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    Benefits & Certifications Unit   
503-947-7585   

Claims examiner certification

WCD has set standards (OAR 436-055) for certification to be administered by insurers, self-insured employers, and third party administrators (service companies).

All insurers, self-insurers, and service companies processing Oregon Workers' Compensation claims shall maintain records of their individuals processing claims (claims examiners). These records shall include:

A listing of all certified claims examiners

Identification of all certified claims examiners, which includes:
a. Verifiable documentation of current certification
b. Beginning and ending dates of these certifications

Identification of all temporary claims examiners, including:
a. Documentation verifying the 2 year experience requirement
b. Dates of employment for the 12 month period (or audit period)
c. Name of supervising certified claims examiner

Identification of all claims examiner trainees, including:
a. Dates of employment for the 12 month training period (or audit period)
b. Name of supervising certified claims examiner

Records of qualified training for certified claims examiners, subsequent to most recent certification, including:
a. Name of instructor(s)
b. Syllabus
c. Date(s) of training
d. Time(s) of training
e. Hours of training
f. Type of training (note if related to changes in
    workers’ compensation statutes, administrative
    rules, case law, and training related to interacting with     independent medical examination providers.)

Records supporting initial acknowledgments of certification and renewals issued by the insurer, self-insurer or service companies

 

 

Certified claims examiners may wish to maintain copies of these items for their own records.

Note: At time of a Compliance Audit or other inquiry by Workers' Compensation Division, the division will notify the insurer, self-insurer, or service company of the specific records they are required to provide for review. The initial emphasis will be to ensure these companies have developed a plan for certifying their claims examiners and also a process in place to obtain and maintain these required records.

If you have questions about the information contained in this document, please contact Benefits & Certifications Unit, 503-947-7585.

 

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