A Claims Administrator for Workers’ Compensation is a company working under the guidelines of the California Division of Workers’ Compensation (DWC) and is charged with expediting the delivery of workers’ compensation benefits and services to injured workers’ without unnecessary litigation or delays. Typical examples of claims administrators are:

  • Insurance Carrier – internal claims department
  • Third-Party Administrator (TPA) – that is where we fit in, Elite Claims Management
  • Self-Insured Employer – employer’s internal claims department

Here are a few important details to keep in mind about a workers’ compensation claim:

  • Within 14-days of knowledge of the claim a notice will be mailed to the injured employee and all parties of either acceptance, delay, or denial of the claim
  • The date of knowledge begins with the employer’s date of knowledge not the claim analyst’s date
  • If claim is delayed a decision must be made within 90-days of receipt of the DWC 1 claim form
  • If claim is delayed and later accepted lost time benefits must be mailed within 14-days of the claim being accepted