Chapter 8. Office of the Director
Subchapter 2. Administration of Self-Insurance Plans
Article 12. Claims Administration

§15452. Administrator Competence.

(a) Each self insurer or third party administrative agency shall conduct the administration of each self insurance program through the services of a competent person or persons located in California.

EXCEPTION1:Upon a showing of good cause, the Manager may authorize administration from locations outside California by an administrator with staff who has demonstrated individual competence. The desire to consolidate claims from other states in one location or the desire to reduce expenses related to utilizing a third party administer are not good cause for out-of-state administration. The demonstration of individual competence of an out-of-state administrator is not in itself good cause for out-of-state administration.

Exception2:The Manager shall not authorize claims administration outside of the State of California for any private group self insurer.

(b) Any person may demonstrate individual competence as an administrator for a self-administered self insurer or an agency administered self insurance program by successfully passing the written examination designed to test technical knowledge of workers' compensation law and claims administration. The Manager shall ensure that the test shall be administered at least twice a fiscal year (July 1 to June 30).

(c) Application for the administrator's examination shall be made on forms provided by the Manager (Form A4-100, Rev. 9/91). A complete application shall include the application form and fees in accordance with subsection (d) of this section. The applicant will be notified in writing within 14 days if the application is deficient. Confirmation of the test date will be sent two weeks before the scheduled test date.

(d) The fee to take the Self Insurance Administrator's examination shall be $150. The fee shall not be refundable after confirmation of entrance to the exam has been issued by the Office of Self Insurance Plans. Exception1:Upon a written showing of good cause, the Manager may authorize a refund of the application fee.

(e) Upon passing the written examination a Certificate of Achievement will be issued within eight weeks of the test date.

(f) Each adjusting location of a third party administrative agency or a self-administered self insurer shall have at least one person who has passed the self insurance administrator's examination. All workers' compensation self insurance claims at such reporting locations shall be administered and adjusted under the direct supervision of a person who has passed the self insurance administrator's examination. Supervision of claims decisions, setting of estimates of future liability of claims, and proper payment of benefits to injured workers shall be made or reviewed by a person who has passed the self insurance administrator's examination.

(g) Lack of competent administrators at any adjusting location shall be good cause for revocation of the certificate to administer for that location and may be grounds to revoke the certificate to self insure.

Note: Authority cited: Sections 54, 55, 59, and 3702.10, Labor Code. Reference: Sections 59, 3702, 3702.1 and 3702.10, Labor Code; and Sections 15375 and 15376, Government Code.

HISTORY

1. Amendment filed 2-19-92; operative 3-20-92 (Register 92, No. 13).

2. New (a) Exception2 and amendment of Notefiled 6-30-94; operative 6-30-94 (Register 94, No. 26).

3. Amendment of subsections (a)-(f) filed 2-9-2006; operative 3-11-2006 (Register 2006, No. 6).