Free Self Insurance Continuing Education Sponsor/Instructor Application for Course Approval - Washington

Labor & Industries Self Insurance

Standards and Criteria for Self Insurance Continuing Education Courses and Sponsor/Instructor Application for Course Approval
The purpose of continuing education is to encourage department-approved claims administrators to stay abreast of evolving knowledge and skills in the profession and, in doing so, promote the ongoing competency of those certified. Continuing education courses must be designed to increase the participant's knowledge or skill regarding the administration of workers' compensation claims under Title 51 RCW. It is presumed that individuals holding current department-approved claims administrator status already have a solid working knowledge of claims administration practices and the rules and laws governing claim adjudication. Therefore, no credit will be granted for introductory or basic level courses. Credit will be assigned based on the following criteria: · Complexity · Technical accuracy · Duration The Department of Labor & Industries (L&I) is responsible for establishing continuing education (CE) requirements and credits.

Course Accreditation Process
1. Submit a completed "Continuing Education Sponsor/Instructor Application for Course Approval" form and supporting course information to L&I (the form is on pages 3 & 4 of this document). 2. Your application will be pre-screened for completeness, and may be returned to you if it lacks all the necessary information. (Note: If returned to you, your application is not considered to be "pending". You must resubmit the entire package.) 3. The Self Insurance Curriculum Review Committee will review courses submitted for CE credit approval. 4. To obtain CE credit approval, topics covered must be classified under one or more of the following categories (see definitions on the following page): · Claims process/procedures · Legal · Medical · Ethics · Electives 5. The applicant will be notified in writing of acceptance or denial of the course; and if accepted, the number of credits assigned. · Once the committee has reviewed the materials, no additional documentation will be accepted. The committee's decisions are final.

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Assessment and Evaluation
L&I may audit CE courses at any time to assess appropriateness and effectiveness. Participant course evaluations may also be required.

Employer In-House Training
Self Insured employers (or their representatives) who make education available for their employees may submit an application to have their education considered for CE credits.

Instructor Commitment
By submitting an application for CE approval, the instructor makes a commitment to: · Deliver education programs through to their completion. · Issue a certificate of completion to each attendee who completes the course, or sign the Sponsor/Instructor Verification of Course Completion. · Maintain a roster of attendees who completed the course, and provide a copy of that roster to L&I upon request. The roster must be retained for six years, and include: o Name of the attendee o Course name o Course approval number o Course date(s) o Course location o Sponsor's name and address o Instructor's name

Failure to abide by these Standards and Criteria may result in the department's refusal of future course credit applications.

Category Definitions
Claims process / procedure Instruction on any complex claim adjudication activity which is not specific to the "Legal" or "Medical" category. (Examples: Complex benefit calculations; vocational issues; etc.) Effective communication skills and relationship building with workers/their representatives, physicians, and the Department. Legal 1) Case law: Primarily, instruction on new case law as it is handed down. Classes on existing case law may be considered on a case-by-case basis, depending on complexity. Credit will not be awarded for basic classes on established case law. 2) Statutory changes: Instruction on recent changes to Title 51. ("Recent" means within twelve months of the effective date of the legislation.) Medical Instruction on complex medical issues related to the adjudication of claims under Title 51. (Examples: Study of specific medical conditions and their standard courses of treatment; Medical case management in complex or multiple injury claims; etc.) Ethics Instruction about values, principles, professional conduct, etc., as it relates to workers' compensation. Elective Additional instruction in one or more of the above categories; or, instruction on industry-specific issues related to workers' compensation, safety and injury prevention, disability, etc.
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MAIL COMPLETED FORM TO:
Department of Labor and Industries Self Insurance Program PO Box 44890 Olympia, WA 98504-4890 E-mail: [email protected]

Self Insurance Continuing Education Sponsor/Instructor Application for Course Approval
This Space is for Department Use Only Course ID #

NOTE: Credits will be awarded for advanced courses only; please read pages 1 and 2 carefully before completing this form. The department reserves the right to request additional information before approving a course or assigning credits.
CHECK ONE FOR COURSE DELIVERY METHOD CHECK CATEGORY(s)

Classroom Live webinar Online / self-guided instruction Other (Explain in detail)

Claims process/procedures Legal Medical Ethics Elective
Contact information for registration:

Course Title:

COURSE

Location: Date(s): # of Attendees (or # expected): Hours of credit requested:

SPONSOR

Sponsor Name: UBI #: Address: City: Contact Person: Fax #: Instructor(s) Name: Email address: State: Phone #: ZIP+4:

INSTRUCTOR QUALIFICATIONS Provide years of experience, and in what capacity, administering Title 51 RCW; and/or relevant experience to the topic you are teaching:

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COURSE CONTENT AND OBJECTIVES What are the objectives of your course?

Please attach: · A course agenda showing detailed time allotments · A detailed description of the course content · A description of the training method(s) to be used · A copy of course texts, references and handouts The information you supply must support the number of credit hours requested. Will you be measuring the effectiveness/success of your course? If so, specify how you will accomplish that measurement:

Please note: Your application will be pre-screened for completeness, and may be returned to you if it lacks adequate information. Once your materials are reviewed by the Curriculum Review Committee, additional documentation will not be accepted. The committee's decisions are final. Your signature on this form constitutes a signed agreement to adhere to the Washington State Self Insurance Continuing Education Standards and Criteria. ________________________________________________________ Applicant name and title (print) ________________________________________________________ Applicant Signature

RESET

Applications will be reviewed by the Curriculum Review Committee and you will be notified of approval or denial of your course. *********************************************************************** FOR DEPARTMENT USE ONLY - DO NOT WRITE IN THIS AREA.
APPROVED [ ] COURSE ID #: CATEGORY OF CREDITS ASSIGNED: Claims process /procedure: Legal: Medical: Ethics: DENIED [ ] Elective:

________________________________________ Department Representative Signature

Date

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