MCCCD Program Description

State Compensation Insurance Claim Adjuster

Course: CSR283

First Term: 2010 Summer I

Lec + Lab 3 Credit(s) 5 Period(s) 4.4 Load
Subject Type: Occupational
Load Formula: S

Description: Overview of the State Compensation Claims Service Division and the responsibilities of a claim adjuster. Covers steps for gathering, reviewing, and researching data, as well as procedures for internal operating systems. Also includes customer accounts, claims procedures, benefits, workers compensation reports, compensation fraud, and wages.

MCCCD Official Course Competencies
1. Identify teams that are part of the State Compensation Claims Services Division. (I) 2. Compare types of responsibilities and authority of various regulatory agencies. (I) 3. Explain steps for gathering, reviewing, and researching data. (I) 4. Review procedures for internal operating systems. (II) 5. Access internal operating systems. (II) 6. Use the Intranet/Internet, online insurance, and document scanning systems. (II) 7. Use various search methods. (III) 8. Create a customer account. (III) 9. Summarize types of claims and injuries. (IV) 10. Explain when an injured worker is entitled to receive medical, surgical, and hospital benefits. (IV) 11. Determine when a notice of claim status should be amended, vacated, and resent. (IV) 12. Differentiate between types of workers compensation reports for an employer and a supervisor. (V) 13. Summarize key indicators of compensation fraud. (V) 14. Explain when an average monthly wage can be established. (VI) 15. Determine when to use a wage calculation sheet. (VI) 16. Complete a wage calculation sheet. (VI)
MCCCD Official Course Competencies must be coordinated with the content outline so that each major point in the outline serves one or more competencies. MCCCD faculty retains authority in determining the pedagogical approach, methodology, content sequencing, and assessment metrics for student work. Please see individual course syllabi for additional information, including specific course requirements.

MCCCD Official Course Outline
I. Customer Service Underwriters A. General Overview 1. Claims Services Division 2. Regulatory Agencies B. Responsibilities 1. Gather 2. Review 3. Research 4. Issue Policies 5. Cancel Policies 6. Renew Policies 7. Review Losses C. Policy 1. Contracts 2. Plans 3. Coverage 4. Workflow II. Internal Operating Systems A. Procedures B. Telephone C. Intranet/Internet 1. E-Mail 2. Sending/Forwarding/Attaching/Deleting 3. Printing D. Online Insurance System E. Document Scanning System 1. Routed 2. Archived 3. Retrieved F. Accessing 1. Log-On/Log-Off 2. Policy Screens 3. Customer Accounts G. Navigate III. Customer Accounts A. Search Methods B. Record Information C. Open/Create/Enter/Modify/Delete D. Financial Transaction 1. Bills 2. Payments E. Case Tools F. Tasks/Notes IV. Claims A. Types 1. Medical 2. Indemnity 3. Incident B. Injury Types 1. Medical Only 2. Temporary Total 3. Temporary Partial 4. Permanent Partial ? Scheduled 5. Permanent Partial ? Unscheduled C. Benefits D. State E. Initiating 1. New Claims 2. Forms 3. Contacts 4. Questions F. Maintenance G. Status H. Notices 1. Protest 2. Amend 3. Vacate V. Workers? Compensation A. Initial Reports 1. Employer 2. Supervisors 3. Worker?s and Physician?s 4. Forms 5. Deadlines B. Compensability 1. Arising Out of Employment (AOE) 2. Course of Employment (COE) 3. Fraud 4. Surveillance VI. Wages A. Average Monthly Wage (AMW) 1. Sources of Wage 2. Worker?s Report 3. Temporary Wage B. Calculate C. Payments

MCCCD Governing Board Approval Date: 5/25/2010

All information published is subject to change without notice. Every effort has been made to ensure the accuracy of information presented, but based on the dynamic nature of the curricular process, course and program information is subject to change in order to reflect the most current information available.