Section III - Record Layouts
A. Overview
In order for the PCRB to properly receive data submissions, data providers are required to comply with specific requirements regarding record layouts, data elements, and link data when reporting Call data. Data files are transmitted in specific record layouts to allow for efficient processing. This allows the data contained within the record layouts to be formatted, sorted, and customized according to the user’s specifications.
The record layouts that comprise the Indemnity Data Call are provided in this section of the manual.
B. File Control Record Layout
| Field No. | Field Title/ Description | Class | Position | Bytes |
| 1 | Record Type Code | N | 1-2 | 2 |
| 2 | Submission File Type Code | A | 3 | 1 |
| 3 | Carrier Group Code | N | 4-8 | 5 |
| 4 | Reporting Quarter Code | N | 9 | 1 |
| 5 | Reporting Year | N | 10-13 | 4 |
| 6 | Submission File Identifier | AN | 14-43 | 30 |
| 7 | Submission Date | N | 44-51 | 8 |
| 8 | Submission Time | N | 52-57 | 6 |
| 9 | Record Total | N | 58-68 | 11 |
| 10 | RESERVED FOR FUTURE USE | 69-300 | 232 |
C. Transactional Record Layout
| Field No. | Field Title/ Description | Class | Position | Bytes |
| Processing Data Elements (Fields 1-4) | ||||
| 1 | Record Type Code | N | 1-2 | 2 |
| 2 | Transaction Code | N | 3-4 | 2 |
| 3 | Transaction Date | N | 5-12 | 8 |
| 4 | Transaction Identifier | AN | 13-32 | 20 |
| Key Data Elements (Fields 5-9) | ||||
| 5 | Carrier Code | N | 33-37 | 5 |
| 6 | Policy Number Identifier | AN | 38-55 | 18 |
| 7 | Policy Effective Date | N | 56-63 | 8 |
| 8 | Claim Number Identifier | AN | 64-75 | 12 |
| 9 | Accident Date | N | 76-83 | 8 |
| Transactional Data Elements (Fields 10-18) | ||||
| 10 | Jurisdiction State Code | N | 84-85 | 2 |
| 11 | Transaction From Date | N | 86-93 | 8 |
| 12 | Transaction To Date | N | 94-101 | 8 |
| 13 | Transaction Amount | N | 102-113 | 12 |
| 14 | Benefit Type Code | N | 114-115 | 2 |
| 15 | Lump-Sum Indicator | A | 116 | 1 |
| 16 | Benefit Offset Code | N | 117 | 1 |
| 17 | Benefit Offset Amount | N | 118-128 | 11 |
| 18 | Weekly Benefit Amount | N | 129-137 | 9 |
| 19 | RESERVED FOR FUTURE USE | 138-300 | 163 | |
D. Quarterly Record Layout
| Field No. | Field Title/ Description | Class | Position | Bytes | |
| Processing Data Elements (Fields 1-2) | |||||
| 1 | Record Type Code | N | 1-2 | 2 | |
| 2 | Transaction Date | N | 3-10 | 8 | |
| Key Data Elements (Fields 3-7) | |||||
| 3 | Carrier Code | N | 11-15 | 5 | |
| 4 | Policy Number Identifier | AN | 16-33 | 18 | |
| 5 | Policy Effective Date | N | 34-41 | 8 | |
| 6 | Claim Number Identifier | AN | 42-53 | 12 | |
| 7 | Accident Date | N | 54-61 | 8 | |
| Quarterly Indemnity Claim Data Elements (Fields 8-37) | |||||
| 8 | Jurisdiction State Code | N | 62-63 | 2 | |
| 9 | Claimant Gender Code | N | 64 | 1 | |
| 10 | Birth Year | N | 65-68 | 4 | |
| 11 | Hire Date | N | 69-76 | 8 | |
| 12 | Employment Status Code | AN | 77 | 1 | |
| 13 | Closing Date | N | 78-85 | 8 | |
| 14 | Reopen Date | N | 86-93 | 8 | |
| 15 | Maximum Medical Improvement (MMI) Date | N | 94-101 | 8 | |
| 16 | Reported to Insurer Date | N | 102-109 | 8 | |
| 17 | Accident State Code | N | 110-111 | 2 | |
| 18 | Attorney or Authorized Representative Indicator | A | 112 | 1 | |
| 19 | Method of Determining Pre-Injury/Average Weekly Wage Code | N | 113 | 1 | |
| 20 | Impairment Percentage Basis Code | N | 114 | 1 | |
| 21 | Impairment Percentage | N | 115-117 | 3 | |
| 22 | Disability/Loss of Earnings Capacity (LOEC) Percentage | N | 118-120 | 3 | |
| 23 | Pre-Existing Disability Percentage | N | 121-123 | 3 | |
| 24 | Part of Body Code—Injury Description | N | 124-125 | 2 | |
| 25 | Nature of Injury Code—Injury Description | N | 126-127 | 2 | |
| 26 | Cause of Injury Code—Injury Description | N | 128-129 | 2 | |
| 27 | Act—Loss Condition Code | N | 130-131 | 2 | |
| 28 | Type of Settlement—Loss Condition Code | N | 132-133 | 2 | |
| 29 | Medical Extinguishment Indicator | A | 134 | 1 | |
| 30 | Temporary Disability Benefit Extinguishment Code | N | 135 | 1 | |
| 31 | Indemnity Paid-To-Date | N | 136-144 | 9 | |
| 32 | Medical Paid-To-Date | N | 145-153 | 9 | |
| 33 | Incurred Indemnity Amount | N | 154-162 | 9 | |
| 34 | Incurred Medical Amount | N | 163-171 | 9 | |
| 35 | Employer Legal Amount Paid | N | 172-180 | 9 | |
| 36 | Allocated Loss Adjustment Expense (ALAE) Paid | N | 181-189 | 9 | |
| 37 | Pre-Injury/Average Weekly Wage Amount | N | 190-194 | 5 | |
| 38 | Classification Code | N | 195-198 | 4 | |
| 39 | Return to Work Date | N | 199-206 | 8 | |
| 40 | Zip Code of Injury Site | AN | 207-215 | 9 | |
| 41 | Number of Dependents | N | 216-217 | 2 | |
| 42 | Exposure State | N | 218-219 | 2 | |
| 43 | Indemnity Claim Code | N | 220 | 1 | |
| 44 | RESERVED FOR FUTURE USE | 221-300 | 80 | ||
E. Key Field Change Record Layout
| Field No. | Field Title/ Description | Class | Position | Bytes |
| 1 | Record Type Code | N | 1-2 | 2 |
| 2 | Previous Carrier Code | N | 3-7 | 5 |
| 3 | Previous Policy Number Identifier | AN | 8-25 | 18 |
| 4 | Previous Policy Effective Date | N | 26-33 | 8 |
| 5 | Previous Claim Number Identifier | AN | 34-45 | 12 |
| 6 | Previous Accident Date | N | 46-53 | 8 |
| 7 | Carrier Code | N | 54-58 | 5 |
| 8 | Policy Number Identifier | AN | 59-76 | 18 |
| 9 | Policy Effective Date | N | 77-84 | 8 |
| 10 | Claim Number Identifier | AN | 85-96 | 12 |
| 11 | Accident Date | N | 97-104 | 8 |
| 12 | RESERVED FOR FUTURE USE | 105-300 | 196 |