam is designed to test the technical knowledge of workers’ compensation law and claim administration.
- If you pass, you will immediately receive a successful notification. If you do not pass, you will receive a diagnostic report indicating your strengths and weaknesses.
- Results of the exam and registration information is sent to the Office of Self-Insurance Plans weekly.
After the Examination
- The Office of Self-Insurance Plans contacts those who have passed and will mail out original Qualified Administrator certificates to those individuals.
- If you need a copy of your pass result, please print the search results from OSIP’s Administration Pass Verification . This is used to verify if an individual has passed the exam and holds an active qualified administrator certificate.
- Please direct any other questions regarding qualified administrators to OSIP at (916) 464-7000 or send your inquiries to OSIP Public Box.
- Life tables for men and women: United States 2020
NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2023 and will be utilized by OSIP in 2024 to determine if the figures provided on the 2023 Annual Report are accurate.
- Life tables for men and women: United States 2018
NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2022 and will be utilized by OSIP in 2023 to determine if the figures provided on the 2022 Annual Report are accurate.
Life tables for men and women: United States 2017
NOTE: These tables are to be used by qualified administrators when estimating future liabilities in 2020 and 2021 and will be utilized by OSIP in 2021 and 2022, respectively, to determine if the figures provided on the 2020 and 2021 Annual Report are accurate.