| Updated: |
4/8/2009 |
| Description: |
Insurers, self-insured employers, and third party administrators must employ certified claims examiners to process Oregon workers' compensation claims.
Workers' Compensation Division has set standards (OAR 436 Division 055) for claims examiner certification to be administered by insurers, self-insured employers, and third party administrators. |
| Statutes, Rules, Ordinances: |
ORS 656
OAR 436-055
|
| Duration: |
3 years from the date of the examination. |
| Fees - application, exam, etc.: |
The Workers' Compensation Division does not charge for any claims examiner training provided. However, vendors offering initial certification training or continuing claims examiner training may charge varying fees. |
| Responsible Agency: |
Workers' Compensation Division - Licenses |
| Examination Information: |
Claims examiners must satisfactorily complete an examination that demonstrates the individual's familiarity with the workers' compensation statutes, ability to navigate the administrative rules, capability to perform claim processing activities, and an understanding of activities related to interactions with independent medical examination providers. Any person taking an examination may use a copy of ORS Chapter 656 and the Oregon Administrative Rules Chapter 436 during the examination and must complete the exam with a passing score of 80 percent or greater. |
| Continuing Ed Requirements: |
Claims examiners must complete 24 hours of training during the current certification period.
The training must include, at least, four hours of training on the workers' compensation statutes, administrative rules, and case law since the last certification.
For renewals, three of the 24 hours must be related to interactions with independent medical exam (IME) providers that covers all the components in OAR 436-055-0085(2). The Workers' Compensation Division must first approve the IME training. The three hours of training may be completed in increments.
Training may be provided in the form of a seminar, workshop, association meeting, forum, correspondence, video or similar course.
It may include any of the following subjects: medical case management including, but not limited to, medical terminology, basic human anatomy and interpreting medical reports; communication skills including, but not limited to, courses in ethics, mediation, negotiation and dealing with angry people; and instruction dealing specifically with the processing of Oregon workers' compensation claims. |
| Bonding Requirements: |
None |
| Insurance Requirements: |
None |
| Renewals: |
Certification can be renewed at any time during the three-year certification period by the individual claims examiner providing verification to their employer of completion of 24 hours of training during the current certification period. |
| Service Links: |
 Claims examiner certification
Agency Contact Information
|
| Required Documentation: |
Insurers, self-insured employers, and third party administrators must keep records of qualified training for certified claims examiners in their employ, subsequent to the most recent certification, including: name of instructor(s), syllabus, date(s) of training, time(s) of training, hours of training, type of training, including if the training was related to changes in workers' compensation statutes, administrative rules, case law, and interactions with IME providers.
Insurers, self-insured employers, and third party administrators must retain these records for six years. A certified claims examiner may request a complete copy of all records verifying their most recent certification and any subsequent training from their employer. The records must be provided within 14 days of a written request or termination of employment. |
| Additional Information: |
For additional information or questions regarding the Claims Examiner Certification, please contact the Benefits & Certification Unit 800-452-0288.
For information about Workers' Compensation Division approved IME training, please contact the medical section at 503-934-6049. |
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Agency Information
|
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Please refer to the Agency Website for further details and additional information.
|
| Agency Name: |
Workers' Compensation Division - Licenses |
| E-mail Address: |
Workcomp.questions@state.or.us
|
| Phone: |
503-947-7810
or 800-452-0288 (toll-free in Oregon)
|
| Mail Address: |
DCBS - Workers' Compensation Division
PO Box 14480
Salem, OR 97309
- 0405
|
| Website Information: |
http://www.wcd.oregon.gov/ |
