Frequently Asked Questions
- Is eClaims a mandate? Yes. The WCB has established an eClaims implementation schedule. All Claim Administrators must complete their transition to the new eClaims filing process per the implementation schedule.
- How will the eClaims mandate be rolled out? The WCB will stagger the implementation beginning in June of 2013 continuing through March of 2014. Initial phases will include national carriers and TPAs followed by groups of New York specific Claim Administrators. The WCB has developed an extensive stakeholder communication plan that has supported transparent and continuous two-way communications with all stakeholders impacted by eClaims. The eClaims implementation schedule was developed based on the extensive feedback received by the Claim Administrator community.
- Does the eClaims mandate effect medical reporting? No. The new eClaims filing process will have no impact on Medical Providers or their reporting requirements. Medical Providers will continue to file their reports as they presently do today using the current medical forms. Medical reporting will be evaluated during the WCB business process reengineering effort that is currently under way.
- Does the eClaims mandate impact the hearing process? No. The hearing process will remain the same but the format of some supporting documentation may change.
- Will the WCB continue to assemble and index cases? Yes. The assembly and indexing process will continue.
- Which WCB forms currently submitted by Claim Administrators will be replaced by the eClaims filing process?
- C-2: Employer's Report of Work Related Injury/ Illness
- VF-2: Political Subdivision's Report of Injury to Volunteer Firefighter
- VAW-2: Political Subdivision's Report of Injury to Volunteer Ambulance Worker
- C-7: Notice that Right to Compensation is controverted
- C-669: Notice to Chair of Carrier's Action on Claim for Benefits
- C-8/8.6: Notice That Payment of Compensation Has Been Stopped or Modified
- Will a C-2 submitted by the employer satisfy the FROI filing requirements? No. Employers will still be able to file C-2 reports; however, claim administrators will be required to submit a FROI for every reportable claim. A FROI will satisfy the C-2 filing requirement, but a C-2 will not satisfy the FROI filing requirement.
- When a carrier submits a FROI to the Board in satisfaction of the employer's obligation to report the injury (WCL §110), does the carrier need to file the C-2F (Employer's First Report of Injury/Illness) with the Board?
No. A timely FROI satisfies the employer's duty to report the injury to the Board.
IMPORTANT: A timely FROI does not replace the requirement of WCL §110(1). The employer and/or carrier should retain the C-2F as required and produce the C-2F to the claimant upon request.
- Will the WCB still require filing of paper forms such as the C-240, C-11, and Employer’s Reimbursement Request? Yes. Some paper forms will still be required since the information cannot be filed via a FROI/ SROI transaction.
- What should an Uninsured Employer or their counsel file to Controvert a claim since the C-7 form is now obsolete? No Insurance cases are controverted by nature and should the employer still wish to file a Notice of Controversy they may raise the issues at the first hearing or file a written letter with the Board that will be scanned into the case folder. A paper C-7 should not be filed on these claims.
- The local Social Security Administration (SSA) office, Dept. of Labor, or social services agency has asked for a C-8/8.6 form which is now obsolete, how do I inform them that the SROI has replaced the C-8/8.6? The Board has done outreach with Social Security Administration offices, Dept. of Labor, and local social services organizations throughout the implementation of eClaims. Part of this outreach included a formal letter informing them of the recent changes. If needed, a copy of this letter can be found here Updated SROI Replaced C-8 document.
- Who can I contact regarding eClaims? The WCB has established an email address specifically for eClaims. Please send your questions and/or comments to eClaims@wcb.ny.gov.
- Who or what is a Trading Partner? A trading partner is an entity that enters into an agreement with the Workers' Compensation Board (WCB) to exchange data electronically. A trading partner can be an Insurance Company, Third Party Administrator or Self-Insured Employer.
- What is a Trading Partner Profile? Trading partners will be required to complete a trading partner agreement and profile. The profile requires the trading partner to specify the type of trading partner they are as well as the specification of key organization attributes such as FEIN, address, contact names, etc.
- Will there be a charge or fee for completing the Trading Partner Profile documents? No.
- When can I register and complete all the forms to become an eClaims Trading Partner? The eClaims Trading Partner Registration process is now available.
- Will Third Party Administrators have any reporting requirements? Yes. TPAs should review section 2 of the eClaims Implementation Guide and register to become an eClaims Trading Partner. Trading Partner Registration must be submitted at least 60 calendar days prior to the Trading Partner testing date, which can be found in the eClaims Test and Implementation Schedule (MS Excel). All registrants should carefully review the overview, requirements, and instructions.
- Will a carrier or self-insured be able to submit data for claims using more than one TPA? Yes. Our Trading Partner Profile will support the submission of data for a single claims administrator and from multiple approved TPAs. Claims administrators will need to communicate these relationship requirements to the WCB when completing a Trading Partner Agreement. Trading partners will need to monitor data quality for timely and accurate submission regardless of the number of TPAs they use to administer their claims processes.
- Who should be involved in eClaims on the claim administrator side? We recommend that you immediately begin to identify the lead business and technical resources within your claims organization that are responsible for regulatory reporting. If you plan to submit flat files, begin project planning immediately with your Information Technology and Project Management units. For all Claim Administrators, begin to evaluate your data quality and the paper based processes that will be impacted by the WCB's transition to the eClaims filing process.
- Our organization is not familiar with Electronic Data Interchange (EDI); where can we get more information? The WCB is developing training that will explain what EDI is; the training will be available on the WCB's website.
- How can we ensure that we collect the required information or data for eClaims? Claim Administrators are strongly encouraged to review the tables in preparation for a full EDI implementation as announced in Subject No. 046-477. These tables should be shared with both business and technical representatives within your organization. We urge claim administrators to pay particular attention to those data elements defined as mandatory or mandatory conditional. We recommend that insurers, along with their Third Party Administrators, evaluate both their business and technical processes to ensure their ability to collect accurate information for timely transmission to the WCB prior to the mandated implementation. NYS Requirement Tables
- How can I submit my eClaims filings? Will there be a web data-entry option? Using a secure file transfer protocol (SFTP), you may submit a flat file. Flat files must adhere to the IAIABC EDI Claims Release 3 format and can be submitted directly to the WCB's SFTP server or through a third-party vendor. The WCB will also offer a secure data-entry web application intended primarily for small volume filers, but not limited solely to that group.
- Will the WCB authorize third party vendors to submit Claims EDI Release 3 filings on behalf of Claim Administrators?
Yes. The WCB does not currently authorize vendors to submit claims data electronically. Below is a partial list of known vendors. The WCB anticipates that, as part of its eClaims implementation, it will authorize experienced Claims EDI Release 3 vendors to submit claims data to the WCB following satisfactory completion of testing with the WCB.
The list below includes known vendors offering a Claims EDI Release 3 related product and/or service for submitting claims data electronically. This listing is in alphabetical order and does not represent an endorsement by the WCB of any vendor listed, or a recommendation of one vendor over another. The WCB does not warrant or represent that this information is current, complete, or accurate. The WCB assumes no responsibility for any errors in the information provided, nor assumes any liability for any damages incurred as a consequence, directly or indirectly, of the use and application of this information, and shall be held harmless against all claims, suits, judgments and/or damages resulting from the disclosure of any of this information, including all costs and fees.
NOTE: If you are a vendor with Claims EDI Release 3 experience and would like to have your company added or removed, please contact eClaims@wcb.ny.gov
- Actec Systems, Inc. (www.actec.net )
- CS Stars (www.csstars.com )
- Ebix/Peak Performance Solutions, Inc. (www.ebix.com )
- HealthTech, Inc. (www.htedi.com )
- Insurance Services Office (www.iso.com)
- Mitchell Workers’ Compensation Solutions (www.mitchell.com )
Additional information regarding EDI vendors may be obtained from the IAIABC at: http://www.iaiabc.org
- How will a trading partner know if the WCB has accepted or rejected an electronic FROI/ SROI filing? The EDI IAIABC claims standard being adopted by the WCB (See Subject Number 046-477) includes an acknowledgment process. Every file and every transaction within a file is acknowledged. Acknowledgments will indicate whether the file or individual transaction has been accepted or rejected. A reason will be provided for rejected transactions.
- Will the WCB develop reports or a process to assist trading partners in monitoring performance? The IAIABC Claims Standard provides an acknowledgment process for every transaction submitted in a data file. The acknowledgment process provides enough information for a trading partner to self-monitor the timeliness of its filings and its acceptance and rejection rates. Trading partners will be able to use the Event, Element Requirement, and Edit Matrix tables the WCB publishes to interpret the acknowledgment reports. The acknowledgment reports will provide the information needed to determine the success or failure of submissions for both events and data elements. Everyone is encouraged to understand the importance of these tables and the relationship they have to their business process and the collection and reporting of quality information.
- Will an XML (Extensible Markup Language) option be available for the submission of EDI Claims Release 3? XML will be a future consideration; however, in the first phase of implementation it will not be considered.
- What is the deadline to submit transactions on a daily basis?
Effective March 10, 2014, the deadline to submit transactions is:
- Monday, Tuesday, Wednesday, and Friday has been extended to be 8 PM EST. Data files uploaded on those nights before 8 PM EST will be processed that night.
- Thursday will continue to be 6 PM EST. Data files uploaded on Thursdays before 6 PM EST will be processed that night.
- Is the Board eliminating the use of W numbers? No. The Board will convert DN0006 (Insurer FEIN) in to the W Number. For most Insurers, the nine digit FEIN will be sent since they only registered one WCB assigned W Number for that FEIN. When multiple WCB assigned W Numbers are registered for the same FEIN, the Board will inform the submitter to send the WCB assigned W Number as the Insurer FEIN value. WCB will return the nine digit FEIN in the acknowledgment record.
- What data should be submitted if the field is "AA" (If Applicable/Available Transaction Accepted) or “AR” (If Applicable/Available Transaction Rejected)? If a Claim Administrator has the information necessary to submit data in the field, the field should be populated with the data. If, however, the Claim Administrator does not have the information to populate this field, it should be left blank and not populated with data that is not accurate. Data Elements listed as “AR” have edits applied and will be rejected if edit is not met. Data Elements listed as “AA” do not have applied edits and will be accepted as entered. For example, Employee Phone Number (DN0051) is listed on the Element Requirement Table as “AR”. This field should only be populated if you can report the claimant's actual phone number, but could be rejected if it does not meet the 0051-111 edit listed on the Population Restriction table which requires the phone number to be between 10 and 15 digits long or the edit listed on the DN Error Message Table with Error Code 028 requiring all digits to be 0-9.
- Would you be able to direct me to where I can find the New York WCB FEIN and Postal Code? We need to add it to our program. The header record of the data file needs to have its Receiver ID (DN0099) be 146013200 122410019 which is WCB's FEIN and Postal Code separated by 7 spaces. Additional information can be found in Section 3.3 of the eClaims Implementation Guide.
- Our organization is not familiar with the IAIABC. Where can we get more information? Visit the IAIABC website
- Where can we obtain a copy of the IAIABC, Claims Release 3.0 Implementation guide? Guides must be obtained from the IAIABC . There is a charge for non-EDI members.
- Will training be provided?
Yes. The WCB provided a series of training programs for Claim Administrators who will be implementing eClaims. The series consists of:
- Course 101: Introduction to NYS eClaims using IAIABC Claims EDI Release 3.0 is designed for all Claim Administrator staff and is an introduction to using EDI for providing WCB with information.
- Course 201 Rev. 9-04-2013 is for business personnel and technical staff
- Course 301 Rev. 9-09-2013 is for technical staff
- Compilation of the training materials for Claim Administrator Claim Adjusters (MS PPT)
Death Benefits: New York legal statute currently requires separate cases for death and accident. How will the eClaims EDI process work with this requirement?
For EDI, each case will require a FROI to precede any SROI filing(s). The FROI for the death case must have some unique values from the FROI on the accident case so that it is not rejected as a duplicate.
The DN's listed below illustrate how NY will distinguish the injury FROI from the death
FROI when the date of death does NOT occur on the same date as the injury:
DN Data Element Name Injury Claim value Death Claim value 0031 Date of Injury Date injury occurred Date death occurred 0057 Employee Date of Death Date death occurred Date death occurred 0146 Death Result of Injury Code N for No Y for Yes or U for Unknown
The DN's listed below illustrate how NY will distinguish the injury FROI from the death
FROI when the date of death does occur on the same date as the injury:
DN Data Element Name Injury and Death Claim are the same case value 0031 Date of Injury Date injury/death occurred 0057 Employee Date of Death Date injury/death occurred 0146 Death Result of Injury Code Y for Yes or U for Unknown
Note: DN0146 Death Result of Injury Code is required if DN0057 Date of Death is not null. DN0057 Date of Death is required if DN0146 Death Result of Injury Code = Y. This requirement will increase to DN0057 Date of Death is required if DN0146 Death Result of Injury Code is not null effective 2/15/2017 based on eClaims change log ID #256 posted on 8/15/2016
For Claim Administrators that generate flat files, we recognize that reprogramming your computer systems to generate the correct FROI-SROI transactions for the death case may be costly and difficult. Therefore, due to the extremely low volume of death cases, Claim Administrators should consider a manual process using the eClaims FROI-SROI Web App to submit FROI and SROI filings for a death cases (when the death is the result of an accident/illness not occurring on the same day). Paper filings will not be allowed.
Please refer to NYS Business Scenarios 4-5 and 4-6 for details.
- If both a SROI-CA and a SROI-CB apply, should only a SROI-CB be sent or both? If both the rate and benefit type code are changing, the SROI-CB is the appropriate MTC to file. Please refer to NYS Business Scenarios 2-5 for details.
- Payments are being suspended to the injured worker because he has failed to respond to the requests for job searches – failed to show labor market attachment. We are not under direction on this particular case so it is not a suspension directed by the WCB. What SROI would be filed? The appropriate MTC would be a SROI-SJ. The reason for suspension should be entered in the suspension narrative field.
- When should a FROI/SROI-04 versus a FROI/SROI-UR be filed on a Legacy Claim? If the Claim Administrator has not previously filed a paper C-7 nor any other FROI then the Board would expect a FROI-04 when controverting the claim. If you have already filed a FROI, then a SROI-04 would be expected to controvert the claim. If the Claim Administrator had previously filed a paper C-7 with the Board then a FROI-UR filing is the most appropriate filing.
- Can I submit a SROI-02 if I recently sent a SROI that was missing historical (prior) benefits but included the more recent benefits?
The Board recently implemented on 11/13/2014 a relaxation of the SROI-02 requirements to allow the introduction of certain “new” historical benefits on the SROI-02. This is permitted if the newly introduced Benefit Type Codes Benefit Period Through Date does not equal or exceed that of the last accepted SROIs Benefit Period Through Date.
Example 1: I submitted a SROI-UR and included the most recent Benefit Type Code (BTC) of 040 (Permanent Partial Disability - PPD/Unscheduled) for benefits paid 1/1/2010 through 12/12/2014. I accidentally left off the historical BTC 050 (Temporary Total - TTD) paid 1/1/2007 through 12/31/2007 and BTC 070 (Temporary Partial - TPD) paid 1/1/2008 through 12/31/2009. Will my SROI-02 including the TTD and TPD be accepted? Yes. The through date on the TTD and TPD benefits does not exceed the through date of the last accepted Benefit Period Through Date of 12/12/2014 for the PPD benefits.
Example 2: I submitted a SROI-UR and included the TTD and TPD benefits from Example 1 but forgot to include my PPD benefits. Will my SROI-02 including the PPD benefits be accepted? No. The through date on the PPD benefits exceeds that on the last accepted Benefit Period Through Date of 12/31/2009 for the TPD benefits.
- The employer (Insured) is paying the claimant wages, however, we (Claim Administrator) are accepting the claim without liability per Section 21-a. Should we file a SROI-EP with Agreement to Compensate Code (DN0075) equal to “W” Without Liability? Yes. Effective 3/28/2016 New York has implemented the IAIABC Claims EDI standard change to allow Claim Administrators to report the Agreement to Compensate Code (DN0075) on the SROI-EP and SROI-ER.
- What should I file if I have filed a suspension and a decision reclassifies a Benefit Type (Modified Prior Awards) as a SROI-CB is not allowed per the sequencing rules when there is a break in continuity of benefits? The IAIABC Standard does not allow for the filing of the SROI-CB (Change in Benefit Type) after a SROI-Sx (Suspension) has been filed if there is a break in continuity of benefits. If you have filed a suspension and the SROI-CB is not a filing option per the sequencing rules, you can file a SROI-PY (Payment Report). The SROI-PY will allow the reclassification of your Benefit Type and should have Reduced Benefit Amount Code (DN0202) populated with “R” (Reclassification of Benefit). In the alternative, you may also file a SROI-RB (Reinstatement of Benefits) immediately followed by a SROI-SD (Suspension, Directed by Jurisdiction).
- When should a FROI-04/SROI-04 be filed?
Both a FROI-04 and a SROI-04 can be used to deny a claim, for example:
(A) A FROI-04 can be used to deny a claim as your first filing.
(B) To accept a claim after your accepted FROI-04, you need to submit a FROI-00 with a value other than N (Notification Only). If you try to file a FROI-00 with N after your FROI-04, it will be rejected.
(C) A SROI-04 can only be used to deny a claim after a FROI-00/AQ/AU/UR has been accepted.
(D) To accept a claim after your SROI-04, you need to submit a SROI that indicates what event has occurred that shows acceptance.
- How do I report an overpayment?
There is no IAIABC field (free text or otherwise) to note an overpayment you are not actively taking credit for.
- If filing a suspension, you can use the extra characters in the suspension narrative to note your overpayment on the record.
- If not filing a suspension, you can file correspondence on your letterhead via mail, fax or email noting your overpayment for the record. It is recommended you include the why and how much in the letter. If you copied other parties previously, you should continue to do so.
- If we are using a vendor, will we be able to access the .zip file containing the Transaction Reports from New York State's sFTP server or will we have to have our vendor download that file and receive it from them? The forms zip file will be placed on our sFTP server for your vendor to pickup. You would obtain the .zip file through your vendor.
- Will the transaction report PDFs in the .zip file be populated with the transaction claim information? Yes. The Board will populate the transaction reports using the transaction data sent by the claim administrator.
- Where can I get all of the technical details for how the Board creates the forms .zip file and the transaction report PDFs contained within it? Please review section 3.6 of the eClaims Implementation Guide.
- Can a FROI or SROI PDF document be served via email on the parties? If either of the parties of interest (POI) have designated email for service, the carrier can serve the PDF via email for that POI. But, for example, if the claimant's attorney allows service by email, and the claimant does not, the PDF must be served by mail on the claimant.
Please see the Periodic Report Event Table for further details.
- When is the periodic report due?
The SROI-SA is due 180 days from the date of accident (or when no date of accident or partial date of accident, then due from filing date of first FROI) so this chart shows when SROI-SA are expected. NOTE: For existing cases, the first periodic is due by the end of the 180 days based on the month reported in date of injury.
If the Date of Accident
(or First FROI) is in:
Then Periodic report is due
in the months of:
January January and July February February and August March March and September April April and October May May and November June June and December July July and January August August and February September September and March October October and April November November and May December December and June
Note: The above chart shows the month based upon the acceptable practice of considering 180 days to be close enough to 6 months and thus always send 2 SROI-SA's per year. It is also acceptable practice for SROI-SA's to be exactly 180 days apart, which means the month will change over the years and there could be a few years when 3 SROI-SA's are sent in that year (for example, if Date of Accident is 7/4/2014, then the first 3 SROI-SA's would be due on 1/2/2015, 7/1/2015, and 12/28/2015).
- For which types of cases is a periodic report required? The sub-annual report is due if the case is open or closed with continuing indemnity payments.
- What is the definition of "open"? If no notice has been issued stating no further action or the claim has been reopened after such a notice has been issued, then the case is considered open. If a notice has been issued stating that no further action is planned at the time, but indemnity benefits are continuing, then the case is considered open.
- Are sub-annual reports due for "medical only" claims? If the case is open at the time that the sub-annual is due, then a report is due. If the case is not open and only medical payments are being made, then the sub-annual report can be filed on a voluntary basis.
- After the first SROI-SA filing, are subsequent SROI-SA's a cumulative total to date or only what was paid since the last SROI-SA was filed? Each SROI-SA is a "cumulative" total of each Benefit Type (BTC) and Other Benefit Type (OBT) paid to date on the claim.
Please see DN Reporting Specifics to NYS Document (MS Excel) for additional details
- What date should be entered for the Suspension Effective Date (DN0193)? The suspension effective date should be the last THROUGH date which the indemnity benefit is due.
- What date should be entered for the Award Order Date (DN0299)?
This should be the date that the Notice of Decision was duly filed if decision is from a hearing, Reserved Decision, or Board Panel Decision. This should not be the date of hearing. If decision is from an Administrative Decision or Proposed Decision, the date should be the date the decision became final.
Note: An exception would be in the situation of an ATF deposit. Since Notices of Decision are issued in advance of the due date of the deposit, the date deposit is due should be listed as the Award/Order Date. (i.e., Notice of Decision filed on 10/30/13 directing an ATF deposit due on 12/9/13. In this situation the Award/Order Date should be listed as 12/9/13)
- How do I indicate that indemnity payments are being made without acceptance of liability pursuant to §21a? If indemnity benefits are being made without acceptance of liability, Agreement to Compensate Code (DN0075) should be listed as "W" – Without liability. Please note that §21a no longer applies once Accident, Notice, and Causal Relation (or Occupational Disease, Notice, and Causal Relation) has been established.
- How is an acceptance of a claim listed on a FROI/SROI since Form C-669 is obsolete once a Claim Administrator is placed in to production for eClaims filings? Claim Type Code (DN0074) identifies the acceptance of a claim. If this Code is listed as M=Medical Only, I=Indemnity, B=Became Medical Only, or L=Became Lost Time, the Claim Administrator has accepted the claim. If the Claim Type Code is reported as N=Notification Only, the claim has not yet been accepted. If a Notice of Indexing is issued by the Board, the Claim Administrator must indicate if the claim is accepted by entering the appropriate Claim Type Code or file a FROI-04 or SROI-04 indicating that the claim has been denied. Please see the Event Table (MS Excel) for due dates of the acceptance and denial.
- What is the difference between the "through" date (used by IAIABC in Claims EDI) and the "to" date (used by WCB in Decisions)? The "to" date is the next business day beyond the date in which that last benefit day was payable. The "through" date is through the close of business in which that last benefit day was payable. For example, a Notice of Decision directs payments "to" November 15th when the claimant returned to work, however, the "through" date would be November 14th as you are paying through close of business.
- What is the difference between Initial Date Disability Began and First Day of Disability After the Waiting Period?
Initial Date Disability Began is the first day of the waiting period. First Day of Disability After the Waiting Period is the first day after the waiting period requirement has been met. Please note that both of these fields can only be updated on a FROI-02 or SROI-02 if previously reported as an incorrect date.
Note: If there is no waiting period (i.e. VF or VA case) or the waiting period is payable when these dates are first reported, then the First Day of Disability After the Waiting Period is the same date as the Initial Date Disability Began
- When would a reimbursement from the Claim Administrator to the Employer be expected when the Employer Paid Wages in Lieu of Compensation? The Board will issue a decision directing reimbursement to an employer based upon a reimbursement request being submitted by said employer.
- How is the reimbursement paid to the Employer from the Claim Administrator to be reported to the Board? This should be reported on the appropriate SROI. An example of payment of reimbursement after a decision has been issued can be found in NYS Business Scenario 3-3 and NYS Business Scenario 3-4. These scenarios are written per the IAIABC Standard of what is to be reported when paying the reimbursement. The Board would also accept the BTC 250 and 270 in lieu of 050 and 070 for the period in which the employer paid.
- If a Claim Administrator’s system requires Lump Sum Payment/Settlement Code (DN0293) to be populated with a code on the SROI-PY what should be used if we are not reporting a Section 32 settlement? For cases other than a Section 32 settlement the Claim Administrator may use “AW” Award or “NS” Non-Specified Lump Sum Payment. This is an optional reporting for all PY’s that do not report a Benefit Type Code of 5xx.
- How does a Claim Administrator note they are taking credit against a prior schedule loss of use (SLU)?
If a Claim Administrator is taking credit against a prior SLU they could note the lost time under the appropriate degree of disability and then report Benefit Credit Code (DN0126) as “P” Advance. See NYS Business Scenario 9-6.
Note: Certain SROI MTC’s will require a Payment Segment in addition to the Benefit Segment. The Payment Segment should be populated with the relevant dates but Amount Paid may be reflected as “0”.
- How should Special Funds §14-6 and §15-8 recoveries be reported on a SROI?
Recovery Code (DN0226) of 800 (Special Fund Recovery) should be used to report a §14-6 recovery and 850 (Second Injury Fund) should be used to report a §15-8 recovery.
Note: The reporting of Recoveries for §14-6 and §15-8 are optional.
- How should a Claim Administrator who has Section 32 Medical Payments (ie. Medicare Set Aside) payable to the claimant report on the SROI-PY?
The full payment of the Section 32 settlement to the claimant may be reported as Benefit Type Code (BTC) of 500 – Unspecified Lump Sum. If, however, due to internal reporting a Claim Administrator must report these as separate payments they may report the Medicare Set Aside portion as 501 – Medical Lump Sum.
NOTE: You can also still use Other Benefit Type (OBT) 370 – Total Other Medical, however, BTC 501 – Medical Lump Sum would be more appropriate. If the OBT 370 or BTC 501 is used, the Board would expect a Payment Segment for both the indemnity and medical payments to the claimant as they are both monies due directly to the claimant. The underreporting of the Section 32 payment to the claimant could result in a possible penalty that should not have been assessed.
- Which SROI should be reported if the Claim Administrator mistakenly submitted the wrong Benefit Type Code? This would depend on the event and claim circumstances. For example, if a SROI-IP was submitted with TTD benefits and you later discovered they should have been TPD benefits per the medical report, the SROI-CB would be the most appropriate. Reduced Benefit Amount Code (DN0202) should be equal to “R” Reclassification of Benefit. This will allow you to report the new TPD benefits while dropping the TTD benefits from the SROI-CB transaction. See NYS Business Scenario 10-4.
- When is the Work Week Type Code and Work Days Scheduled Code required?
Work Week Type Code is required on FROI-00 and FROI-UR if all of the following occurs:
- Number of Days Worked Per Week (DN0064) is a value other than 5
- Date of Injury (DN0031) is on or after 3/1/14
- Type of Loss Code (DN0290) is either 01 (Traumatic Injury) or is not present
- Claim Type Code (DN0074) is either I or L (Indemnity or Became Lost Time)
- What are the Values for Work Week Type Code and Work Days Scheduled Code? See NYS Business Scenario 10-1 and 10-2.
WORK WEEK TYPE CODE Values are:
S = Standard Work Week (set work days each week are Monday through Friday inclusive)
F=Fixed Work Week (Set work days each week, but not Monday through Friday inclusive)
V = Varied Work Week (scheduled work days change from week to week)
WORK DAYS SCHEDULED CODE Values are: S= Scheduled and N = Not Scheduled
FORMAT = DDDDDDD where each D is a calendar day of the week (First position is Sunday, Second position is Monday, Third position is Tuesday, etc)
- How do I file a SROI when I am paying intermittent lost time?
If there is intermittent lost time on a claim, you should file the appropriate SROI and indicate the earliest start date and latest through date for the period of intermittent lost time. The Claims Weeks and Days would be inclusive of the days paid and/or awarded for intermittent lost time.
Note: A C-11 should continue to be filed to note the various intermittent lost time periods.
- Carrier files FROI-00 with N (Notification Only) and then ANCR/ODNCR is established. Does carrier need to file FROI/SROI for acceptance?
Yes per regulation 300.22 the carrier should file the proper FROI/SROI to correct claim type code (M, I, B or L) for “acceptance”.
- I have noticed while using eCase and Web Data Entry at the same time that my Web Data Entry freezes at times. What causes this and how can I avoid it?
Since both applications utilize the same user name and password, if you log out of eCase and/or are timed out of eCase you will also be logged out of any other WCB applications that you are currently logged into within the same browser.
If you open a separate browser for each application (for example, Explorer for eCase and Chrome for Web Data Entry) you will be able to avoid your Web Data Entry application from logging out/freezing if you log out of the eCase application.