Proposed Text
CHAPTER 90
PROCEDURAL REGULATIONS FOR FILING FIRST REPORTS UNDER THE VIRGINIA WORKERS' COMPENSATION ACT (REPEALED)
16VAC30-90-10. Authority for regulations. (Repealed.)
Section 65.2-900 of the Virginia Workers' Compensation Act
vests authority in the Virginia Workers' Compensation Commission for the
development of regulations for the correct filing of first reports.
Statutory Authority
§65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996.
16VAC30-90-20. Definitions. (Repealed.)
The following words and terms, when used in this chapter,
shall have the following meanings unless the context clearly indicates
otherwise:
"Commission" or "VWC" means the
Virginia Workers' Compensation Commission.
"First report" means a complete injury report
provided to the commission when the injury meets any of the following seven
criteria:
1. Lost time or partial disability exceeding seven days.
2. Medical expenses exceeding $1,000.
3. Any denial of compensability.
4. Any disputed issues.
5. An accident that results in death.
6. Any permanent disability or disfigurement.
7. Any specific request made by the commission.
"Insurer" means a company licensed to write
workers' compensation coverage in Virginia.
"Minor injury" means an injury that meets none of
the seven criteria for filing a first report.
"Self-insurer" means an entity providing workers'
compensation coverage directly to its employees based on formal approval by
either the Virginia Workers' Compensation Commission or the State Corporation
Commission.
"USPS" means the United States Postal Service.
Statutory Authority
§65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996.
16VAC30-90-30. Procedures for filing written reports. (Repealed.)
A. Written first reports must be submitted on the
commission's form No. 3 within 10 days of the injury.
B. If an injury first reported as minor subsequently meets
one of the seven criteria for filing a first report, that report must be filed
immediately.
C. The commission will issue notification letters to all
parties based on the information provided in the first reports.
D. The filing of first reports is a separate procedure from
the reporting of minor injuries and medical costs. Injuries not meeting the
criteria for filing of a first report must be provided separately according to
the existing guidelines for reporting of minor injuries and medical costs.
E. It is essential that all data requested be provided. The
only exceptions are that:
1. A VWC file number will usually not be available.
2. Certain other information that applies only to specific
kinds of injuries or situations may not be applicable in all cases (e.g.,
return to work dates).
3. Certain supporting information may not be necessary if
adequate summary information is provided (e.g., miscellaneous information on
hours worked may not be needed if there is a certified average weekly wage).
Statutory Authority
§65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996.
16VAC30-90-40. Overview of electronic filing. (Repealed.)
A. Electronic first reports must be filed weekly and
according to the specified record format. Test transmissions and formal
approval by the commission are required before moving into production.
B. If an injury first reported as minor subsequently meets
one of the seven criteria for filing a first report, that report must be filed
immediately.
C. Transmission of the data may be on a 3½-inch diskette or
through deposit in the commission's electronic mail box.
D. The commission will issue notification letters to all
parties based on the information provided on the first reports. An electronic
"error report" will also be provided to the submitting insurer or
self-insurer on request.
E. The electronic reporting of first reports is a separate
procedure from the electronic reporting of minor injuries and medical costs.
Injuries not meeting the criteria for filing of a first report must be reported
separately according to the existing guidelines for electronic reporting of
minor injuries and medical costs.
F. It is essential that all data requested be provided. The
only exceptions are that:
1. A VWC file number will usually not be available.
2. Certain other information that applies only to specific
kinds of injuries or situations may not be applicable in all cases (e.g.,
return-to-work dates).
3. Certain supporting information may not be necessary if
adequate summary information is provided (e.g., miscellaneous information on
hours worked may not be needed if there is a certified average weekly wage).
Statutory Authority
§65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996.
16VAC30-90-50. Record format for electronic filing. (Repealed.)
Information should be arranged by record, delimited by
commas within the records, and with records separated by the equivalent of hard
carriage returns. A normal DOS end-of-file character should appear at the end
of the report. All character data (including null values) must be enclosed in
double quotation marks, and neither single nor double quotation marks may be
used for any other purpose. Note that there are specific record requirements
for the following:
1. Dates must be in a MM/DD/YY format, must include the
indicated slashes, and may never be null.
2. Times must be in a 24-hour HH:MM format.
3. Social security number must include the hyphens.
4. Federal tax identification number must include the single
hyphen after the first two digits.
5. Employee name must be in a LAST, FIRST MIDDLE format.
6. Phone numbers must include the area code and be in the
format "(888) 777-6666."
7. Zip codes must have trailing zeros to fill out the full
nine digits if only the five-digit form is being provided.
8. Miscellaneous letter codes must be "Y" and
"N" for yes and no, "M" and "F" for sex, and
"S" for single, "M" for married, "D" for divorced,
and "W" for widowed.
9. VWC codes for nature of injury, the type of accident, and
body parts affected may be substituted for equivalent text fields.
10. Standard 3-digit SIC codes may be substituted for the
equivalent nature of business text field.
To the extent possible, abbreviations in titles, addresses,
and other text fields should follow the commission's one-page summary of
abbreviations which are, for the most part, a subset of the far more extensive
USPS abbreviations.
Statutory Authority
§65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996.
16VAC30-90-60. Alternate formats for electronic filing. (Repealed.)
Alternate formats will be considered and may be approved on
a case-by-case basis by the commission if they meet the four conditions listed
below:
1. The alternate format must include all information
required by the standard electronic and manual formats.
2. The information provided by the alternate format must be
convertible to the specific data specifications of the standard format.
3. The alternate format must be based on an open,
nonproprietary standard of wide use and demonstrated industry support (e.g.,
ANSI certified).
4. Those proposing the alternate format must be willing to
provide all hardware and software necessary for converting the alternate format
to one compatible with the commission's data system.
Statutory Authority
§65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996.
16VAC30-90-70. Detailed record format. (Repealed.)
On VWC
Form No.3 Description Type
VWC File Number (7 digits) chr-7
Reason for filing chr-1
Insurer code chr-5
Insurer location chr-3
Insurer claim number chr-20
Date insurer claim file created date
Employer
01 Name chr-35
02 FEIN (include hyphen) chr-10
03 reserved chr-10
04A Address (Number, Street) chr-30
04B Address (City ) chr-26
04C Address (State) chr-2
04D Zip code chr-9
05A Alternate address (Number, Street) chr-30
05B Alternate address (City and State) chr-30
05C Alternate zip code chr-9
06 Parent corporation Insured name chr-35
07 Nature of business chr-30
08 Insurer name chr-35
09 Policy number chr-20
10 Effective date (MM/DD/YY) date
Time and Place of Accident
11 City/county where accident occurred chr-20
12 On employer's premises? chr-1
13 On state property? chr-1
14 Date of injury (MM/DD/YY) date
15 Hour of injury (HH:MM) chr-5
16 Date of incapacity (MM/DD/YY) date
17 Hour of incapacity (HH:MM) chr-5
18 Employee paid in full for day of injury? chr-1
19 Employee paid in full for day incapacity began? chr-1
20 Date injury/illness reported (MM/DD/YY) date
21 Person to whom reported chr-18
22 Name of other witness chr-18
23 If fatal: date of death (MM/DD/YY) date
Employee
24 Name (LAST, FIRST MIDDLE) chr-35
25 Phone number chr-13
26 Sex chr-1
27A Address (Number, Street, Apt) chr-30
27B Address (City) chr-26
27C Address (State) chr-2
27D Zip code chr-9
28 Date of birth (MM/DD/YY) date
29 Marital status chr-1
30 SSN (include hyphens) chr-11
31 Occupation at time of injury/illness chr-35
32 Department chr-18
33 Number of dependent children chr-1
34 Date started current job date
35 Date of employment date
36 Piecework or hourly payment basis chr-1
37 Hours worked per day #
38 Days worked per week #
39 Value of perquisites per week #
40 Wages per hour #
41 Earnings per week (gross) #
Nature and Cause of Accident
42 Machine/tool/object causing injury/illness chr-25
43 Specify part of machine, etc. chr-20
44 Safeguard/safety equipment provided? chr-1
45 Safeguard/safety equipment utilized? chr-1
46A Describe how injury/illness occurred chr-75
46B Injury/illness cont. chr-75
47A Describe nature of injury/illness
47B Describe parts of body affected chr-75
48 Physician (name and address) chr-35
49 Hospital (name and address) chr-35
50 Probable months of disability #
51 Has employee returned to work? chr-1
52 At what wage? #
53 On what date? (MM/DD/YY) date
54 Employer:prepared by chr-35
55 Date (MM/DD/YY) date
56 Phone number chr-13
57 Insurer: processed by chr-35
58 Date (MM/DD/YY) date
59 Phone number chr-13
Commission Fields
Date received date
Date processed date
Processor chr-5
Statutory Authority
§65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996.
16VAC30-90-80. List of abbreviations. (Repealed.)
(Do not use an abbreviation for the first word in a company
title.)
A. Business abbreviations
ADJUSTOR ADJ
ADMINISTRATOR ADMIN
AMERICAN AMER
AND &
ASSISTANT ASST
ASSOCIATION ASSOC
BOARD BD
BROTHERS BROS
COMPANY CO
COMPENSATION COMP
CONSTRUCTION CONST
COORDINATOR COORD
CORPORATION CORP
DEPARTMENT DEPT
DIRECTOR DIR
DISTRIBUTOR DISTR
DIVISION DIV
ESQUIRE ESQ
GENERAL GEN
GUARANTY GUAR
INCORPORATED INC
INDEMNITY INDEMN
INDUSTRIES IND
INSURANCE INS
INTERNATIONAL INTL
LIMITED LTD
MANAGEMENT MGMT
MANAGER MGR
MANUFACTURER MFR
MERCHANDISE MDSE
METROPOLITAN METRO
NATIONAL NATL
NO. #
PERSONNEL PERS
PRESIDENT PRES
REPRESENTATIVE REP
SERVICES SERV
SPECIALIST SPEC
SUITE NO. #
SUPERINTENDENT SUPT
SUPERVISOR SUPVR
UNIVERSITY UNIV
VICE PRESIDENT VP
B. Address abbreviations
APARTMENT APT
AVENUE AVE
BUILDING BLDG
BOULEVARD BLVD
CENTER CTR
CIRCLE CIR
COURT CT
CREEK CRK
DRIVE DR
FLOOR FL
HIGHWAY HWY
LANE LN
PARK PK
PARKWAY PKWY
PLACE PL
POST OFFICE BOX PO BOX
ROAD RD
RURAL ROUTE RR
ROUTE RT
SQUARE SQ
STREET ST
TERRACE TER
TURNPIKE TPKE
C. Never use
1. "County of," "city of" (except at end
of name);
2. Extra spaces;
3. Punctuation (single quote, double quote, comma, period,
colon, semicolon), except a comma between claimant's last and first name;
4. "The," "a," or "an" at the
beginning of a company name;
5. Hyphen, except in hyphenated words, between name and
title, or in SSNs and FEINs.
D. State and territory abbreviations
ALABAMA AL
ALASKA AK
ARKANSAS AR
ARIZONA AZ
AMERICAN SAMOA AS
CALIFORNIA CA
COLORADO CO
CONNECTICUT CT
DELAWARE DE
DISTRICT OF COLUMBIA DC
FLORIDA FL
GEORGIA GA
GUAM GU
HAWAII HI
IDAHO ID
ILLINOIS IL
INDIANA IN
IOWA IA
KANSAS KS
KENTUCKY KY
LOUISIANA LA
MAINE ME
MARYLAND MD
MASSACHUSETTS MA
MICHIGAN MI
MINNESOTA MN
MISSISSIPPI MS
MISSOURI MO
MONTANA MT
NEBRASKA NE
NEVADA NV
NEW HAMPSHIRE NH
NEW JERSEY NJ
NEW MEXICO NM
NEW YORK NY
NORTH CAROLINA NC
NORTH DAKOTA ND
NORTHERN MARIANAS CM
OHIO OH
OKLAHOMA OK
OREGON OR
PENNSYLVANIA PA
PUERTO RICO PR
RHODE ISLAND RI
SOUTH CAROLINA SC
SOUTH DAKOTA SD
TENNESSEE TN
TRUST TERRITORIES TT
TEXAS TX
UTAH UT
VERMONT VT
VIRGINIA VA
VIRGIN ISLANDS VI
WASHINGTON WA
WEST VIRGINIA WV
WISCONSIN WI
WYOMING WY
Statutory Authority
§65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996.
FORMS (Repealed.)
Employer's First Report of Accident (VWC #3) w/instructions
Report of Minor Injuries w/instructions
Procedures for Automated Reporting
CHAPTER 91
CLAIMS REPORTING
16VAC30-91-10. Definitions.
The following words and terms, when used in this chapter, shall have the following meanings unless the context clearly indicates otherwise:
"Claims reports" means FROI and SROI reports concerning an injury filed by or on behalf of an insurer or self-insurer with the commission pursuant to the requirements set forth in the Implementation Guide.
"Commission" means the Virginia Workers' Compensation Commission.
"EDI," or "Electronic Data Interchange," means the method used to exchange data electronically between the commission and those organizations submitting claims reports to the commission.
"Filed electronically" means filed with the commission through EDI or through the internet portal established by the commission for submission of claims reports, pursuant to the requirements set forth in the Implementation Guide.
"First Report of Injury," or "FROI," means the initial claims report filed with the commission concerning an injury.
"Implementation Guide" means the requirements published and updated by the commission to be followed when claims reports are filed electronically with the commission.
"Insurer" means a company licensed to write workers' compensation coverage in Virginia.
"Minor injury" means an injury that meets none of the following seven reporting criteria:
1. Lost time or partial disability exceeding seven days.
2. Medical expenses exceeding $1,000.
3. Any denial of compensability.
4. Any disputed issues.
5. An accident that results in death.
6. Any permanent disability or disfigurement.
7. Any specific request made by the commission.
"Self-insurer" means an entity providing workers' compensation coverage directly to its employees based on formal approval by either the Virginia Workers' Compensation Commission or the State Corporation Commission.
"Subsequent Report of Injury," or "SROI," means a claims report filed with the commission after a FROI, which reports medical or indemnity payment activity about an injury or a decision to deny or no longer make payment on an injury.
Statutory Authority
§§65.2-201, 65.2-701, and 65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume , Issue , eff. Month dd, yyyy.
16VAC30-91-20. Procedures for filing claims reports.
A. By no later than July 1, 2009, all claims reports must be filed electronically with the commission.
B. The commission shall publish an Implementation Guide describing the requirements to be followed when claims reports are filed electronically with the commission. Any changes or updates to the Implementation Guide shall be published by the commission on an annual basis on or about September 1.
C. A FROI must be filed on all injuries in accordance with the Implementation Guide.
D. SROI reports concerning denials, indemnity payments, medical payments, and suspensions must be filed on all injuries that do not meet the definition of a minor injury, in accordance with the Implementation Guide.
E. An injury that meets the definition of a minor injury may be reported as such to the commission on a FROI in accordance with the Implementation Guide. If an injury that is reported to the commission as being a minor injury subsequently fails to meet the definition of a minor injury, then an updated FROI on that injury, followed by required SROI reports, must be filed with the commission immediately, in accordance with the Implementation Guide.
Statutory Authority
§§65.2-201, 65.2-701, and 65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume , Issue , eff. Month dd, yyyy.
FORMS
Implementation Guide (rev. May 1, 2008).
First Report of Injury.