California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 8 - Office of the Director › Subchapter 2 - Administration of Self-Insurance Plans › Article 12 - Claims Administration › Section 15452 - Administrator Competence

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(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.
EXCEPTION 1: 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.
EXCEPTION 2: 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.
EXCEPTION 1: 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.
1.
						Amendment filed 2-19-92; operative 3-20-92 (Register 92, No. 13).
2.
						New (a) EXCEPTION 2 and amendment of NOTE filed 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).
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.