1. (a) The course of study required by Section 2592.02 for claims adjusters shall include, but not be limited to, the following topics:

   1. (1) Historical overview of the workers' compensation system.
   2. (2) Organizational structure of the system.
   3. (3) The workers' compensation insurance policy, its forms and endorsements, insurance principles of compensation.
   4. (4) Concepts and terminology.
   5. (5) Benefit provisions.
   6. (6) Compensability.
   7. (7) Notice requirements.
   8. (8) Temporary disability.
   9. (9) Permanent disability, including evaluation and rating.
   10. (10) Death benefits.
   11. (11) Return to work and vocational rehabilitation.
   12. (12) Cumulative trauma.
   13. (13) Serious and willful misconduct.
   14. (14) Workers' Compensation Appeals Board procedures, forms, hearings, and penalties.
   15. (15) Investigation.
   16. (16) Fraud.
   17. (17) Medical terminology.
   18. (18) Knowledge and use of utilization guidelines (American College of Occupational and Environmental Medicine or other guidelines approved by the Administrative Director of the Division of Workers' Compensation.)
   19. (19) Medical evidence.
   20. (20) Medical dispute resolution (Qualified Medical Examiners, spinal surgery second opinions, pre-designation of physicians, independent medical reviewers, utilization review.)
   21. (21) Fee schedules.
   22. (22) Liens.
   23. (23) Apportionment.
   24. (24) Subrogation.
   25. (25) Reserving.
   26. (26) Ethical issues.
2. (b) The course of study required for the training of medical-only claims adjusters shall include, at a minimum, all the topics specified in subdivision (a) above, with the exception of (8), (9), (10), (11), (13), and (23).
3. (c) The course of study required by Section 2592.02(d) for post-designation training shall include changes in the law that affect workers' compensation claims and any other topics relevant to the work of a claims adjuster or medical-only claims adjuster as specified in subdivision (a) above.

Note: Authority cited: Section 11761, Insurance Code. Reference: Section 11761, Insurance Code.

History

1. New section filed 1-23-2006; operative 2-22-2006 (Register 2006, No. 4).