Workers Compensation Claims Adjuster and Medical Bill Reviewer Training, insurance claims adjuster training.#Insurance #claims #adjuster


Workers’ Compensation Claims Adjuster and Medical Bill Reviewer Training

The insurers listed on this Web page, which include insurance companies, self-insured employers, and third-party administrators, certified to the Insurance Commissioner that all claims adjusters, medical-only claims adjusters and medical bill reviewers met the requisite initial training or experience requirements and subsequent training requirements for handling workers’ compensation claims in California. Each insurer must certify this annually to the Commissioner, on or before July 1st. These requirements are outlined in the regulations promulgated by the Commissioner in accordance with Section 11761 of the California Insurance Code.

Insurer, Third Party Administrator (TPA) and Self Insured Employer Certification Summaries

Certification Forms

NOTE: Certification Forms are the ONLY forms that should be submitted by the insurer to the Department of Insurance. DO NOT submit Designation Forms to the Department of Insurance. Designation Forms are provided for the insurer’s convenience to use in issuing required designations to employees.

Designation Forms

Initial Training or Experience Requirements and Subsequent Training Requirements

To handle workers’ compensation claims, each claims adjuster shall receive a Claims Adjuster Designation Form that verifies that he or she has completed a minimum of 160 hours of training, with at least 120 hours of training being conducted in a classroom with an instructor or has met the requisite experience requirements as set forth in the regulations (Section 2592.01(f)). Subsequent to the initial designation, all claims adjusters shall receive a Post-Designation Training Form that demonstrates he or she has met the required 30 hours of post-designation training every two years.

Medical-only Claims Adjuster Training

To handle claims involving only medical benefits, each medical-only claims adjuster shall receive a Medical-Only Claims Adjuster Designation Form that verifies he or she has completed at least 80 hours of training, with at least 50 hours of training being conducted in a classroom with an instructor or has met the requisite experience requirements as set forth in the regulations (Section 2592.01(g)). Subsequent to the initial designation, all designated medical-only claims adjusters shall receive a Post-Designation Training Form that demonstrates he or she has met the required 20 hours of post-designation training every two years.

Medical Bill Reviewer Training

To handle medical bill review for an insurer or medical billing entity, each medical bill reviewer shall receive a Medical Bill Reviewer Designation Form that verifies he or she has completed at least 40 hours of training with at least 30 hours of training being conducted in a classroom by an instructor or has met the requisite experience requirements as set forth in the regulations (Section 2592.01(h)). Subsequent to the initial designation, all designated medical bill reviewers shall receive a Post-Designation Training Form that demonstrates they have met the required 16 hours of post-designation training every two years.

Curriculum

Required curriculum topics for each are listed below. All on-the-job training shall be done under the supervision of an instructor or an experienced claims adjuster.

Claims Adjuster Curriculum

All workers’ compensation claims adjuster training programs in California shall include but not be limited to the following topics:

  1. Historical overview of the workers’ compensation system.
  2. Organizational structure of the system.
  3. The workers’ compensation insurance policy, its forms and endorsements, insurance principles of compensation.
  4. Concepts and terminology.
  5. Benefit provisions.
  6. Compensability.
  7. Notice requirements.
  8. Temporary disability.
  9. Permanent disability, including evaluation and rating.
  10. Death benefits.
  11. Return to work and vocational rehabilitation.
  12. Cumulative trauma.
  13. Serious and willful misconduct.
  14. Workers’ Compensation Appeals Board procedures, forms, hearings, and penalties.
  15. Investigation.
  16. Fraud.
  17. Medical terminology.
  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. Medical evidence.
  20. Medical dispute resolution (Qualified Medical Examiners, spinal surgery second opinions, pre-designation of physicians, independent medical reviewers, utilization review.)

Training for medical-only claims adjusters shall, at a minimum, include all the topics specified above in the claims adjuster training, with the exception of topics 8, 9, 10, 11, 13, and 23, which may, but are not required to, be included.

Medical Bill Reviewer Curriculum

Training for medical bill reviewers shall include but not be limited to the following topics:

  1. The correct use of billing codes and detection of improper use of billing codes.
  2. All fee schedules applicable in California to workers’ compensation medical care, including statutes and regulations authorizing the fee schedules.
  3. Workers’ compensation benefit provisions.
  4. Fraud.
  5. Medical terminology.
  6. Utilization guidelines (American College of Occupational and Environmental Medicine or other guidelines approved by the Administrative Director of the Division of Workers’ Compensation).
  7. Medical evidence.
  8. Liens.
  9. Ethical issues.

Workers’ Compensation Claims Adjuster Regulation Frequently Asked Questions

If you need further assistance, please call CDI’s Education Unit at (916) 492-3064. Please be sure to include your name, telephone number, license number and e-mail address in all correspondence with the California Department of Insurance.


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  • Not paying the required fee – In most cases, the fee is $50, but please consult the form to determine the proper fee for the license being sought.

  • Not including the fingerprint receipt if required, with the application – Without the fingerprint receipt, TDI staff cannot complete the criminal history background check.

  • Not including the course completion certificate – For licenses requiring a pre-licensing course, the course certificate is the only way TDI can verify that the requirement has been satisfied.

  • Not having original notarized signatures on the application – In order to verify the validity of the notarized signature, the original is required. (paper applications only)

  • The applicant’s name, date of birth, or social security number not matching the information contained on the criminal history report – Many times this is a result of typographical errors. Please verify that all of the information is correct on the application.

  • Not providing addresses All four addresses; business, mailing, residential, and an email address are required for TDI’s records, in order to facilitate communications with applicants and licensees.

  • Not answering screening questions – Please be aware that all portions of Part I of the application should be completed regardless of the type of license being sought. If a question is not answered, the application will be deemed incomplete.

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Adjuster Licensing Training

BECOME AN INSURANCE ADJUSTER by becoming licensed in the state in which you would like to work!

What is a CATASTROPHE ADJUSTER?

To become licensed as an adjuster in your state,

State Specific Training Products include:

Agency and Corporate Services include:

Insurance Schools has developed an inexpensive pre-screening process to help companies determine which employees are suited for the insurance adjuster training school. This process has saved our clients much time and money by eliminating the expenses associated with training those who are not particularly suited for insurance adjusting.

Types of insurance adjusters:

  • Company Adjuster – A company adjuster is an adjuster representing the interests of the insurer, including independent contractors and salaried employees of the insurer.
  • Public Adjuster – An independent contractor representing solely the financial interests of the insured named in the policy. The insured and not the insurance company pays the adjuster.

3. An insurance adjuster is expected to perform all or some of the following tasks:

  • Inspect damaged properties and estimate amount of loss.
  • Determine if claimants’ policies cover the type of damage they are claiming.
  • Talk to policyholders, witnesses, and police to gather information. Read hospital records and police reports.
  • Analyze information about claims. May contact policyholders or insurance agents to clarify information.
  • Write reports explaining their decisions.
  • Negotiate with policyholders to settle claims.
  • Gather evidence to support contested claims in court. Meet with lawyers.
  • May testify in court.

The Adjuster’s Investigation:

The adjuster’s investigation may be as simple as verification of bills and estimates, or it may be expanded to include taking photographs, interviewing witnesses, or recording statements, as the circumstances require. Also, the facts obtained during the adjuster’s initial investigation must be transferred into evidence, if and when the claim goes into suit, so that allegations made by the insurer may be substantiated.

A general plan of investigation will consist of all or some of the following elements in this sequence:

1. Critical Evidence –

• Statement of the claimant (or claimants in the order of the

severity of the injuries).

• Photograph of the accident scene, showing skid marks and

other evidence of the accident.

• Examination and photographs of the vehicles themselves

showing the damage and point of impact.

• The product itself or the instrumentality causing the injury.

• Statement of the insured, his driver, or employee having

knowledge of the accident, the instrumentality causing it, or

the part of the premises in which the accident is alleged to

• Negative statements from persons who were in a position to

have seen the accident or have some knowledge of its

occurrence, but who deny having such knowledge.

• State motor vehicle reports filed by the parties to the accident

• Fire department reports

• Reports of state motor vehicle inspectors

• Traffic court proceedings

• Arraignment in magistrate court

• Coroner’s inquest transcript

• Birth and marriage certificates

• Certified copies of court records showing prior convictions of

• Hack bureau reports (if a taxi cab is involved)

• C.A.B. reports (aircraft)

• I.C.C. reports (interstate truckers)

• Coast Guard reports (boats)

• Attending physician’s report and records

• Medical or hospital reports covering preexisting injury or disease

• Contracts and agreements, especially contracts for

construction, alterations and repair, as well as hold harmless

• Index bureau reports

• Workers’ compensation claims made by injured, arising out of


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Edith “Edie” Windsor, who sued the government for failing to recognize her marriage to her late spouse, Thea Spyer, asked the U.S. Supreme Court today to hear her challenge to the so-called “Defense of Marriage Act” (DOMA). Full Story

In addition to suspending the 10 percent surcharge rule on property insurance provided by Louisiana’s property insurer of last resort in certain coastal parishes, recently passed state legislation includes provisions for allowing electronic proof of Full Story

This year’s Atlantic hurricane season got off to a busy start, with six named storms to date, and may have a busy second half, according to the updated hurricane season outlook issued today by government weather forecasters. Full Story

A former Plainville, Conn., doctor has been sentenced to four months in prison for dealing prescription drugs Full Story

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Insurance Claim Center, Travelers Insurance, insurance claim information.#Insurance #claim #information


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How much does it cost for a Diminished Value Report? Understandably, this is one of our most frequently asked questions and the most difficult to answer simply because the cost of a Diminished Value Report depends upon a number of factors that are unique to each individual situation and pricing of the service(s) may be based upon several factors. For example:

  • The nature and severity of the property s damages?
  • The location of the vehicle to be inspected
  • The type, age and condition of the vehicle
  • How much research will be required to establish an accurate pre-loss market value for the subject vehicle?

These are just some of the factors that can affect the cost of your individual report. The best way to determine the cost for your particular needs is to complete our convenient, online Inquiry Form and receive a free, no obligation consultation. When completing the form, please provide as much information as possible; upon receipt, we will contact you to discuss your particular needs, the recommended service(s) and their anticipated costs.

While many Diminished Value (DV) service providers are available today, they vary in the types and quality of services offered as they do in professionalism and credibility. As an example, there are some who offer an Internet based Diminished Value report with no inspection of the vehicle! It only makes common sense that one of the main factors in making a fair and proper valuation is to determine the pre-loss condition and value of the subject vehicle. What about the quality of the performed repair? How would the parties know if the vehicle was, or was not repaired properly? What if serious safety related flaws and defects, identifiable only by experts, remained, potentially placing the driver, their passengers and others on the roadway in harms way?

To resolve a claim for Diminished Value, in an efficient and equitable manner, the parties must select representatives with the knowledge required to ascertain and provide the required information in a succinct and convincing manner. Not knowing the pre-loss condition of a vehicle would be, at best, detrimental to the parties involved.

Be cautious! As in any profession, there are the best of the best, the worst and of course everything in between. It is vital to secure the services of true experts to assist you. When seeking a Diminished Value expert to assist you in such matters it would be wise to remember the age old adage: Cheaper is Rarely Better and Better is Rarely Cheaper .

Note: In most instances, the costs of Diminished Value appraisal services may be recoverable as part of your claim.

Whether an individual consumer, or a seasoned professional, one would be wise to seek and secure the services of the professionals whose work product has and continues to withstand scrutiny. We are ready to ADE you!


AdjusterPro – 7 Habits of the Highly Effective Independent Insurance Claims Adjuster, insurance claims adjuster


The 7 Habits of Highly Effective Adjusters:

Professional Skills and Personal Virtues Needed to Succeed as an Insurance Claims Adjuster

Habit 1: Communication

Insurance claims adjusters ought to possess excellent people skills. An insurance adjuster will deal with all manner of people in every frame of mind – from happy and grateful to angry and suspicious. As representatives of insurance companies, claims adjusters are often the only point of contact between the insurer and insured. Customer service with an emphasis on cordial, patient, and professional communication should always be striven for.

Habit 2: Time Management

Wasted time and stress are twin enemies of an insurance adjuster – particularly an independent adjuster handling catastrophic claims. Effective time-management will minimize stress and maximize profits. It is not uncommon for insurance adjusters to be handed stacks of claims numbering in the hundreds. And in a catastrophic situation, each claimant wants the adjuster there yesterday. Managing expectations, multi-tasking, and using time wisely are essential to surviving the insurance claims “storm”.

Habit 3: Computer Proficiency

The days of hand-writing estimates are over and nearly every major insurance carrier now requires that claims estimates be delivered electronically. Becoming proficient in general computer usage will dramatically elevate the ability of an insurance adjuster to close claims quickly. Those who struggle with typing, using a mouse, or navigating through a Windows based program should strongly consider enrolling in a basic computer skills course before taking on insurance claims.

Habit 4: Integrity

An insurance adjuster, particularly an independent adjuster, has significant freedom and power and therefore responsibility. Temptations to abuse the position (i.e. taking bribes, contractor kickbacks, etc) exist and a good insurance adjuster should constantly be vigilant in guarding against even the appearance of ethical infractions. Crime may pay in some professions but not in insurance adjusting – an unethical adjuster is an adjuster soon to be out of work.

Habit 5: Insurance Policy Knowledge and Application

Knowing how to read an insurance policy is fundamental to proper insurance claims adjusting. But the real skill is in applying the policies within the context of very specific aspects of a particular insurance claim. Excellence in adjusting is as much art as science – formulas and rules can lead you through the black and white but when grey areas arise an adjuster must rely upon intuition, conscience, and experience – in short, good judgment.

Habit 6: Construction/Engineering Knowledge

Being familiar with the makeup of the property adjusted is obviously essential. If an adjuster doesn’t know what is behind a wall in a house, he or she certainly won’t know to account for it in the estimate. The goal of the insurance adjuster is to compensate the homeowner, car owner, or business owner to an extent sufficient to return their property to its pre-damaged condition. Understanding how those properties are constructed, from foundation to roof, is indispensable in coming to a fair and accurate claim settlement amount.

Habit 7: Innovation and The Will to Succeed

Sometimes claims adjusters find themselves confronted with seemingly impossible situations. Difficulties ranging from language barriers, unresponsive claimants, impassible roads, and software bugs can make an insurance adjuster long for greener pastures. In catastrophic events this is particularly true. Some folks take their footballs and go home, and some muddle through an event not to return the next year. But others rise to the challenge, facing problems with innovation and the will to succeed. Being proactive and having perseverance are hallmarks of the highly effective adjuster.


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Class Schedule

What We Do

HOW TO BECOME AN ADJUSTER – The Adjuster School is a Certified continuing education provider by the Texas Department of Insurance (Provider # 33399). We offer courses for individuals that are interested in obtaining the highly recognized Texas All-Lines Adjuster’s License (Classroom course On-Line course), which is the most versatile and sought after adjuster’s license in the Insurance industry. In addition to the Texas All-Lines course, we also offer Xactimate 28 Training, Advanced Xactimate 28 Training, The Keys to Success in Adjuster Training, Property Field Adjuster Training, Auto Adjuster Technical Training, and On-Line Continuing Education for Agents Adjusters.

Our courses and training products are supported by experienced instructors with Property Casualty Claims and Management experience. Our Classroom Texas All-Lines Adjuster Licensing Course and Xactimate 28 Training are taught by an instructor that has 24 years of Claims Experience. Our goal is to provide you with the tools and resources that you need in order to become a valued Staff or Independent Claims Professional!

You will only make yourself more marketable by having the Texas All-Lines Adjuster License. The All-Lines License allows you to handle a wide variety of claims, such as: Catastrophe, Homeowner’s, Auto, Liability, Casualty, Inland/Ocean Marine, Flood, Commercial, Bonds, Worker’s Compensation and more.

It is important for you to understand why the Texas All-Lines Adjuster License is so highly regarded. The Texas license is so highly regarded because it is RECIPROCAL in 30 states. Click here to learn more about Reciprocity.

Our 40 Hour course and final exam satisfies all of the Texas Department of Insurance requirements for obtaining your Texas All-Lines Adjuster License. No further testing or coursework will be required.

As stated above, The Adjuster School offers both Classroom Training and Online Training courses. Customer Satisfaction is our main priority. We work very hard at providing the best learning experience possible, and stand committed to offer you flexibility and options to fit your specific needs. Let us help you Become A Licensed Adjuster!

Insurance claims adjuster trainingThe Adjuster School is committed to providing you with the training, tools, and resources to become a successful Independent or Staff Adjuster. All of our classes are thorough, comprehensive, and reasonably priced. The Adjuster School does not employ any commissioned sales personnel, or any type of phone solicitors or telemarketers to twist your arm to come to our classes. The money that we save by not employing this commissioned sales staff and phone solicitors are directly passed on to our customers.

Our reputation in the Insurance industry speaks for itself. In fact, when you contact our office you will probably speak to the Owner/Instructor Eric Thomas on the phone. Mr. Thomas likes to speak to each and every customer to ensure that all of your questions are answered by someone with 24 years of Insurance Adjusting experience, including 9 years as a Claims Manager with Allstate Insurance. The Adjuster School will give you the Straight Story on Insurance Adjusting. Not scripted answers that were discussed in a Sales Meeting.

If you want to be an Independent or Staff Adjuster, we will give you the Straight Story on the Step by Step process to make this happen for you. We will tell you what you really need to do, not just what someone else wants you to do for a fee. We will tell you what certifications are important vs. what certifications are meaningless and just ways to make money off of you. Our Combo Package provides you with sample resumes, additional post class training, employment directories, and much more. The Adjuster School has helped thousands of individuals just like yourself go to work as Staff and Independent Claims Adjusters. We encourage you to look over our website to learn who will be providing your training, and also to see the training products and resources that we have to offer. If you have any questions, please feel free to contact our office at (281) 546-5873.