The FROI/SROI tab displays the information transmitted electronically by claim administrators in eCase.
There are three tabs on the FROI/SROI tab:
In addition, there will be copies of servable documents in the case folder. These pdfs are created from the electronic FROI/SROI transmissions. Samples of these documents may be found on the eClaims Transaction Reports page.
- Claim Administrator
- The organization that administers a workers' compensation claim. It can be an insurer, a licensed third-party administrator (TPA), a self-insured employer, a self-insured group trust, or a guarantee fund.
- First Report of Injury (FROI)
- The data transaction that occurs early in a workers' compensation claim. The FROI is most commonly the initial report of injury for a claim. A FROI may also be a denial of a claim.
- Subsequent Report of Injury (SROI)
- A record of an event sent to the Board that completes a subsequent report of injury requirement.
- Legacy Claim
- Any claim that already exists in the Board's claim system with a case number at the time the claim administrator begins transmitting data electronically.
- Maintenance Type Code (MTC)
- A two-character code that identifies the claim event that requires the filing of a FROI or SROI. In text that refers to FROI and SROI transactions, MTC immediately follows "FROI" or "SROI."
- Servable Document
- A printable copy of the FROI or SROI transaction found in the case folder that can be sent by parties whenever a copy of the document must be filed with the claimant, the claimant's attorney, a health care provider, etc. Any registered eCase user who is a party of interest on the case has access to these documents in eCase.
Latest Values Tab
This tab displays the latest value received by the Board for each data field. If the data was received on the latest FROI or SROI transaction, the text is blue. If received in a prior transaction, the text is red with an *.
- Claim Type Code: Indicates claim acceptance by claim administrator for dates of accident before 1/1/2019.
- Anything but "N - Notification of an Incident Only" indicates acceptance.
- Agreement to Compensate Code: Indicates claim acceptance by claim administrator for dates of accident on or after 1/1/2019.
Agreement to Compensate Code Agreement to Compensate Code Agreement to Compensate Code Definition L With Liability W Without Liability (includes temporary payment under WCL section 21-a or section 25-1-f)
- Work Status
- Any field noted as Initial is related to the first period of lost time. Any field noted as Current or Latest may be related to subsequent periods of lost time.
- Initial Date Disability Began: Date of the initial injury or onset of illness.
- Return to Work Type: May be Actual or Released.
- Part of Body: In the International Association of Industrial Accident Boards and Commissions' (IAIABC) Claims Electronic Data Interchange Release 3.1 (Claims EDI R3.1), claim administrators may now report up to 10 individual body parts, including the side of the body (left/right/bilateral), and the specific finger or toe, if applicable.
- Insurer name: If there are multiple insurers, payments made by each would be listed separately.
- Pass days: Submitted by the claim administrator and may be updated as part of a decision.
- Current Overpayment: The amount of alleged current overpayment as reported by the Claim Administrator. The claim administrator must update this amount no later than 10 days prior to a hearing date. A Judge will confirm this amount and direct recoupment, if necessary.
- Benefits Periods:
- Reportable events are listed here. Some examples are:
- CB - Change in benefit type
- IP - Initial payment
- SX - Payments suspended
Reduced Benefit Amount Code: A code that identifies the reason a benefits segment may be missing from a transaction or may contain values less than reported in a previous transaction due to the benefit amount being decreased or reclassified or a claim being reported that was settled under another Date of Injury.
- D - Decrease in Indemnity
- N - No Money Settlement
- R - Reclassification of Benefit
- S - Claim Settled Under Another DOI
- Reportable events are listed here. Some examples are:
- Benefit Adjustments, Credits and Redistributions (ACR): Examples of Adjustments/Credits/ and Redistribution include Apportionment/Contribution, Subrogation, Illegally Employed Minor, etc.
- Payments: Each benefit payment is listed, showing the payment reason, the payee, the amount, and date information.
- The Through Date (an International Association of Industrial Accident Boards and Commissions standard data field) comes from the claim administrator. eCase calculates the To Date, which continues to be used by the Board.
- Reduced earnings: In Claims EDI R3.1, claim administrators must include the start and end date for reduced earnings periods.
- Insurer information: This is information about the insurer that made the payments.
- Cumulative Benefits: Cumulative Benefit paid by claim administrator listed by Benefit Type and total amount paid to date. These benefits are not listed as separate periods or by MTCs.
- Other Benefit Types (OBTs): Other benefits paid by the claim administrator and the total amount paid to date.Examples include:
- Total funeral expenses
- Total penalties
- Total employee penalties
- Total interest
- Total claimant's legal expenses
- Total hospital costs
- Total other medical
- Recoveries: Recoveries made by Insurer and totals to date.
Examples of some Recovery Types include:
- Special Fund recovery
- Deductible recovery
- Overpayment recovery
|Claim Type Code
|Claim Type Code Definition
|Notification of an Incident Only (Carrier has not accepted)
|Lost Time with No Paid Indemnity
|Indemnity/No Lost Time Beyond Waiting Period
|Indemnity for Lost Time
|Became Medical Only
Summary of Benefits Tab
Information displayed on this tab is sent in SROIs.