Section 2592.02 - Training Required for Claims Adjusters and Medical-Only Claims Adjusters(a) Every insurer shall require all claims adjusters and medical-only claims adjusters who handle workers' compensation claims on the insurer's behalf, other than those who are defined in subdivisions (f) and (g) of Section 2592.01, to be trained pursuant to these subparagraphs:(1) The insurer shall require at least 160 hours of training for claims adjusters, at least 120 hours of which shall be conducted in a classroom with an instructor. The insurer shall require at least 80 hours of training for medical-only claims adjusters, at least 50 hours of which shall be conducted in a classroom with an instructor. Any training not conducted in a classroom with an instructor may be done on the job under the supervision of an instructor or an experienced claims adjuster.(2) A medical-only claims adjuster who has completed 80 hours of training pursuant to this section may be designated as a claims adjuster upon completion of 80 additional hours of workers' compensation claims training, 70 hours of which shall be in a classroom with an instructor, provided that such training is completed within six months of the claims adjuster beginning to adjust claims that include more than medical benefits.(b) The training required by this section shall be completed within a twelve (12) consecutive month period, during which time a claims adjuster or medical-only claims adjuster trainee may adjust claims under the supervision of an instructor or experienced claims adjuster. No individual may adjust claims on behalf of one or more insurers for a combined total of more than twelve (12) months unless such individual has been trained pursuant to this article. However, if a claims adjuster or medical-only claims adjuster trainee requires leave from his or her employment because of illness, disability, military service, or leave required or permitted by state or federal law, and the leave has begun after the training has started, the training shall be completed within a period not to exceed 24 months after the commencement of the training.(c) Any classes or courses taken within three (3) years before the effective date of these regulations that satisfy the curriculum requirement may be used to meet the hourly requirements upon verification by the student to the insurer of the type of course taken, the course of study, the date or dates taken, the person or organization providing the class or course, and the number of hours taken.(d) Upon the effective date of these regulations, every insurer shall require a minimum of 30 hours of post-designation training every two (2) years for all claims adjusters and 20 hours of training every two (2) years for all medical-only claims adjusters.(e) Post-designation training may include seminars, workshops, or other informational meetings pertaining to California workers' compensation and need not be in a classroom with an instructor. Such training shall be verified by the insurer with the type of course taken, the subject matter, the date or dates taken, the location of the training, the person or organization providing the training, and the number of hours taken.(f) Failure of a claims adjuster or medical-only claims adjuster who has received a designation pursuant to subdivisions (a) or (b) of section 2592.05 to fulfill the requirements for post-designation training every two years pursuant to subdivisions (d) and (e) above shall result in that person being no longer considered a designated claims adjuster or medical-only claims adjuster. That person shall not be authorized to adjust claims until the requisite number of hours of post-designation training is completed.(g) The insurer may provide the designation training directly or by sending its employees or its agents to be trained by a training entity for the entire designation curriculum. An insurer shall certify to the Insurance Commissioner that the course of instruction provided for training meets all the requirements set forth in this article and that all of the claims adjusters and medical-only claims adjusters who adjust claims on behalf of the insurer have actually attended the training for the required number of hours, in the manner provided for in sections 2592.07 and 2592.08.(h) A claims adjuster or medical-only claims adjuster who has completed the training required by this section shall not be required to be retrained and re-designated in order to adjust claims for a different insurer.(i) An insurer may not authorize an individual to act in the capacity of claims adjuster or medical-only claims adjuster who has not been trained and designated pursuant to this article or who is not an experienced claims adjuster or an experienced medical-only claims adjuster and designated pursuant to this article, except that an individual who is undergoing training may adjust claims under the direct supervision of an instructor or experienced claims adjuster.Cal. Code Regs. Tit. 10, § 2592.02
1. New section filed 1-23-2006; operative 2-22-2006 (Register 2006, No. 4). Note: Authority cited: Section 11761, Insurance Code. Reference: Section 11761, Insurance Code.
1. New section filed 1-23-2006; operative 2-22-2006 (Register 2006, No. 4).