Virginia Regulatory Town Hall

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Workers' Compensation Claims Reporting Via Electronic Data ...
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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PROCEDURAL REGULATIONS FOR FILING FIRST REPORTS UNDER THE VIRGINIA WORKERS' COMPENSATION ACT (REPEALED)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 (Repealed.)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 (Repealed.)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 (Repealed.)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.