You Are Viewing an Archived Report from the New Jersey State Library

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1 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK his Guidebook does not replace or revise reporting requirements set forth in the WI Workers ompensation ata pecifications Manual, or the tatistical Plan found in the New ersey Workers ompensation and mployers Liability Insurance Manual. he Guidebook is intended solely as an information resource for insurers, producers and employers. ompensation Rating and Inspection ureau

2 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK ummary of hanges ecember th Release Page able of ontents... i thru iv ection III Hard opy...2 ection IV IR Reporting Requirements (eliminated)...3 thru 5 ection VII onditions for esting... 6 ection VIII Replacement Report ode... 7 onditions hree Year Fixed Rate...9 plit Period ode...11 ate ode...12 ection XI URs with ata Quality Issues...21 ection XII dit tatus and everity...21 rror Reports...21 Monthly tatistical rror ummary Report (eliminated)...21 thru 22 dit rror List (new)...22 thru 33 ection XIII orrection Reports...34 ate Method Header orrections...35 xposure orrections Loss orrections...37 Replacement Reports ection XIV hree Year Fixed Rate Policies (eliminated)...38 ubrogation Notes...39 laim Reporting Procedures...40 thru 41 ection XVI UR xamples and Illustrations...47 thru 67 ection XVII IR xamples and Illustrations (eliminated)...68 thru 69 ection XVII ontact Information and Form...68 thru 69 ection XVIII Glossary...70 thru 74 anuary rd Release Page able of ontents... i thru iv ection III ubmission and Formatting of UR ata...2 ection VIII UR ata lements Applicable in New ersey...7 ection XIV ubrogation laim Reporting Procedures ection XV Increased L limits New ersey pecial lass odes...32 ummary of pecial tatistical Plan odes...33 ection XVI Illustration Illustration

3 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK ummary of hanges March nd Release able of ontents...iii ection VIII Injury code 06 description...13 ection XI Monetary anctions...17 ection XV New ersey pecial lass odes...29 ection XVIII ontact Form...56 anuary st Release riginal Unit tatistical Reporting Guidebook 2

4 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK AL F NN Page IN I Introduction...1 IN II Purposes of UR Reporting xperience Rating Ratemaking overage Verification Verification of Aggregate Financial ata...1 IN III ubmission and Formatting of UR ata lectronic ransmission ureau ntry and dit Package ( P ) Hard opy...2 IN IV WA lectronic Reporting Requirements Record escriptions Link ata Minimum Record Requirements per Report...3 IN V Notification of Receipt of UR ata FP X... 5 IN VI Processing of UR ata... 5 IN VII esting of UR ata Quantity of ata of ata onditions for esting... 5 IN VIII UR ata lements Applicable in New ersey Report Number orrection equence Number orrection Replacement Report ode arrier ode Number Number ffective ate xpiration ate xposure Previous Report Number Previous orrection equence Number...9 i

5 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK AL F NN 12. Previous arrier ode Number Previous Number Previous ffective ate Previous xposure ffective ate onditions...9 A. hree Year Fixed Rate...9. Multistate Interstate Rated stimated Audit Retrospective Rated...10 F. ancelled Mid-erm...10 G. Managed are rganization () Page Number Last Page Number Unit Format ubmission ode Insured Name Insured Address Modification ffective ate Rate ffective ate plit Period ode ate ode xposure overage Act lassification ode xposure Amount Manual Rate Premium Amount xperience Modification Factor otal ubject Premium otal Modified Premium otal tandard xposure otal tandard Premium laim Number Accident ate/number of laims laim ount Incurred Indemnity Incurred Medical Loss lassification ode Injury ode tatus ode Loss onditions...15 A. Loss overage Act of Loss of Recovery...15 ii

6 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK AL F NN. of laim of ettlement urisdiction atastrophe Number ode Injury escription odes...17 A. Part of ody Nature of Injury ause of Injury ccupation escription Paid Indemnity Paid Medical laimant s Attorney Fees mployer s Attorney Fees Weekly Wage ALA Paid ALA Incurred otal Number of laims otal Incurred Indemnity otal Incurred Medical otal Paid Indemnity otal Paid Medical otal laimant s Attorney Fees otal mployer s Attorney Fees otal ALA Paid otal ALA Incurred...19 IN IX Pre-delinquent, ue and elinquent ata...19 IN X Pre-delinquent and elinquent listings WNL...20 IN XI Monetary anctions UR ime Line chedule elinquent URs URs with ata Quality Issues...21 IN XII diting of URs by NRI dit tatus and everity rror Reports riticism Letters dit rror List...22 IN XIII orrection of ata When to orrect ata orrection Reports ate Method...34 iii

7 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK AL F NN 4. orrection s Preparation of UR orrections...35 A. Header orrections xposure orrections Loss orrections Multiple orrections otal orrections Replacement Reports...38 IN XIV ther Reporting Issues ancelled Flat Policies xtended erm Policies plit xposure Policies ubrogation xclusive Per apita Policies anceled Flat List ransmittal Procedure hort Rate Penalty Premium laim Reporting Procedures...40 IN XV Miscellaneous Increased L Limits New ersey pecial lass odes ummary of pecial tatistical Plan odes How to Report tatistical and Incidental Per apita odes on UR ode List...46 IN XVI UR xamples and Illustrations...47 IN XVII ontact Information and Form...68 IN XVIII Glossary...70 iv

8 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK IN I Introduction his guidebook outlines the preferred reporting and correction practices for the submission of New ersey workers compensation unit statistical data to the New ersey ompensation Rating and Inspection ureau ( ureau ). It supplements the rules set forth in the tatistical Plan, Part 3, ection 13 of the New ersey Workers ompensation and mployers Liability Insurance Manual ( he Manual ), which describes the reporting requirements relating to unit statistical data. his guidebook is intended to: Provide details and illustrative examples of unit statistical reporting as required by the tatistical Plan; ncourage common and effective reporting practices; Inform data providers of the ureau s processes; and Provide procedures relating to specific reporting requirements. IN II Purposes of UR Reporting he ureau is the statutorily designated statistical agent and rating organization for New ersey workers compensation insurance. imely and complete unit statistical reporting is necessary for both the ratemaking process and the promulgation of experience rating data. 1. xperience Rating he ureau is responsible for the calculation and distribution of experience modifications for workers compensation policies with New ersey exposure. Unit statistical data is required to determine whether a risk qualifies for experience rating, and provides the exposure and loss experience from which the ratings are calculated. Further information about the xperience Rating Plan can be found in Part 3, ection 11 of the Manual. 2. Ratemaking Unit statistical data is one source of information used in the preparation of the ureau s annual rate filing and to determine class relativities for the Manual rates. 3. overage Verification he ureau makes policy and coverage data available to meet employers proof of coverage obligations to the. Unit statistical data is matched to the coverage data and constitutes the last report of the policy coverage period. 4. Verification of Aggregate Financial ata Unit statistical data and aggregate financial data reported by insurers are compared to verify the accuracy of both sets of data. espite timing and definitional differences between the submission and valuation of unit statistical and aggregate financial data, meaningful comparisons can be made between these two sources of data as a test for consistency

9 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK IN III ubmission and Formatting of UR ata In 1996, the Advisory tatistical Work Group ( AWG ), a subcommittee of the WI, expanded the unit statistical report. his revised format is currently used industry wide. he lectronic ata Interchange ( I ) committee, also a subcommittee of the WI, is charged with maintaining countrywide reporting standards for workers compensation data. he ureau utilizes the I standards. he ureau is a member of the American ooperative ouncil on ompensation echnology ( A ). As a member of A, the ureau accepts statistical data via a software program known as the ureau ntry and dit Package ( P ). P Allows for the manual entry, import and electronic submission of statistical data. he ureau accepts the following data reporting media: 1. lectronic ransmission he ureau permits the electronic transmission of UR data which must use the WA file specifications in the WI Workers ompensation ata pecifications Manual. he file ransfer Protocol ( FP ) service is available to insurers via the ompensation ata xchange ( X ) or the ureau s website, X is an A product which provides member insurers a secure, internet-based method for sending, receiving and managing a wide variety of transactions utilizing WI tandards. 2. Hard opy Hard copy forms (UR-AWG-A) may be printed in-house, secured from outside vendors or the ureau s website. Forms printed in-house or secured from outside vendors must match the approved WI form and be properly aligned to accommodate the data fields. he ureau recommends that data providers move to the electronic transmission medium. IN IV WA lectronic Reporting Requirements he minimum WA reporting requirements are set forth below. For complete reporting instructions, refer to the WI Workers ompensation ata pecifications Manual

10 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 1. Record escriptions Record type code Record escription 1 Header record 2 Risk Name record 3 Risk Address record 4 xposure record 5 Loss record 6 Unit otal record 9 ubmission ontrol record ontains information regarding the policy. his record type is required for UR reports. ontains the primary name of the insured. his record type is required for UR reports. ontains the mailing address of the insured. his record type is optional, but desired, for UR reports. Provides detailed exposure data. his record type is required for UR first reports. Provides detailed loss data. his record type is required for UR subsequent reports. Provides totals for each unit report. his record type is required for UR reports. Provides the total number of records and units contained in a submission. his record is required for each submission of data. 2. Link ata Link data (the first forty positions of each record) is common to all records. Link data is critical when matching records for a given unit report. omplete link records are required for all WA records, excluding Record code Minimum Record Requirements per Report 1 st Report MU NAIN H RR ANN NAIN MAY NAIN 1 & only 1 Record ode 1 - Header Record ode 3 - Address 1 & only 1 Record ode 2 - Risk Name Record ode 5 - Loss At least 1 Record ode 4 - xposure 1 & only 1 Record ode 6 Unit otal xposure orrection MU NAIN H RR ANN NAIN MAY NAIN 1 & only 1 Record ode 1 - Header Record ode 5 - Loss Record ode 3 - Address 1 & only 1 Record ode 2 - Risk Name At least 1 Record ode 4 - xposure 1 & only 1 Record ode 6 - Unit otal - 3 -

11 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK Header orrection MU NAIN H RR ANN NAIN MAY NAIN 1 & only 1 Record ode 1 - Header Record ode 4 - xposure Record ode 3 - Address 1 & only 1 Record ode 2 - Risk Name Record ode 5 - Loss Record ode 6 - Unit otal Loss orrection MU NAIN H RR ANN NAIN MAY NAIN 1 & only 1 Record ode 1 - Header Record ode 4 - xposure Record ode 3 - Address 1 & only 1 Record ode 2 - Risk Name At least 1 Record ode 5 - Loss 1 & only 1 Record ode 6 - Unit otal otal orrection MU NAIN H RR ANN NAIN MAY NAIN 1 & only 1 Record ode 1 - Header Record ode 4 - xposure Record ode 3 - Address 1 & only 1 Record ode 2 - Risk Name Record ode 5 - Loss 1 & only 1 Record ode 6 - Unit otal Multiple orrection MU NAIN H RR ANN NAIN MAY NAIN 1 & only 1 Record ode 1 - Header Record ode 3 - Address 1 & only 1 Record ode 2 - Risk Name At least 1 Record ode 4 - xposure At least 1 Record ode 5 - Loss 1 & only 1 Record ode 6 - Unit otal ubsequent Report MU NAIN H RR ANN NAIN MAY NAIN 1 & only 1 Record ode 1 - Header Record ode 4 - xposure Record ode 3 - Address 1 & only 1 Record ode 2 - Risk Name At least 1 Record ode 5 - Loss 1 & only 1 Record ode 6 - Unit otal - 4 -

12 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK IN V Notification of Receipt of UR ata arriers will receive notification that UR data has been received by the ureau. he type of notice depends on how the UR data was transmitted to the ureau. 1. NRI.com he ureau will notify the sender of the status of the UR data submission via the primary and alternate addresses provided when the insurer registered for File ransfer ervice through NRI.com. 2. X A system-generated confirmation is sent from X to the file sender once the data file is received by X. A second confirmation is triggered when the ureau updates the X File tatus. he second confirmation notifies the carrier that the data has been rejected or accepted for processing. IN VI Processing of UR ata Files received on a particular day are not assured of being processed that same day. ubmissions are typically processed within two days. However, files received on Friday will typically be processed on Monday. Files may be rejected in their entirety if they do not meet the minimum data quality standards. URs will be rejected from the submission file if they have fatal errors. IN VII esting of UR ata arriers must submit test files to the ureau in order to obtain approval. arriers must submit test electronic submissions with duplicate hard copy unit reports for verification. arriers will be approved to submit production files after the submission of one successful test electronic file. A successful test is a file with no WA file pre-processing rejection errors; a limited number of other errors; and no discrepancies between the electronic transmission and the hard copy reports. Immediately after processing each file, the ureau will contact the carrier with the test results. 1. Quantity of ata ach test file must contain between 25 and 50 unit reports. If this is not possible, contact the ureau for assistance. 2. of ata ubmit live production data during the test phase. If live production test data is not available, make prior arrangements with the ureau for the submission of artificial data. 3. onditions for esting he test file must contain one example of each of the following: - 5 -

13 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 1. XPRIN MIFIAIN 2. PLI RPR AIIAL NIIN RQUIR FR ING 3. AIIAL PRMIUM IUN 0900 XPN NAN 0931 HR RA PNALY PRMIUM URHARG 0942 PLAN PRMIUM AUMN FAR 0945 RRPIV RAING PRMIUM INRA.L. LIMI 9849 MIN PRM HARG (9849 FLA NLY) 0990 MINIMUM PRMIUM 0998 FLA RA INRA HARG 9874 UIN 9046 PRMIUM RI NPAP 9663 UIL PRMIUM RI AMUN RIPRA & AARPH (other than certified acts of terrorism) HUL RAING RI & I 4. L Injury 1- AH 2- PRMANN AL 3- MAR 4- MINR 5- MPRARY 6- MIAL NLY L NIIN U VRAG N A LA All loss conditions must be submitted in accordance with the NRI tatistical Plan. 5. RRIN NW L LAIM LIMINA L LAIM UPA L LAIM NW XPUR LIMINA XPUR UPA XPUR orrection HAR XPUR L MULIPL AL 6. UQUN L RPR NW LAIM LIMINA LAIM UPA LAIM 7. FIR RPR 8. IF ANY (N XPUR) UNI AR 9. ININAL PR APIA (0910, 0912, 0913 & 0915) - 6 -

14 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK IN VIII UR ata lements Applicable in New ersey 1. Report Number Report the one or two-digit numeric code that corresponds to the report level based on the loss valuation date. lectronic Reporting: Report 1 through 9 and then A. ode Valued as of the: 1 18 th month after the month in which the policy became effective 2 30 th month after the month in which the policy became effective 3 42 nd month after the month in which the policy became effective 4 54 th month after the month in which the policy became effective 5 66 th month after the month in which the policy became effective 6 78 th month after the month in which the policy became effective 7 90 th month after the month in which the policy became effective nd month after the month in which the policy became effective th month after the month in which the policy became effective th month after the month in which the policy became effective 2. orrection equence Number Report the two-digit sequential number that corresponds to the number of correction reports submitted within a particular report level. xposure and loss corrections on the same report level must be numbered consecutively. lectronic Reporting: Report 1 through 9 and then A through Z. 3. orrection Report the one-letter code that identifies the type of correction report being submitted. ode H L M escription Header xposure Loss otal Multiple record types 4. Replacement Report ode Report the code that indicates that the UR is replacing a previously submitted report. Replacement reports can only be filed if the status of the unit report being replaced is Rejected. 5. arrier ode Number Report the five-digit code assigned to the reporting company by the NI

15 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 6. Number Report the complete alpha/numeric policy number that uniquely identifies the policy and will make it possible to locate the policy record in the company files. his number must be identical to the number set forth on the policy Information Page or as endorsed. he policy number must remain the same throughout the life of the policy and for all experience reporting. 7. ffective ate Report the month, day and year that the policy became effective. his date must be identical to the date set forth in Item 2 of the policy Information Page or as endorsed. For interstate policies endorsed after the policy effective date to provide coverage for New ersey, report the effective date of the policy. For the second and third periods of three-year variable rate policies, report the effective date as one and two years, respectively, subsequent to the policy effective date set forth in Item 2 of the policy Information Page. For the first period, report the policy effective date as shown on the policy Information Page, or as endorsed. If the policy contains a Period ndorsement, then the effective date must coincide with the dates indicated on the schedule of that endorsement. For the second period of extended-term policies, report the effective date as the date that the second period began as shown in the Period ndorsement. lectronic Reporting Format: YYMM 8. xpiration ate Report the month, day and year upon which the policy expired. For mid-term cancelled policies, report the cancellation date as the expiration date. For policies issued not longer than one year and sixteen days (considered standard one-year term policies), report the expiration date as shown on the policy Information Page. For the first and second periods of three-year variable rate policies, report the expiration date as one and two years, respectively, subsequent to the policy effective date set forth in Item 2 of the policy Information Page. For the third period, report the policy expiration date as shown on the policy Information Page, or as endorsed. If the policy contains a Period ndorsement, then the expiration date must coincide with the dates indicated on the schedule of that endorsement. For the first and second period of extended-term policies, report the associated expiration date as shown in the Period ndorsement. lectronic Reporting Format: YYMM - 8 -

16 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 9. xposure Report the two-digit state code in which coverage has been provided for the classifications and corresponding exposures, if any, and to which the payrolls of claimants have been assigned. ode 29 New ersey 10. Previous Report Number Provide the report number code that was previously reported. 11. Previous orrection equence Number Provide the correction sequence number that was previously reported. 12. Previous arrier ode Number Provide the carrier code that was previously reported 13. Previous Number Provide the policy number that was previously reported. 14. Previous ffective ate Provide the policy effective that was previously reported. 15. Previous xposure Provide the exposure state code that was previously reported. 16. ffective ate Report the ndorsement ffective ate if New ersey coverage was added, mid-term, to an interstate policy. lectronic Reporting Format: YYMM 17. onditions his data element is comprised or the following: hree Year Fixed Rate, Multistate, Interstate Rated, stimated Audit, Retrospective Rated, ancelled Mid- erm and Managed are rganization. Report the Y (Yes), N (No) or U (Uncooperative) indicator code as applicable. A. hree Year Fixed Rate ode escription N his is not a three-year fixed rate policy

17 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK.... F. G. Multistate ode escription Y his is a multistate policy. N his is not a multistate policy. Interstate Rated ode escription N his is not an interstate rated policy. stimated Audit ode escription Y his policy has an estimated exposure. N his policy does not have an estimated exposure. U Uncooperative Retrospective Rated ode escription Y his is a retrospective rated policy. N his is not a retrospective rated policy. ancelled Mid-erm ode escription Y his policy was cancelled mid-term. N his policy was not cancelled mid-term. Managed are rganization () ode escription Y his is a managed care organization () policy. N his is not a managed care organization () policy. 18. Page Number his is a hard copy field to be used only in risks with multiple pages

18 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 19. Last Page Number his is a hard copy field to be used only in risks with multiple pages. 20. Unit Format ubmission ode his is an electronic field only. Use the following code: ode A escription AWG format 21. Insured Name Report the name of the person or business with whom an insurance contract is made and who is specifically designated by name in Item 1 of the policy Information Page or as endorsed. 22. Insured Address Report the street address, city, state and zip code of the insured as shown in Item 1 of the Information Page or as endorsed. he address record is an optional field. 23. Modification ffective ate Normally, this is the effective date of the policy. However, when a split period due to an anniversary rating date (AR) change is reported, report the appropriate dates applicable to the respective exposure periods. Note that, within each exposure period, the modification and rate effective dates must be the same. Furthermore, for electronic reporting, a modification effective date is required on all exposure records. lectronic Reporting Format: YYMM 24. Rate ffective ate Normally, this is the effective date of the policy. However, when a split period due to an AR change is reported, report the appropriate dates applicable to the respective exposure periods. Note that, within each exposure period, the modification and rate effective dates must be the same. Furthermore, for electronic reporting, a modification effective date is required on all exposure records. lectronic Reporting Format: YYMM 25. plit Period ode his is an electronic field only, used to indicate a change in the manual/charged rates or modification factors. ode escription 0 First exposure period 1 econd exposure period 2 hird exposure period

19 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 26. ate ode his data element applies to both exposure and loss information. Report the one-letter code that identifies the activity of an exposure or loss record. Method 1 Previous and Revised Procedure ode escription P Previous R Revised Note: Additions of exposure or loss records must be identified by update type R only. eletions of exposure or loss records must be identified by update type P only. hanges of exposure or loss records must be identified by update types P and R. 27. xposure overage Act Report the two-digit code indicating the Act/Law or coverage under which the exposure for this record s classification code is associated. ode escription 00 For Use with tatistical odes 01 Act or Federal Act xcluding UL&H 02 UL&H overage on F and Non F lasses 28. lassification ode Report the four-digit classification code corresponding to the classification assigned to the insured according to the rules of the Manual or the statistical code, under which the basis of premium was actually audited and the insured billed. here cannot be more than one exposure record per unit for any classification code with the same manual/charged rate, exposure coverage code, experience modification, rate effective date and modification effective date. 29. xposure Amount his figure constitutes the basis for determining premium on a per classification level. xposure amount is normally on a payroll basis. Refer to the tatistical plan for classification code exceptions. Report the entire whole dollar exposure amount for each classification assigned to the policy to the nearest whole dollar amount. 30. Manual Rate Report the rate actually charged per unit of exposure for each classification code

20 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 31. Premium Amount Report the premium amount corresponding to each classification. he premium amount for payroll classes is the result of multiplying the exposure by the manual/charged rate divided by 100. Report the premium amount developed by extension of payroll or other exposure amount at the authorized rate to the nearest whole dollar. For non-exposure classifications, the premium is defined by the classification/statistical code. For other than payroll exposure classifications, the premium is the exposure amount times the manual/charged rate. 32. xperience Modification Factor Report the factor based on the past experience of the insured that is used to modify an insured s premium. Multiple experience modification factors may apply. If a change in the experience modification factor occurs after the policy effective date due to an AR change, then the payrolls, authorized rates and corresponding premiums must be split. 33. otal ubject Premium Report the sum of premium amounts subject to experience modification prior to the application of the modification factor. For exposure corrections, this must be the revised total amount. 34. otal Modified Premium his is a hard copy field only. Report the sum of premium amounts subject to experience modification after the application of the modification factor. For exposure corrections, this must be the revised total amount. 35. otal tandard xposure Report the sum of all payroll exposure amounts to be included in standard exposure. For exposure corrections, this must be the revised total amount. 36. otal tandard Premium Report the sum of all premium dollars, both subject to modification and not subject to modification, to be included in standard premium. For corrections, this must be the revised total amount. 37. laim Number Report the alphanumeric number that uniquely identifies the claim. he complete claim number must remain the same throughout the life of the claim. laim number is not reported if the insurer elects the claim grouping option (discontinued for policies affective on or after 1/1/13). 38. Accident ate/number of laims Report the month, day and year on which the injury occurred. For hard copy reporting, the grouped claim count is reported in the Accident ate/number of laims field (discontinued for policies effective on or after 1/1/13). laim count is not reported for individually listed claims on hard copy

21 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK For electronic reporting, this field applies only to individually listed losses. Leave blank when reporting grouped losses (discontinued for policies effective on or after 1/1/13). lectronic Reporting Format: YYMM 39. laim ount his is an electronic field only. Report the claim count as defined by the tatistical Plan. his field is never left blank or zero-filled. For grouped claims, report the number of claims in the grouping. 40. Incurred Indemnity Report the whole dollar amount of incurred indemnity, including all paid and outstanding reserve benefits due to an employee s lost wages or inability to work including compensation paid to the deceased prior to death, burial expenses, claimant s attorney fees, vocational rehabilitation, payments to the state and employers liability losses and expenses as of the valuation date. Note: Allocated Loss Adjustment xpenses for other than employers liability coverage must be excluded from incurred indemnity loss amounts. 41. Incurred Medical Report the whole dollar amount of incurred medical, including all paid and outstanding reserve benefits as of the loss valuation date. 42. Loss lassification ode Report the appropriate four-digit classification code where the payroll of the claimant was reported. No claims should be charged to a classification if no exposure was reported. 43. Injury ode Report the two-digit code that identifies under which provision of the law benefits are paid or expected to be paid. ode escription 01 eath 02 Permanent otal isability 03 Major Permanent Partial isability 04 Minor Permanent Partial isability 05 emporary otal isability 06 Non-ompensable Medical laims Also known as Medical nly claims 44. tatus ode Report the one-digit code that indicates the status of the claim. ode escription 0 pen 1 losed

22 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 45. Loss onditions his data element is comprised of the following: Loss overage Act, of Loss, of Recovery, of laim and of ettlement. Report the two-digit codes that correspond to each data element. A. Loss overage Act ode escription 01 Act or Federal Act xcluding UL&H 02 UL&H overage on F and Non F classes. of Loss ode escription efinition 01 rauma An injury resulting in disability or death traceable to a definite compensable accident occurring during the employee s employment which cannot be classified as either a isease Loss or umulative Injury as defined below. 02 ccupational isease Any condition resulting in disability or death not traceable to a definite accident occurring during the employee s employment. he condition is caused by exposure to a disease-producing agent(s) present in the worker s occupational environment. 03 umulative Injury other than disease In order for a claim to be coded as a disease claim, it must have resulted from repetitive exposure extending over a period of time. laims which arise from single identifiable incidents should not be coded as disease claims even though they may have been caused by inhalation, absorption, ingestion or environmental factors. Any injury which results in a disability or death and is not traceable to a definite compensable accident occurring during the employee s employment. he injury occurs from, and is aggravated by, a repetitive-related activity.. of Recovery ode escription 01 No recovery 02 econd Injury Fund nly 03 ubrogation nly (hird Party) 04 ubrogation with econd Injury Fund (hird Party)

23 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK. of laim ode escription efinition 01 Workers ompensation (Part ne) nly laim incurred under provisions of Part ne of the Workers ompensation & mployers Liability Insurance. 02 mployers Liability (Part wo ) nly laim incurred under provisions of Part wo of the Workers ompensation & mployers Liability Insurance. 03 ombination of Workers ompensation (Part ne) and mployers Liability laim incurred under provisions of both Part ne and Part wo of the Workers ompensation and mployers Liability Insurance. (Part wo) 04 Liability ver Refers to a particular mployer s Liability coverage situation where a third party, who is being sued by an employee, in turn sues the employer. Any damages incurred by the employer are classified as liability over, and are in addition to compensation payments made to the injured employee.. of ettlement ode escription efinition 00 laim not subject to settlement 03 tipulated Award (carrier/ A settlement agreed to by the claimant and the carrier. claimant settlement) 04 Findings and Award (judicial award) An award issued by a udge of ompensation on evidence presented. 05 ismissal or take nothing A claim dismissed after judicial review or the claimant fails to pursue the claim. 06 ompromise ection 20 A judicial settlement over the issues of applicability and extent of injury in accordance with N...A. 34: urisdiction Report the two-digit state code of the governing jurisdiction that will administer the claim and whose statutes will apply to the claim adjustment process when that state code is different from the exposure state code. 47. atastrophe Number Any accident resulting in a compensable injury to two or more persons shall be considered a catastrophe. In reporting catastrophes, all claims resulting from the accident shall be designated by the numeral (1). If there is more than one catastrophe under the policy, each succeeding catastrophe should be designated by means of a separate sequential number (2), (3), etc., up to and including (10). After number (10) is assigned, the next number in the sequence will reprocess to number (1). Numbers (11) through (99) are reserved for I assigned catastrophe codes

24 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 48. ode Report the two-digit code to identify whether the claim is administered by an approved Managed are rganization. ode escription 00 laim not administered by an approved managed care organization program. 01 laim is administered by an approved managed care organization program. 49. Injury escription odes his data element is comprised of the following elements: Part of ody, Nature of Injury and ause of Injury. his data element is not required for closed grouped medical only claims (discontinued for policies effective on or after 1/1/13). A. Part of ody Report the two-digit code that represents the part of body for a given claim. Refer to the Injury escription ode able in the tatistical Plan for applicable codes.. Nature of Injury Report the two-digit code that represents the nature of injury for a given claim. Refer to the Injury escription ode able in the tatistical Plan for applicable codes.. ause of Injury Report the two-digit code that represents the cause of injury for a given claim. Refer to the Injury escription ode able in the tatistical Plan for applicable codes. 50. ccupation escription Report a narrative description of the regular occupation of the injured worker. 51. Paid Indemnity Report the whole dollar amount of paid indemnity for the claim as of the loss valuation date. hese losses consist of all paid benefits due to an employee s lost wages or inability to work, including compensation paid to a deceased prior to death, burial expense, claimant s attorney fees, vocational rehabilitation benefits, payments to the state and employers liability losses and expenses. Note: ALA for other than employers liability coverage must be excluded from indemnity losses. 52. Paid Medical Report the whole dollar amount of medical losses paid for the claim as of the loss valuation date. 53. laimant s Attorney Fees Report the whole dollar amount paid plus outstanding reserves for claimant s legal representation during the settlement of the claim as of the loss valuation date. 54. mployer s Attorney Fees (ptional ata lement) Report the whole dollar amount paid plus outstanding reserves for employer s legal representation during the settlement of the claim as of the loss valuation date

25 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 55. Weekly Wage (ptional ata lement) Report the actual weekly wage amount at the date of the injury upon which the indemnity benefits are based. Report whole dollars only. 56. ALA Paid Report the whole dollar amount of loss adjustment expense allocated and paid by an insurance company when handling a claim as of the loss valuation date. 57. ALA Incurred (ptional data lement) Report the whole dollar amount of loss adjustment expense allocated and paid or reserved by an insurance company when handling a claim as of the loss valuation date. 58. otal Number of laims Report the total number of claims within the policy. In the case of loss corrections or subsequent reports, this must be the revised total. 59. otal Incurred Indemnity Report the total of the incurred indemnity amount within the policy. In the case of loss corrections or subsequent reports, this must be the revised total. 60. otal Incurred Medical Report the total of the incurred medical amount within the policy. In the case of loss corrections or subsequent reports, this must be the revised total. 61. otal Paid Indemnity Report the total of the paid indemnity amounts reported for the state within the policy. In the case of corrections and subsequent reports, this must be the revised total. 62. otal Paid Medical Report the total of the paid medical amounts reported for the state within the policy. In the case of corrections and subsequent reports, this must be the revised total. 63. otal laimant s Attorney Fees Report the total of the incurred claimant s attorney fees reported for the state within the policy. In the case of corrections and subsequent reports, this must be the revised total. 64. otal mployer s Attorney Fees (ptional ata lement) Report the total of the incurred employer s attorney fees reported for the state within the policy. In the case of corrections and subsequent reports, this must be the revised total

26 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK 65. otal ALA Paid Report the total of the paid ALA reported for the state within the policy. In the case of corrections and subsequent reports, this must be the revised total. 66. otal ALA Incurred (ptional ata lement) Report the total of the incurred ALA reported for the state within the policy. In the case of corrections and subsequent reports, this must be the revised total. IN IX Pre-delinquent, ue and elinquent ata Unit statistical data must be reported for any and all workers compensation policies reported in New ersey. When coverage information is sent to the ureau and a policy record created, a unit report must follow at a later date based on the valuation dates for report levels set for the policy effective date. uring the period of time from policy issuance until the first valuation of losses, the first report UR is termed pre-delinquent. he premium and losses of each policy are first valued as of eighteen (18) months after the policy effective date, and must be reported no later than twenty (20) months after the policy effective date. Unit statistical reports are termed due from the first possible day of valuation until the data is overdue. First reports are due beginning on the first day of the 18 th month through the fifteenth day of the 20 th month from the policy effective date. First reports not submitted by the fifteenth day of the 20 th month are delinquent and subject to financial penalties. ubsequent report valuations are at 30, 42, 54, 66, 78, 90, 102, 114 and 126 months, respectively, after the policy effective date. he subsequent reports must be submitted no later than the fifteenth day of the 32, 44, 56, 68, 80, 92, 104, 116, and 128 months, respectively, after the policy effective month. ubsequent reports are required when: 1. he previous report contained open claims; 2. ne or more claims are reopened; 3. Previously unreported claims have become known; or 4. here are changes in the loss valuation of one or more claims. ubsequent reports are pre-delinquent from the prior report with open claims until the valuation for the subsequent report. ubsequent reports are due from the first possible day of valuation until the day the data is overdue. ubsequent reports are delinquent if not received by the ureau by the due date, and become subject to financial penalties

27 You Are Viewing an Archived Report from the New ersey Library NW RY MPNAIN RAING AN INPIN URAU UNI AIIAL RPRING GUIK IN X Pre-delinquent and elinquent listings WNL Pre-delinquent and delinquent listings are distributed to carriers via regular mail or electronically via Workers ompensation ontrol Listings ( WNL ). he hard copy pre-delinquent list is mailed on the first work day of each month, and the delinquent list no later than the nineteenth day. ata providers may also obtain this data electronically via WNL (the WI standard electronic reporting format for pre-delinquent and delinquent listings). In order to receive and return this data electronically carriers must contact the ureau. ureau contact information can be found in ection XVIII of this guidebook. he insurer response fields found in the paper and electronic listings are advisory notices only, and are not substitutes for required notices of cancellation, reinstatements, policy submissions or endorsements. Missing policy data must be filed with the ureau in the appropriate manner prior to the submission of the unit statistical reports. IN XI Monetary anctions In accordance with section 3:13 of the Manual, all members of the ureau must report the required unit statistical data in a timely, accurate and complete manner. 1. UR ime Line chedule ffective an Feb Mar Apr May un ul Aug ept ct Nov ec M M M M M M M M M M M M Pre-delinquent List Mar Apr May un ul Aug ept ct Nov ec an Feb (14 months) M M M M M M M M M M M M laims to be Valued ul Aug ept ct Nov ec an Feb Mar Apr May un (18 months)* M M M M M M M M M M M M Reports to be Filed ept ct Nov ec an Feb Mar Apr May un ul Aug (19 ½ months)* M M M M M M M M M M M M elinquent List ct Nov ec an Feb Mar Apr May un ul Aug ept (20 ½ months) M M M M M M M M M M M M ubject to Fines Nov ec an Feb Mar Apr May un ul Aug ept ct (21 ½ months) *For additional details, see ection 3:13-7 in the tatistical Plan

28 NW RY You Are MPNAIN Viewing an Archived Report RAING from the New AN ersey INPIN Library URAU UNI AIIAL RPRING GUIK 2. elinquent URs Any arrier or arrier group with fifty (50) or more delinquent reports in one month will be assessed a monetary sanction of $50.00 per report per delinquent month or any part thereof until the required unit statistical reports are filed and accepted by the ureau. 3. URs with ata Quality Issues Any arrier or arrier group with more than one hundred unit statistical reports in error (edit status severity code 2, 3 & 4) and an error rate of 10% and higher of URs filed in one month, is subject to a monetary sanction of $25.00 for each error-filled UR. IN XII diting of URs by NRI When arriers use P to enter UR data, some of the data is edited and validated prior to submission to the ureau. When the unit statistical data is processed in the ureau s system, that data is then validated by another extensive and comprehensive edit process. 1. dit tatus and everity he status of a UR is determined by the severity of the edits appearing on that particular UR. tatus everity Accepted With Warnings (AWW) 1 Rejected 2 Accepted With rrors (AW) 3 ritical rrors 4 Accepted With Warnings are those URs which contain questionable errors. arriers will have to review these URs and verify that whatever was reported is correct and submit either written notifications to that effect or correction reports. Rejected are those URs with fatal errors which cannot be processed by the ureau. In order to resolve these errors carriers will have to submit replacement URs, correction reports or file the necessary data (policy, endorsements, cancellation and reinstatement notices), so that URs can be processed and entered in the ureau s database. Accepted With rrors are those URs that contain non-fatal errors, which require correction reports or supporting documentation (policy data) to be filed with the ureau. ritical rrors are fatal errors that require immediate attention from the arrier and/or the ureau. 2. rror Reports aily and monthly follow-up error reports are sent via regular mail to the unit statistical contact for the carrier. 3. riticism Letters riticism letters are sent via regular mail to the unit statistical contact for the carrier

29 NW RY You Are MPNAIN Viewing an Archived Report RAING from the New AN ersey INPIN Library URAU UNI AIIAL RPRING GUIK 4. dit rror Message List everity tatus ode. Identifies the severity of the edits appearing on a UR, for additional information please refer to dit tatus and everity in ection XII. Preliminary rror. he edits flagged by the Y (Yes) code identify the edits that are used to evaluate ata Quality of submissions. he system rejects any submission that has or exceeds 20 % (threshold) of these errors. Auto Load Reject rror. ubmissions that include any UR with edits flagged with the Y (Yes) code will be automatically rejected by the system. Auto Fail/Reject rror. If a UR contains any of the edits flagged with Y (Yes) code, the system will automatically flag the UR for rejection. dit # dit rror Message everity Auto Load Auto WI Preliminary tatus Reject Fail/Reject WA rror ode rror rror rror # UR has more than 1 header record. 2 Y Y N Name record (type=2)-either none or more than 1 is reported. 2 Y Y N UR must have 1 and only 1 otals record. 2 Y Y N xposure lass code is invalid or expired. 2 Y N N orrection ode is invalid. 4 N N N Injury ode (Injury ) is invalid. 2 Y N N ode is not Acceptable. 2 Y Y N hree-year Fixed Rate Indicator is invalid. 2 N N N Multistate Indicator is invalid. 2 N N N Interstate Rated Indicator is invalid. 2 N N N ondition - stimated Audit ode - is invalid. 2 N N N Retrospective Rated indicator is invalid. 2 N N N anceled Mid-erm Indicator is invalid. 2 N N N Managed are rganization () indicator is invalid. 2 N N N

30 NW RY You Are MPNAIN Viewing an Archived Report RAING from the New AN ersey INPIN Library URAU UNI AIIAL RPRING GUIK dit # dit rror Message everity Auto Load Auto WI Preliminary tatus Reject Fail/Reject WA rror ode rror rror rror # xposure ate is invalid. 4 N N Y xposure overage ode (A) is invalid. 2 N N N Loss ate is invalid. 4 N N Y laim tatus is invalid. 2 N N N Loss onditions - of Loss - is invalid. 2 N N N of Recovery is invalid. 2 N N N of laim is invalid. 2 N N N of ettlement is invalid. 2 N N N Loss onditions - A - is invalid. 2 N N N is invalid. 2 N N N Part of ody is invalid. 2 N N N Nature of Injury is invalid. 2 N N N ause of Injury is invalid. 2 N N N xposure amount must be zero for statistical codes. 2 Y N N xposure Amount must be zero for this lass ode. 2 N N N Loss record is not allowed for this lass ode. 2 N N N Premium Amount is incorrect. 2 N N N Incorrect mod effective date. 2 N N N N/A AWG Unit ubmission Indicator is invalid. 4 N N Y xposure lass ode - odes 0063 and should not be on the same policy. 2 N N N Rate ffective ate is incorrect. 2 N N N Multiple ffective ate of Rate values supplied within the same split period. 2 N N N plit Period Indicator is invalid. 2 N N N Number of laims is incorrect. 2 N N N Accident ate is outside of policy period. 2 N N N laim Number is invalid. 2 N N N uplicate laim Number is not allowed. 2 N N N Incurred Indemnity amount cannot be 0 for this Injury ode. 2 N N N Incurred Indemnity amount must be zero for this Injury ode. 2 N N N here must be 2 or more claims for each distinct catastrophe. 2 N N N atastrophe numbers are not in sequence. 2 N N N