California offers employers several options for funding a workers' compensation program. Employers can elect standard workers' compensation insurance, they can join a pool that provides coverage, they may choose the state's workers' compensation insurance offering or instead can elect self-insurance. When selecting self-insurance, the employer has two more options, manage the program from within or hire a third-party administrator of workers' compensation claims. In either case of the two, whoever administers the workers' compensation caseload must have active self-insurance certification through California's Department of Industrial Relations Self-Insurance Plan.
Obtain experience working as a claims examiners for workers' compensation claims either through an insurance agency, a self-insured employer or third-party administrator of workers' compensation claims.
Become knowledgeable of all California state laws regarding the administration of workers' compensation claims. This includes the deadlines under which claims are reported, filed, responded to and administered. Specific deadlines between date of application, medical care and payment of temporary total disability payments must be known by the claims examiner to ensure compliance with the state's workers' compensation laws. All claims examiners must adhere to the deadlines specified by California or self-imposed penalties must be included with untimely payments. The Self-Insurance arm of the state's Department of Industrial Relations may also levy penalties for unmet timelines.
Become knowledgeable of the payment structures with respect to TTD payments. Injuries in prior years receive different payout amounts than injuries in current years. In California, workers' compensation claimant can report an injury sustained in prior years. A claims examiner must know how to correctly calculate TTD based upon the date of injury or the self-insured entity may be penalized.
Learn the state's vocational rehabilitation requirements for employees who cannot return to the job they held due to an accident on the job.
Become familiar and memorize the various forms the state requires for reporting and administering claims. Learn the various terminology and letter-types required in specific communications between the claims examiner and the claimant. Each milestone has a specific letter used to communicate with the injured worker. Become familiar with all the industry-related acronyms and methods of calculating medical payments to doctors as well as the acceptable amounts for specific injuries.
Develop the ability to calculate future indemnity and medical costs for all claims under your administration.
Study to take the California Department of Industrial Relations Self-Insurance Plans certification test.
Register to take the test and pay the $150 fee as of June 2011. Conducted three times a year in various locations across the state, candidates are eligible to register online or by mail (see Resource). Pay fees with a money order, cashier's check, company check or credit card; cash or personal checks are not accepted. Payment must be made at time of registration.
Take and pass the test. Examiners who fail may retake the test after paying the fees and registering again.