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PROCEDURAL REGULATIONS FOR FILING FIRST REPORTS UNDER THE VIRGINIA WORKERS' COMPENSATION ACT (REPEALED)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 (Repealed.)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 July 1, 1996; repealed, Volume 25, Issue 11, eff. March 4, 2009.

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 (Repealed.)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 July 1, 1996; repealed, Volume 25, Issue 11, eff. March 4, 2009.

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 (Repealed.)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; repealed, Volume 25, Issue 11, eff. March 4, 2009.

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; repealed, Volume 25, Issue 11, eff. March 4, 2009.

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; repealed, Volume 25, Issue 11, eff. March 4, 2009.

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; repealed, Volume 25, Issue 11, eff. March 4, 2009.

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; repealed, Volume 25, Issue 11, eff. March 4, 2009.

16VAC30-90-80. List of abbreviations. (Repealed.)

(Do not use an abbreviation for the first word in a company title.)

A. Business abbreviations

B. Address abbreviations

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

Statutory Authority

§ 65.2-900 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 12, Issue 18, eff. July 1, 1996; repealed, Volume 25, Issue 11, eff. March 4, 2009.

FORMS (16VAC30-90) (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 Electronic Data Interchange (EDI) Implementation Guide, May 1, 2008 Edition, which contains 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 25, Issue 11, eff. March 4, 2009.

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 25, Issue 11, eff. March 4, 2009.

FORMS (16VAC30-91)

First Report of Injury (rev. 5/1/08).

DOCUMENTS INCORPORATED BY REFERENCE (16VAC30-91)

Electronic Data Interchange (EDI) Implementation Guide, Virginia Workers' Compensation Commission, May 1, 2008 Edition.