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