THE SHORT ANSWER
A claims administrator is the company running your claim: an insurer, a self-insured employer or public pool that handles its own claims, or a third-party administrator hired by one of them. Every benefit notice must name it and the examiner assigned to you, with a telephone number and mailing address.
On this page
The company whose name is on your workers’ comp letters may not be your employer, and may not be an insurance company either. This page explains what a claims administratorClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer. is, the ways a claim can be set up, how to find out who has yours, and what each of their letters means. Then there is a page for each administrator people ask us about.
What a claims administrator is
It is the company running your claim. The law defines a claims administrator as “a self-administered workers’ compensation insurer; or a self-administered self-insured employer; or a self-administered legally uninsured employer; or a self-administered joint powers authority; or a third-party claims administrator for an insurer, a self-insured employer, a legally uninsured employer, or a joint powers authority.”
A third-party administrator is a contractor. DWCDWC Division of Workers’ Compensation, part of the Department of Industrial Relations. Administers the system. Information Services Center: 1-800-736-7401.’s audit regulations define a third-party administrator as an agent under contract to administer the workers’ compensation claims of an insurer, a self-insured employer, a legally uninsured employer, or a self-insured joint powers authority. The same definition includes the State Compensation Insurance Fund at locations where it administers claims for self-insured and legally uninsured employers.
The adjuster is a person inside that company. The regulations call that person the claims examiner: every benefit notice must name “the individual claims examiner responsible for the payment and adjusting of the claim” (8 CCR § 9810(c)(1)). Companies use their own titles for the job.
Whoever administers the claim, the law is the same. Every benefit and every deadline in the Labor Code applies whether the claim is run by an insurer, by the employer itself, or by a contractor. My employer is self-insured · Every term in plain English
Insurer, third-party administrator, or self-insured employer
Every employer except the state must secure the payment of compensation. The law lists the ways to do it.
| HOW THE EMPLOYER IS COVERED | WHO PAYS | WHO MAY RUN THE CLAIM | HOW YOU CAN CHECK |
|---|---|---|---|
| A policy with an insurer authorized to write workers’ comp in California | The insurance company | The insurer’s own claims staff, or a third-party administrator | The WCIRB’s coverage inquiry site gives the insurer that wrote a policy for an employer on a specific date within the last five years |
| A certificate of consent to self-insure from the Director of Industrial Relations | The employer | The employer’s own claims staff, or a third-party administrator | The Office of Self-Insurance Plans’ roster of private self-insured employers. The WCIRB site has no information about self-insured employers |
| A county, city, public district or other public agency, including members of a joint powers pool, with a certificate to self-insure | The agency, or the pool | The agency, the joint powers authority, or a third-party administrator | The Office of Self-Insurance Plans’ rosters of public self-insured agencies and joint powers authorities |
A contractor running self-insured claims needs a state certificate. A claims administrator that administers or adjusts self-insurance claims must hold a valid Certificate to Administer, with listed exceptions that include admitted insurers and self-insurers handling their own claims. The Office of Self-Insurance Plans publishes a list of third-party administrators, and all eight administrators on our list below appear on its list dated July 31, 2026.
No coverage at all is a different route. When your employer has no insurance
Office of Self-Insurance Plans rosters WCIRB coverage inquiry
How to find out who is handling your claim
Start with paper you already have.
- The claim form — The employer section of the DWC 1 asks for the insurer or claims administrator and the policy number. Within one working day of receiving your form, the employer must give you a dated copy. The DWC 1, part by part
- Any benefit notice — Every notice must give the claims administrator’s name, mailing address, telephone number and website if available, your claim number, your date of injuryDate of injury For a cumulative or occupational disease claim, the law sets it as when you first suffered disability and knew or should have known it was work-related — not when the wear began. Almost every deadline runs off this., and the name, telephone number and mailing address of the examiner handling your claim.
- The poster at work — the law requires every employer to keep posted a notice that states the name of its current workers’ comp insurer, or that it is self-insured, and who is responsible for claims adjustment.
- The WCIRB coverage inquiry — It gives the insurer, not a third-party administrator, and it has nothing on self-insured employers. How to check coverage
- The Appeals Board’s case search — Once an Application for AdjudicationApplication for Adjudication Opens your case at the Appeals Board. One year. has been filed, DWC’s public case search lists the active case participants, with each one’s name, role and address. Look up your case
- A written question — Ask your employer by email or letter who the claims administrator is and what your claim number is. Keep a copy.
Your claim number and your ADJ numberADJ number Your case number at the Appeals Board. are different. The claim number is the administrator’s number for your claim, and it is on every benefit notice. The ADJ number is the Appeals Board’s case number, and it exists only once an Application for Adjudication has been filed.
No claim form yet? For an injury that kept you off work beyond your shift or needed treatment beyond first aid, if the claims administrator learns your employer did not give you a claim form and the notice of potential eligibility, the law requires it to provide them within three working days.
What their letters mean
Every benefit notice follows rules. It must have a title at the top that identifies its subject, and it must end with the bold line “Keep this notice. It contains important information about your workers’ compensation benefits.” (8 CCR § 9810(g)). It must tell you that you have a right to disagree with decisions affecting your claim and a right to be represented by an attorney, and give DWC’s information line. Notices must be available in English and Spanish, as appropriate.
| THE LETTER | WHAT IT MEANS | WHEN IT IS DUE |
|---|---|---|
| Delay in deciding liability | They have not decided yet. The notice must give the reasons for the delay, any information they need, and when they expect to decide. It must also explain the 90-day presumption and the up to $10,000 of treatment owed while they decide | Within 14 days after the date of knowledge of the injury |
| Denial of all liability | They have rejected the claim. The notice must give the reasons and include any medical report the decision rests on, except psychiatric reports the psychiatrist recommended be withheld | No later than 14 days after the decision to deny |
| First temporary disability payment | The amount, how it was calculated, and how long and how often you will be paid | No later than the 14th day after the employer knew of the injury and the disability |
| Benefits ending | The reason payments are ending, with an accounting of everything paid in that benefit, including dates, amounts and any penalties | With the last payment |
| Utilization review decision | A decision on one treatment request: approved, modified or denied. A modification is a denial of what it left out | On a prospective request, the written denial is due to you within 2 business days, with the IMR application and an addressed envelope. You then have 30 days to request IMR, or 10 for a dispute only about MTUS Drug List drugs |
| MPN notification | Which medical network you treat in, how to reach it, and how to choose and change doctors | When the injury is reported or the employer learns of it |
A delay letter is not a denial. The 90-day clock keeps running, and the treatment obligation applies while they decide. My claim is delayed · Denied and delayed claims
A treatment denial is not a claim denial. An accepted claim can produce many utilization reviewUR Utilization Review. The process that approves, modifies, or denies each treatment request. A modification is a denial of what it left out. decisions. How to check a UR decision · They approved part of my treatment
Some letters come with a 10-day form. If you have no lawyer and the issue is medical, a delay or denial notice may include the form to request a panel of Qualified Medical Evaluators, with a statement that you must submit it within 10 days. The QME process
Ask for the medical reports. On request, the administrator must give you copies of the medical reports relevant to any notice it sends, other than psychiatric reports the physician recommended be withheld.
Keep every notice with its envelope. The dates are how you prove the timeline. I can’t read the paperwork
When the adjuster does not answer
Write instead of calling. A dated email or letter, with your claim number, what you need and a date for a response, is what every remedy for delay depends on. My adjuster won’t call me back
A late check carries an automatic 10%. A late indemnity payment is increased 10 percent and paid “without application,” with narrow exceptions.
Unreasonable delay costs more. Compensation unreasonably delayed or refused is increased up to 25 percent or up to $10,000, whichever is less. The deadline is two years from the date the payment was due. Late payments and penalties
The state’s help is free. Every DWC district office has an Information & Assistance officer. The DWC Information Services Center is (800) 736-7401. Where the offices are
The administrators
One page for each company people ask us about. Each covers who the company is, what that means for your claim, how to reach the examiner, which medical network may apply, and what to do when nobody answers. Each states only what the company itself or a state agency publishes.
On the state’s list of third-party administrators
| ADMINISTRATOR | NAME ON THE STATE’S LIST (JULY 31, 2026) | PAGE |
|---|---|---|
| Sedgwick | Sedgwick Claims Management Services, Inc. | Sedgwick |
| CorVel | CorVel Enterprise Claims, Inc. | CorVel |
| Broadspire | Broadspire Services, Inc. | Broadspire |
| Gallagher Bassett | Gallagher Bassett Services Inc. | Gallagher Bassett |
| TRISTAR | TRISTAR Claims Management Services, Inc. · TRISTAR Risk Management | TRISTAR |
| Intercare | Intercare Holdings Insurance Services, Inc. | Intercare |
| Athens Administrators | Athens Administrators | Athens |
| Keenan | Keenan & Associates | Keenan |
Also on the letters people bring us
Frequently asked questions
What is the difference between a claims administrator and an adjuster?
The claims administrator is the company running the claim. The adjuster, or claims examiner, is the person there assigned to yours. Every benefit notice must give that person’s name, telephone number and mailing address.
Is a third-party administrator my insurance company?
No. It administers claims under contract for an insurer, a self-insured employer, a legally uninsured employer or a self-insured joint powers authority. The money comes from whoever hired it.
My letters come from a company I have never heard of. Is that normal?
Yes. An employer or insurer can hire an outside company to run its claims, and the notices then come from that company. Send your correspondence to the examiner named on the notices, and keep your employer informed too: reporting to your employer still matters for notice purposes.
How do I find out who is handling my claim?
Look at the employer section of your DWC 1, at any benefit notice, or at the workers’ comp poster at work, which must say who is responsible for claims adjustment. If none of those answers it, ask your employer in writing.
Does it matter who administers my claim?
Not for what you are owed. The benefits and the deadlines are set by the Labor Code. What changes is who you write to.
Sources
Labor Code § 138.4§ 3550§ 3700§ 4610§ 4610.5§ 4650§ 5402(a), (b), (c)§ 58148 CCR § 9767.12§ 9810§ 9812§ 10100.2§ 10140§ 15450Office of Self-Insurance Plans, rostersOffice of Self-Insurance Plans, Third Party Administrators List, July 31, 2026 (PDF)WCIRB, California Workers’ Compensation Coverage InquiryDWC EAMS public information case searchDWC Information & AssistanceLabor Code § 138.4(a)8 CCR § 10100.2(pp)§ 3700(a)§ 3700(b)§ 3700(c)8 CCR § 15450(a)8 CCR § 10140(a)Labor Code § 3550(a)Labor Code § 138.4(b)(1)§ 9810(e)(1)§ 9810(l)8 CCR § 9812(g)§ 9812(i)§ 9812(a)(1)§ 9812(d)8 CCR § 9767.12(a)§ 5402(c)§ 9812(g)(3), (i)(1)(B)§ 9810(h)§ 4650(d)§ 5814(g)§ 5814(a).
(213) 380-9310
General information about California law, not legal advice about your case.
Reviewed by Jamey Teitell, Partner & Trial Attorney · Last reviewed
Law Offices of Solov & Teitell, APC · (213) 380-9310
Printed from https://www.solovteitell.com/resources/claims-administrators/ · Last reviewed