Section IV - Data Dictionary

The Data Dictionary provides information on each data element. Coding Values are also included in this section.

All data elements should be reported, except for a Transaction Identifier, which should only be reported if a data provider is going to use Option 1 (refer to Section V—Reporting Rules for details) for changing or deleting Transactional records. However, many of the data elements are conditional and would only be reported when they are applicable to a Transactional or Quarterly record.

Except for the key fields (which are always required to be reported), when the appropriate value is not available to the data provider or is unknown, do NOT provide defaulted values. Rather, leave the field blank/zero-filled as per the element details below:

• Alpha and alphanumeric fields—Leave Blank
• Numeric fields (including data fields)—Zero Fill

Example 1: Attorney or Authorized Representative Indicator (Alpha field)

Scenario	Valid Format
Claimant is known to have an attorney	Y
Claimant is known to not have an attorney	N
It is unknown whether the claimant has an attorney or authorized representative	Leave Blank

Example 2: Employment Status Code (Alphanumeric field)

Scenario	Valid Format
Claimant’s work status is known to be Regular Full-Time	1
Claimant’s work status is known but is not one of the four specified codes; i.e., Other	X
Claimant’s work status is unknown	Leave Blank

Example 3: Benefit Offset Code (Numeric field)

Scenario	Valid Format
There is no Benefit Offset; i.e., None	1
A Benefit Offset exists and is based upon SSDI	2
A Benefit Offset exists and is based on something other than SSDI	3
It is unknown whether a Benefit Offset exists	Zero-Fill

1. Accident Date

Record Type:	Quarterly (Key), Transactional (Key), and Key Field Change
Field(s):	7 (Quarterly), 9 (Transactional), and 11 (Key Field Change)
Position(s):	54-61 (Quarterly), 76-83 (Transactional), and 97-104 (Key Field Change)
Class:	Numeric (N) – Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The month, day, and year on which the injury occurred
Reporting Requirement:	The Accident Date must be reported for all Transactional and Quarterly records. This date must be within the policy period. The Accident Date must be before the quarter end valuation date as determined by the Reporting Quarter and Reporting Year found in the File Control Record. The Accident Date must be consistently reported across all PCRB data types for the life of the claim. Refer to Section II-Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields. For all claims where the Accident Date is known, report the date on which the claim occurred. For Occupational Disease and Cumulative Injury Other Than Disease claims where the Accident Date is not known, report the Accident Date as the claimant’s last date of exposure to the conditions causing or aggravating the injury. For additional details, refer to PCRB’s Statistical Plan Manual.

2. Accident State Code

Record Type:	Quarterly
Field(s):	17
Position(s):	110-111
Class:	Numeric (N) – Field contains only numeric characters
Bytes:	2
Format:	N 2
Definition:	The code that corresponds to the state or foreign location where the claimant was injured or contracted an occupational disease.
Reporting Requirement:	Report the code that corresponds to the state or foreign location where the claimant was injured or contracted a disease. The Accident State Code must be consistently for the life of the claim. Refer to Section II-Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields. The Accident State does not have to be one of the states included in the list of applicable Indemnity Data Call jurisdiction contained in Section I—General Rules of this manual. The Accident State may be different from the Jurisdiction State. Zero-fill if unknown. Note: The Accident State Code should correspond to the Zip Code of Injury Site.

State and Province Code

State or Province	Code	State or Province	Code	State or Province	Code
Alabama	01	Louisiana	17	Oklahoma	35
Alaska	54	Maine	18	Ontario	67
Alberta	61	Manitoba	63	Oregon	36
Arizona	02	Maryland	19	Pennsylvania	37
Arkansas	03	Massachusetts	20	Philippine Islands	57
British Columbia	62	Michigan	21	Prince Edward Islands	66
California	04	Minnesota	22	Puerto Rico	58
Canadian Provinces (NOC—Not Otherwise Classified)	55	Mississippi	23	Quebec	68
Canada Zone	56	Missouri	24	Rhode Island	38
Colorado	05	Montana	25	Saskatchewan	69
Connecticut	06	Nebraska	26	South Carolina	39
Delaware	07	Nevada	27	South Dakota	40
District of Columbia	08	New Brunswick	64	Tennessee	41
Florida	09	New Hampshire	28	Texas	42
Foreign Territory (Not Otherwise Classified)	80	New Jersey	29	Utah	43
Georgia	10	New Mexico	30	Vermont	44
Hawaii	52	New York	31	Virginia	45
Idaho	11	Newfoundland/Labrador	72	Virgin Islands	51
Illinois	12	North Carolina	32	Washington	46
Indiana	13	North Dakota	33	West Virginia	47
Insular Possession	53	Northwest Territories	60	Wisconsin	48
Iowa	14	Nova Scotia	65	Wyoming	49
Kansas	15	Nunavut	70	Yukon	71
Kentucky	16	Ohio	34

3. Act-Loss Condition Code

Record Type:	Quarterly
Field(s):	28
Position(s):	130-131
Class:	Numeric (N) – Field contains only numeric characters
Bytes:	2
Format:	N 2
Definition:	The code that identifies the act or law governing the basis of liability for the claim
Reporting Requirement:	Report the code that corresponds to the act or law governing the basis of the liability for the claim. For additional details, refer to PCRB’s Statistical Plan Manual. This code must be reported consistently between Indemnity data and Unit Statistical data. Zero-fill if unknown.

Code	Act	Description
1	State Act or Federal Act excluding USL&HW and Federal Mine Safety and Health Act	A claim with benefits determined according to the workers compensation law or federal compensation laws, excluding United States Longshore and Harbor Workers Compensation Act and excluding coverage under the Federal Mine Safety and Health Act
2	USL&HW F-Classes and USL&HW coverage on Non-F-Classes	A claim with benefits determined according to the United States Longshore and Harbor Workers Compensation Act
3	Federal Mine Safety and Health Act Only	A claim with benefits determined according to the Federal Mine Safety and Health Act
4	Federal Mine Safety and Health Act and the State Act	A claim with benefits determined according to the Federal Mine Safety and Health Act and state workers compensation law

4. Allocated Loss Adjustment Expense (ALAE) Paid

Record Type:	Quarterly
Field(s):	37
Position(s):	181-189
Class:	Numeric (N) – Field contains only numeric characters
Bytes:	9
Format:	N-9—Amount is rounded to the nearest whole dollar; data field is to be right-justified and left zero-filled
Definition:	The cumulative amount of all ALAE paid for the specific claim, net of recoveries.
Reporting Requirement:	Report the whole-dollar amount of ALAE that has been paid for the claim as of the loss valuation date. Employers Liability ALAE and claimant attorney fees are excluded from ALAE Paid and must be included in the Indemnity Paid-To-Date and Indemnity Incurred Amount. For additional details on what to include in ALAE paid, please refer to the Expenses section provided in PCRB’s Statistical Plan Manual, Section 1—General Rules/Definitions, Part N—General Rules and Definitions. The reporting must be consistent with the reporting of ALAE for this same claim for Unit Statistical data.

5. Attorney or Authorized Representative Indicator

Record Type:	Quarterly
Field(s):	18
Position(s):	112
Class:	Alpha (A)—Field contains only alphabetic characters
Bytes:	1
Format:	Y/N
Definition:	Indicates whether the claimant has an attorney or authorized representative.
Reporting Requirement:	Report “Y” or “N” to indicate whether the claimant has an attorney or authorized representative. Report “Y” if the claimant has obtained attorney representation regardless of whether the claim is litigated. Leave blank if unknown.
Example:	An accident occurs March 15 and the claimant initially does not obtain attorney representation. The claimant obtains attorney representation on April 2. The data provider submits the 1st Quarterly record on April 30 and the 2nd Quarterly record on July 31. •For the 1st Quarterly record, the Attorney or Authorized Representative Indicator is set to “N” because no attorney for the claimant was involved based on the latest information as of the 1st quarter valuation date (March 31). •For the 2nd Quarterly record, the Attorney or Authorized Representative Indicator is set to “Y” because an attorney for the claimant was involved based on the latest information as of the 2nd quarter valuation date (June 30).

Indicator	Description
Y	Claimant has an attorney or authorized representative
N	Claimant does not have an attorney or authorized representative

6. Benefit Offset Amount

Record Type:	Transactional
Field(s):	17
Position(s):	118-128
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	11
Format:	N 11—Amount includes dollars and cents; data field is to be right-justified and left zero-filled
Definition:	The amount of the benefit offset applied because of payments from another source (i.e., the statutory payment amount had there not been any offsets for payments/contributions from other source, such as social security disability insurance, employer-paid disability plans, retirement plans, and unemployment insurance, less the Transactional Amount).
Reporting Requirement:	This data element is a conditional field and is only required to be reported when applicable to the Transactional record. The amount reported includes dollars and cents. Offsetting amounts do not include penalties and liens or subrogation recoveries. There is an implied decimal between positions 126 and 127. If the reported amount does not include digits after the decimal, add 00 to the right of the reported amount. Reporting examples: • $123.45 is reported as 00000012345 • $123 is reported as 00000012300 Zero-fill if unknown or not applicable. Refer to Benefit Offset Code below for an example.

7. Benefit Offset Code

Record Type:	Transactional
Field(s):	16
Position(s):	117
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	1
Format:	N 1
Definition:	The code that indicates that the claim had an offset for payments/contributions from another source. That is, a code that indicates whether the statutory payment amount has been explicitly reduced to reflect payments/contributions from other sources such as social security disability insurance (SSDI), employer-paid disability plans, retirement plans, and unemployment insurance. Benefit Offsets do not include wage garnishments for child support, reductions due to previous overpayments of benefits, etc.
Reporting Requirement:	Report the applicable Benefit Offset Code to reflect payments/contributions from other sources, such as social security disability insurance (SSDI), employer-paid disability plans, retirement plans, and unemployment insurance When multiple benefit offsets apply to the transaction, report Benefit Offset Code 3 (Other). “Other” should be reported only when it applies to that particular transaction. Zero-fill if unknown.
Examples:	Reporting a Benefit Offset for SSDI (weekly basis) An injured worker is awarded statutory workers compensation indemnity benefits of $500 per week. However, the law allows for an offset against the statutory workers compensation benefit for SSDI benefits received. Given an allowable SSDI offset amount of $200 per week, the resulting transactional fields would be reported as follows for the applicable weekly period: • Transaction Amount ($500-$200=$300) = 000000030000 • Weekly Benefit Amount ($300) = 000030000 • Benefit Offset Amount ($200) = 00000020000 • Benefit Offset Code = 2 Reporting a Benefit Offset for SSDI (bi-weekly basis) An injured worker is awarded statutory workers compensation indemnity benefits of $500 per week, payable on a bi-weekly basis. However, the law allows for an offset against the statutory workers compensation benefit for SSDI benefits received. Given an allowable SSDI offset amount of $200 per week, the resulting transactional fields would be reported as follows for the applicable weekly period: • Transaction Amount ([$500 x 2] – [$200 x 2] = $600) = 000000060000 • Weekly Benefit Amount ($500 - $200 = $300) = 000030000 • Benefit Offset Amount ($200 x 2 = $400) = 00000040000 • Benefit Offset Code = 2

8. Benefit Type Code

Record Type:	Transactional
Field(s):	14
Position(s):	114-115
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2
Definition:	The code that corresponds to the type of benefits paid to or on behalf of the claimant or recovery reimbursement amounts received.
Reporting Requirement:	At least one Benefit Type Code must be reported for all claims for which a benefit payment has been made. Use Benefit Type Code 99 if indemnity benefit type is unknown.

Code	Description	Additional Rules and/or Exceptions (If Applicable)
01	Death Benefits—The transactional amount of indemnity benefits paid for the death of the claimant resulting from a work-related accident or occupational injury or disease.	Includes burial expenses Benefits for multiple survivors may be reported as a single transaction for all the survivors or one transaction per survivor for each payment made.
02	Permanent Total Disability Benefits—The transactional amount of indemnity benefits paid for permanent total disability as defined by statute.
03	Scheduled Permanent Partial Disability Benefits—The transactional amount of indemnity permanent partial disability benefits paid as established by a statutory list (schedule) of weeks for specific parts of body.
04	Unscheduled Permanent Partial Disability Benefits—The transactional amount of indemnity benefits paid for injuries to parts of the body not specifically listed in a statutory schedule.
05	Temporary Total Disability Benefits—The transactional amount of indemnity benefits paid for the period that the claimant is temporarily but totally disabled as defined by statute.
09	Disfigurement Benefits—The transactional amount of indemnity benefits paid for any scarring or cosmetic defect as defined by statute.
11	Temporary Partial Disability Benefits—The transactional amount of indemnity benefits paid for the period that the claimant is temporarily but partially disabled as defined by statute.
12	Employers Liability—The transactional amount of all indemnity benefits and expense (ALAE) paid under the Employers Liability portion of the Workers Compensation policy.
20	Claimant Legal Amount Paid—The transactional amount paid by the employer or insurer for the fee of the claimant’s attorney or authorized representative as specified in an award or paid without an award.	Report only when a separate payment is made to the claimant attorney (i.e., separate checks).
20
30	Indemnity Recovery Reimbursement Amount—Third-Party Actions—The transactional amount of indemnity recovery reimbursed to the carrier from a third-party action less recovery expenses.	Recovery reimbursements should be reported with positive transaction amount
30
31	Indemnity Recovery Reimbursement Amount—State Administered Funds—The transactional amount of indemnity recovery reimbursed to the carrier from a state-administered fund (e.g., Second Injury Fund).	Recovery reimbursements should be reported with positive transaction amount
48	Penalties, Assessments, Interest—The transactional amount of all penalties, assessments, and/or interest accrued as defined in PCRB’s Statistical Plan	Examples of what is included: • Payments due to improper delays or denials of benefits that occur despite the good-faith effort of the insurer and are paid as a bonus to the injured worker Examples of what are not included: • Payments due to unreasonable claim denials or delays, or due to the deliberate actions of the insurer • Bad faith judgements, or any other award due to a tort claim • Payment to a state agency or regulatory body rather than a claimant • Assessment against an employer (for unsafe workplace, failure to carry insurance, failure to report claim to insurer, etc.)
49	Indemnity and Medical Combined—The transactional amount of benefits paid for indemnity and medical on a combined basis which cannot be separated out.
50	Other Specified Indemnity Benefits—The transactional amount of indemnity benefits paid for specific injuries in addition to previously defined indemnity benefits.
60	Vocational Rehabilitation—Evaluation Benefit Costs—The transactional amount paid for testing and evaluating the claimant’s ability, aptitude, and/or attitude in determining suitability for vocational rehabilitation or placement.
61	Vocational Rehabilitation—Education Benefit Costs—Transactional amounts paid for education/training costs including tuition, books, and tools.	Transaction From and To Dates are required for these payments. Refer to the Transaction From/To Date fields in this section of the manual for examples.
62	Vocational Rehabilitation—Maintenance Benefit Costs—Transactional amount paid for any expense, such as transportation, lodging, and meal costs, that enables the claimant to receive or participate in vocational rehabilitation services.	Temporary disability benefits that are paid while the claimant receives vocational rehabilitation services are excluded from this field and reported in the appropriate Benefit Type Code (i.e., 05 or 11).
63	Vocational Rehabilitation—Payment NOC—Transactional amount paid for vocational rehabilitation services that is not classified as either evaluation, educational, or maintenance costs.
79	Lump Sum Including Multiple Indemnity—The transactional amount paid via lump sum for multiple indemnity benefit types that cannot be reasonably separated out.	If payment included medical benefits that cannot be reasonably separated from the indemnity portion of the payment, then use Benefit Type Code 49.
99	Other Indemnity Benefits Not Otherwise Specified—The transactional amount of indemnity benefits paid, not otherwise classified by PCRB.	It is expected that this benefit type will be used infrequently.

9. Birth Year

Record Type:	Quarterly
Field(s):	10
Position(s):	65-68
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	4
Format:	CCYY
Definition:	The actual or estimated year the claimant was born.
Reporting Requirement:	Report the year the claimant was born. If the claimant's birth year is unknown but the claimant's age is known, then report the estimated birth year (accident year minus claimant age). The Birth Year must be before the Accident Date year. Zero-fill if neither the birth year nor age is known.

10. Carrier Code

Record Type:	Quarterly (Key), Transactional (Key), and Key Field Change
Field(s):	3 (Quarterly), 5 (Transactional), and 7 (Key Field Change)
Position(s):	11-15 (Quarterly), 33-37 (Transactional), and 54-58 (Key Field Change)
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	5
Format:	N 5
Definition:	The carrier code assigned to the carrier by NCCI.
Reporting Requirement:	Report the 5-digit NCCI assigned Carrier Code. The Carrier Code must be consistently reported across all PCRB data types for the life of the policy. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

11. Carrier Group Code

Record Type:	File Control
Field(s):	3
Position(s):	4-8
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	5
Format:	N 5
Definition:	The carrier group code assigned to the carrier by NCCI
Reporting Requirement:	Report the 5-digit NCCI assigned Carrier Group Code that corresponds to the Reporting Group for which the data provider has been certified to report on its behalf.

12. Cause of Injury-Injury Description

Record Type:	Quarterly
Field(s):	26
Position(s):	128-129
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2
Definition:	The code that corresponds to the cause of injury sustained by the claimant.
Reporting Requirement:	Report the applicable code that corresponds to the cause of injury sustained by the claimant using the Injury Description. For additional details, refer to PCRB’s Statistical Plan Manual. This code must be reported consistently between Indemnity data and Unit Statistical data. Zero-fill if unknown.

Code	Narrative Description
I. Burn or Scald – Heat or Cold	*
01. Chemicals	Includes hydrochloric acid, sulfuric acid, battery acid, methanol, antifreeze.
02. Hot Objects or Substances	*
03. Temperature Extremes	Non-impact injuries resulting in a burn due to hot or cold temperature extremes. Includes freezing or frostbite.
04. Fire or Flame	*
05. Steam or Hot Fluids	*
06. Dust, Gases, Fumes or Vapors	Includes inhalation of carbon dioxide, carbon monoxide, propane, methane, silica (quartz), asbestos dust and smoke.
07. Welding Operation	Includes welder's flash (burns to skin or eyes as a result of exposure to intense light from welding.)
08. Radiation	Includes effects of ionizing radiation found in X-rays, microwaves, nuclear reactor waste, and radiating substances and equipment. Includes non-ionizing radiation such as sunburn.
09. Contact With, NOC	Not otherwise classified in any other code. Includes cleaning agents and fertilizers.
11. Cold Objects or Substances	*
14. Abnormal Air Pressure	*
84. Electrical Current	Includes electric shock, electrocution and lightning.
II. Caught In, Under or Between	*
10. Machine or Machinery	Running or meshing objects, a moving and a stationary object, two or more moving objects
12. Object Handled	Includes medical hospital bed & parts, wheelchair, clothespin vise.
13. Caught In, Under or Between, NOC	Not otherwise classified in any other code.
20. Collapsing Materials (Slides of Earth)	Either man made or natural.
III. Cut, Puncture, Scrape Injured By	*
15. Broken Glass	*
16. Hand Tool, Utensil; Not Powered	Includes needle, pencil, knife, hammer, saw, axe, screwdriver.
17. Object Being Lifted or Handled	Includes being cut, punctured or scraped by a person or object being lifted or handled.
18. Powered Hand Tool, Appliance	Includes drill, grinder, sander, iron, blender, welding tools, nail gun.
19. Cut, Puncture, Scrape, NOC	Not otherwise classified in any other code. Includes power actuated tools.
IV. Fall, Slip or Trip Injury	*
25. From Different Level (Elevation)	Includes collapsing chairs, falling from piled materials, off wall, catwalk, bridge.
26. From Ladder or Scaffolding	*
27. From Liquid or Grease Spills	*
28. Into Openings	Includes mining shafts, excavations, floor openings, elevator shafts.
29. On Same Level	*
30. Slip, or Trip, Did Not Fall	Slip or trip and did not come in contact with the floor or ground.
31. Fall, Slip or Trip, NOC	Not otherwise classified in any other code. Includes tripping over object, slipping on organic material, slip but fall not specified.
32. On Ice or Snow	*
33. On Stairs	*
V. Motor Vehicle	*
40. Crash of Water Vehicle	*
41. Crash of Rail Vehicle	*
45. Collision or Sideswipe With Another Vehicle	Vehicle collision, both vehicles in motion.
46. Collision with a Fixed Object	Collision occurring with standing vehicle or stationary object.
47. Crash of Airplane	*
48. Vehicle Upset	Includes overturned or jackknifed.
50. Motor Vehicle, NOC	Not otherwise classified in any other code. Includes injuries due to sudden stop or start, being thrown against interior parts of the vehicle and vehicle contents being thrown against occupants.
VI. Strain or Injury By	*
52. Continual Noise	Injury to ears or hearing due to the cumulative effects of constant or repetitive noise.
53. Twisting	Free bodily motion that imposes stress or strain on some part of body. Includes assumption of unnatural position, involuntary motions induced by sudden noise, fright or loss of balance.
54. Jumping or Leaping	*
55. Holding or Carrying	Applies to objects or people. Includes restraining a person.
56. Lifting	Includes objects or people.
57. Pushing or Pulling	Includes objects or people.
58. Reaching	*
59. Using Tool or Machinery	*
60. Strain or Injury By, NOC	Not otherwise classified in any other code.
61. Wielding or Throwing	Physical effort or overexertion from attempts to resist a force applied by an object being handled.
97. Repetitive Motion	Cumulative injury or condition caused by continual, repeated motions; strain by excessive use. Includes Carpal Tunnel Syndrome.
VII. Striking Against or Stepping On	NOTE: Applies to cases in which the injury was produced by the impact created by the person, rather than by the source.
65. Moving Part of Machine	*
66. Object Being Lifted or Handled	*
67. Sanding, Scraping, Cleaning Operation	Include scratches or abrasions caused by sanding, scraping, cleaning operations.
68. Stationary Object	*
69. Stepping on Sharp Object	*
70. Striking Against or Stepping On, NOC	Not otherwise classified in any other code.
VIII. Struck or Injured By	NOTE: Applies to cases in which the injury was produced by the impact created by the source of injury, rather than by the injured person.
74. Fellow Worker, Patient or Other Person
75. Falling or Flying Object	*
76. Hand Tool or Machine in Use	*
77. Motor Vehicle	Applies when a person is struck by a motor vehicle, including rail vehicles, water vehicles, airplanes.
78. Moving Parts of Machine	*
79. Object Being Lifted or Handled	Includes dropping object on body part.
80. Object Handled By Others	Includes another person dropping object on injured person's body part.
81. Struck or Injured, NOC	Not otherwise classified in any other code. Includes kicked, stabbed, bitten.
85. Animal or Insect	Includes bite, sting or allergic reaction.
86. Explosion or Flare Back	Rapid expansion, outbreak, bursting, or upheaval. Includes explosion of cars, bottles, aerosol cans, or buildings. "Flare back" involves superheated air and combustible gases at temperatures just below the ignition temperature.
IX. Rubbed or Abraded By	Not otherwise classified in any other code. Includes foreign body in ears.
94. Repetitive Motion	Caused by repeated rubbing or abrading; applies to non-impact cases in which the injury was produced by pressure, vibration or friction between the person and the source of injury. Includes callous, blister.
95. Rubbed or Abraded, NOC	Not otherwise classified in any other code. Includes foreign body in ears.
X. Miscellaneous Causes	*
82. Absorption, Ingestion or Inhalation, NOC	Not otherwise classified in any other code. Applies only to non-impact cases in which the injury resulted from inhalation, absorption (skin contact), or ingestion of harmful substances or vaccinations.
83. Pandemic	Includes disease epidemic that has spread across a large region.
87. Foreign Matter (Body) in Eye(s)	Injury to eyes resulting from foreign matter that is not otherwise classified in any other code.
88. Natural Disasters	Injury resulting from natural disaster. Includes hurricane, earthquake, tornado, flood, forest fire.
89. Person in Act of a Crime	Specific injury, other than gunshot, caused as a result of contact between injured person and another person in the act of committing a crime. Includes robbery or criminal assault.
90. Other Than Physical Cause of Injury	Stress, shock, or psychological trauma that develops in relation to a specific incident or cumulative exposure to conditions.
91. Mold	Includes mildew.
93. Gunshot	Injury is caused by the discharge of a firearm. Includes instances where injury arises from being struck by the fired projectile, burned by muzzle blast or deafened by report of gunshot.
96. Terrorism	An act that causes injury to human life, committed by one or more individuals as part of an effort to coerce a population group(s) or to influence the policy or affect the conduct of any government(s) by coercion.
98. Cumulative, NOC	Cumulative, not otherwise classified in any other code. Involves cases in which the cause of injury occurred over a period of time, any condition increasing in severity over time.
99. Other - Miscellaneous, NOC	Not otherwise classified in any other code.

13. Claim Number Identifier

Record Type:	Quarterly, Transactional (Key), and Key Field Change
Field(s):	6 (Quarterly), 8 (Transactional), and 10 (Key Field Change)
Position(s):	42-52 (Quarterly), 64-75 (Transactional), and 85-96 (Key Field Change)
Class:	Alphanumeric (AN) - Field contains alphabetic and numeric characters
Bytes:	12
Format:	A/N 12, letters A–Z and numbers 0–9 only (if the Claim Number Identifier is less than 12 bytes, this field must be left justified, and blanks in all spaces to the right of the last character).
Definition:	The unique set of numbers and/or letters that identify the specific claim that the report/transaction applies to.
Reporting Requirement:	Report the unique set of numbers and/or letters that identify the specific claim. The Claim Number Identifier must be consistently reported across all PCRB data types for the life of the claim. This number must be used consistently for all future (and prior) reporting of the claim transactions. The Claim Number Identifier can neither be all zeros nor all blanks nor a combination of zeros and blanks. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

14. Claimant Gender Code

Record Type:	Quarterly
Field(s):	9
Position(s):	64
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	1
Format:	N 1
Definition:	The code that corresponds to the claimant's gender.
Reporting Requirement:	Report the code that corresponds to the claimant's gender. If the claimant’s gender is unknown, do NOT report 3 (Other). Zero-fill if unknown.

Code	Description
1	Male
2	Female
3	Other

15. Classification Code

Record Type:	Quarterly
Field(s):	38
Position(s):	195-198
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	4
Format:	N 4- Data Field is to be right-justified and left zero-filled
Definition:	A code used to identify the classification assigned to the insured according to the rules of the manual for workers compensation, or the statistical code defined by the jurisdiction.
Reporting Requirement:	Report the classification code that corresponds to the payroll or other exposure of the claimant (insured employee). For additional details, refer to PCRB’s Statistical Plan Manual.

16. Closing Date

Record Type:	Quarterly
Field(s):	13
Position(s):	78-85
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The date that the claim was closed (i.e., further indemnity or medical payments are not expected), the judgment date, or the date an agreement was made regarding the final amount paid.
Reporting Requirement:	This data element is a conditional field and is only required to be reported when applicable to the Quarterly record. PCRB will derive a claim’s status (Open/Closed) based on the population of the Closing Date and Reopen Date fields. The claim status will be derived as Open if any of these conditions are true: 1. Both the Closing Date and the Reopen Date fields are zero-filled 2. The Reopen Date is greater than the Closing Date The claim status will be derived as Closed if either of these conditions are true: 1. The Closing Date is populated and the Reopen Date is zero-filled 2. The Closing Date is greater than the Reopen Date 3. The Closing Date is zero-filled and the Reopen date is populated

Scenario	Accident Date	Closing Date	Reopen Date	Derived Claim Status
Claim is open	20200101	00000000	00000000	Open
Claim is closed	20200101	20250215	00000000	Closed
Claim reopens *	20200101	20250215	20250705	Open
Claim is closed again**	20200101	20251231	20250705	Closed

*It is not necessary to zero-out the Closing Date field when a claim reopens.

**It is not necessary to zero-out the Reopen Date field when the claim closes again.

17. Disability/Loss of Earnings Capacity Percentage (For Federal Act Coverages Only)

Record Type:	Quarterly
Field(s):	22
Position(s):	118-120
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	3
Format:	N 3-Data field is to be right justified and left zero-filled. Enter the percentage as a whole number with a leading zero or zeros. The percentage is rounded to the nearest whole number (for example, 48.4% is reported as 048 and 48.5% is reported as 049).
Definition:	In jurisdictions where permanent partial disability (PPD) benefits are based on a formal assessment of the claimant's loss of earnings capacity (LOEC) post maximum medical improvement, this is the actual, final LOEC of a claim, expressed as a percentage, which underlies the benefits paid. In jurisdictions where additional factors beyond impairment rating are considered in determining disability (e.g., LOEC, age, education, ability to be retrained, residual physical capacity), this is the actual final disability rating of a claim, expressed as a percentage, which underlies the benefits paid.
Reporting Requirement:	This data element is a conditional field and is required to be reported only when applicable to the Quarterly record. Disability/LOEC percentage will only be applicable to Quarterly records with a Jurisdiction State Code of 59 - Federal Act (USL&HW Act, FELA, Jones Act, Admiralty Law, and Federal Mine Safety and Health Act). If applicable, report the final LOEC or disability of a claim as a percentage, which underlies the permanent benefits paid. The Disability/LOEC percentage field is to be reported on a whole-body basis. If a Disability/LOEC percentage is on a part-of-body basis, then convert it to a whole-body basis. Zero-fill if not applicable. The disability rating percentage and LOEC percentage are mutually exclusive. That is, for the particular jurisdiction/benefit type combination, there would be either one or the other. In jurisdictions where PPD benefits are strictly based on impairment rating, it is expected that the LOEC/Disability Percentage field will be zero-filled.
Example:	Reporting Disability/LOEC Percentage with a Single Impairment: An injured worker has an impairment rating of 30% to the arm and is determined to suffer a loss of earning capacity of 25%. The resulting quarterly fields would be:  Impairment Percentage = 030  Impairment Percentage Basis Code = 2 (impairment percentage based on part of body)  Part of Body Code = 31 (Arm)  Disability/LOEC Percentage = 025 Reporting a Disability/LOEC Percentage with Multiple Impairments A worker has sustained an injury to two body parts. The physician has provided two separate impairment ratings: 50% of arm and 20% of leg. The combination of these impairment ratings results in a whole-body impairment of 38%. If the claim is ultimately determined to have a disability rating of 50%, the quarterly fields would be reported as follows:  Impairment Percentage = 038  Impairment Percentage Basis Code = 1 (impairment percentage based on the whole body)  Part of Body Code = 90 (multiple body parts)  Disability/LOEC Percentage = 050

18. Employer Legal Amount Paid

Record Type:	Quarterly
Field(s):	35
Position(s):	172-180
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	9
Format:	N 9-Amount is rounded to the nearest whole dollar; data field is to be right-justified and left zero-filled
Definition:	The cumulative amount paid by the employer or insurer for the services of an attorney or authorized representative to defend against a proceeding brought under the workers compensation or employer’s liability laws, net of recoveries received.
Reporting Requirement:	The cumulative amount paid by the employer or insurer for the services of an attorney or authorized representative to defend against a proceeding brought under the workers compensation or employer’s liability laws, net of recoveries received.
Example:	Report the whole dollar amount paid by the employer or insurer for the services of an attorney or authorized representative.

19. Employment Status Code

Record Type:	Quarterly
Field(s):	12
Position(s):	77
Class:	Alphanumeric (AN)—Field contains alphabetic and numeric characters
Bytes:	1
Format:	A/N 1—Letter X and numbers 1, 2, 8,and 9 only
Definition:	The code that indicates the employee’s primary work status at the time of the injury with the covered employer.
Reporting Requirement:	Report the code that indicates the employee’s primary work status at the time of the injury with the covered employer as used in the statutory calculation of pre-injury wages. When multiple codes apply, report the lowest one in the hierarchy. Leave blank if unknown.
Examples:	Reporting employment status when multiple employment status apply in the same time period: An injured worker was employed as a part-time seasonal worker at the time of a workplace accident. In this case, two Employment Status Codes would apply (Code 2 for part-time worker and Code 8 for seasonal worker); however, based on the hierarchy provided in the table above, report Employment Status Code 8 (seasonal worker). Reporting employment status when multiple employment status apply in the different time periods: An injured worker was employed on a full-time basis for the first three quarters of the year preceding a workplace accident and on a part-time basis for the quarter directly preceding the workplace accident.  If statutory indemnity benefits are based on the injured worker’s average weekly wage for the 13 weeks preceding the workplace accident, report Employment Status Code 2 (part-time worker).  If statutory indemnity benefits are based on the injured worker’s average weekly wage for the 52 weeks preceding the workplace accident, two employment status codes would apply (Code 2 for part-time worker and Code 1 for full-time worker); however, based on the hierarchy in the table above, report Employment Status Code 1 (full-time worker).

20. Exposure State Code

Record Type:	Quarterly
Field(s):	42
Position(s):	218-219
Class:	Numeric
Bytes:	2
Format:	N 2
Definition:	A code used to identify the state in which coverage has been provided for the classifications and corresponding exposures, if any, and to which the payrolls of claimants have been assigned.
Reporting Requirement:	Report the state code for the state in which coverage has been provided for the classification codes and corresponding exposure and to which the payroll of the claimant has been assigned. For additional details, refer to PCRB’s Statistical Plan Manual.

State and Province Code

State or Province	Code	State or Province	Code	State or Province	Code
Alabama	01	Louisiana	17	Oklahoma	35
Alaska	54	Maine	18	Ontario	67
Alberta	61	Manitoba	63	Oregon	36
Arizona	02	Maryland	19	Pennsylvania	37
Arkansas	03	Massachusetts	20	Philippine Islands	57
British Columbia	62	Michigan	21	Prince Edward Islands	66
California	04	Minnesota	22	Puerto Rico	58
Canadian Provinces (NOC—Not Otherwise Classified)	55	Mississippi	23	Quebec	68
Canada Zone	56	Missouri	24	Rhode Island	38
Colorado	05	Montana	25	Saskatchewan	69
Connecticut	06	Nebraska	26	South Carolina	39
Delaware	07	Nevada	27	South Dakota	40
District of Columbia	08	New Brunswick	64	Tennessee	41
Florida	09	New Hampshire	28	Texas	42
Foreign Territory (Not Otherwise Classified)	80	New Jersey	29	Utah	43
Georgia	10	New Mexico	30	Vermont	44
Hawaii	52	New York	31	Virginia	45
Idaho	11	Newfoundland/Labrador	72	Virgin Islands	51
Illinois	12	North Carolina	32	Washington	46
Indiana	13	North Dakota	33	West Virginia	47
Insular Possession	53	Northwest Territories	60	Wisconsin	48
Iowa	14	Nova Scotia	65	Wyoming	49
Kansas	15	Nunavut	70	Yukon	71
Kentucky	16	Ohio	34

21. Hire Date

Record Type:	Quarterly
Field(s):	11
Position(s):	69-76
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The date that the claimant began his or her most recent employment with the employer.
Reporting Requirement:	This data element is a conditional field and is only required to be reported when the hire date or hire year is known. When available, report the claimant’s hire date. The hire date must be on or before the accident date. If the hire date is unknown but the hire year is available, report the hire year followed by four zeros. Zero-fill if both the Hire Date and the hire year are not available.
Example:	Reporting Hire Date when only hire year is known: The claimant was hired in 1996, but the exact date in 1996 is unknown. Report 19960000 in the Hire Date field.

22. Impairment Percentage

Record Type:	Quarterly
Field(s):	21
Position(s):	115-117
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	3
Format:	N 3—Data field is to be right-justified and left zero-filled; enter the percentage as a whole number with a leading zero or zeros. Amount is rounded to the nearest whole number (for example, 48.4% is reported as 048 and 48.5% is reported as 049.
Definition:	The actual, final impairment rating of a claim (I.e., medical assessment of claimant’s post-MMI functionality) expressed as a percentage.
Reporting Requirement:	This data element is a conditional field and is only required to be reported when applicable to the Quarterly record. When applicable, report the percentage of impairment when the following three conditions occur:  The Jurisdiction State has established calculations that use an impairment rating or allow the ratings to be used in benefit determination  An impairment rating was used to determine the claimant’s benefits  One of the following benefit types has been paid or is expected to be paid: o Benefit Type Code 02 o Benefit Type Code 03 o Benefit Type Code 04 o Benefit Type Code 09 Zero-fill if not applicable. If an impairment percentage is required to be reported in this field, then the basis for the percentage (whole body or part of body) is required to be reported in the Impairment Percentage Basis Code field. The reported impairment percentage must correspond to the reported Impairment Percentage Basis Code. For single impairment ratings, the carrier can choose to use the whole body or part of body to determine the impairment percentage. For multiple impairment ratings, convert each one to a whole-body rating, then add together to find the impairment percentage and indicate the conversion to whole body in the Impairment Percentage Basis Code.

Code	Description
1	Impairment percentage based on the whole body (Applicable in Pennsylvania)
2	Impairment percentage based on part of body (Applicable to Federal Act Coverage Claims only)

23. Impairment Percentage Basis Code

Record Type:	Quarterly
Field(s):	20
Position(s):	114
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	1
Format:	N 1
Definition:	The code that corresponds to whether the reported Impairment Percentage was based on the whole body or part of body.
Reporting Requirement:	This data element is a conditional field and is required to be reported only when applicable to the Quarterly record. When applicable, report the code that corresponds to whether the impairment percentage was reported based on the whole body or part of body. This field must be completed when an impairment percentage is reported in the Impairment Percentage field. With a single impairment, the data provider can choose either whole body or part of body for the basis code. Multiple impairments must be reported based on a whole-body basis. Zero-fill if not applicable.

Coding Values

Code	Description
1	Impairment percentage based on the whole body (Applicable in Pennsylvania)
2	Impairment percentage based on part of body (Applicable to Federal Act Coverage Claims only)

24. Incurred Indemnity Amount

Record Type:	Quarterly
Field(s):	33
Position(s):	154-162
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	9
Format:	N 9—Amount is rounded to the nearest whole dollar; data field is to be right-justified and left zero-filled
Definition:	The Incurred Indemnity Amount is the total of paid-to-date and outstanding reserves, as of the quarter-end valuation date. This definition is equivalent to the rules for unit statistical reporting in accordance with PCRB’s Statistical Plan Manual.
Reporting Requirement:	Report the total of indemnity paid-to-date and outstanding reserves as of the quarter-end valuation date. Incurred Indemnity Includes:  Reserves for future payments, which may include benefits subject to pension table valuation  All paid benefits for the employee’s lost wages or inability to work, including compensation paid to the deceased prior to death, burial expenses, payments to the state or to special funds, and claimant’s attorney fees  Vocational rehabilitation  Employers liability losses including Allocated Loss Adjustment Expenses (ALAE)  Subrogation recoveries and special fund reimbursements  Awards  Penalties for delays in making compensation payments for reasons beyond the carrier’s control  Expenses incurred for the benefit of the claimant (must be reported as either an indemnity or medical loss depending upon the nature of the expense)  Salary in lieu of indemnity benefit payments Incurred Indemnity Excludes:  Legal expenses incurred for the benefit of the carrier  ALAE, excluding Employers Liability ALAE  Unallocated Loss Adjustment Expenses (ULAE)  Penalties for any reason within the carrier’s control that accrue as benefits to the injured worker or to his or her dependents  Deductible reimbursements Refer to the PCRB’s Statistical Plan Manual for information on allocating subrogation recoveries between indemnity and medical.

25. Incurred Medical Amount

Record Type:	Quarterly
Field(s):	34
Position(s):	163-171
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	9
Format:	N 9—Amount is rounded to the nearest whole dollar; data field is to be right-justified and left zero-filled
Definition:	The Incurred Medical Amount is the total of paid-to-date and outstanding reserves as of the quarter-end valuation date. This definition is equivalent to the rules for unit statistical reporting in accordance with PCRB’s Statistical Plan Manual.
Reporting Requirement:	Report the total of medical paid-to-date and outstanding reserves as of the quarter-end valuation date. Incurred Medical Includes:  Reserves for future payments  All payments to doctors and hospitals  Drugs  Physical rehabilitation  Impartial examinations  Clinical medical  Medical loss items, such as transportation expenses associated with medical treatment  Bonuses or return-to-work incentives paid by the carrier to the medical care provider when the policy is written with contract medical  Expenses incurred for the benefit of the claimant (must be reported as either an indemnity or medical loss, depending upon the nature of the expense)  Subrogation recoveries and special fund reimbursements Incurred Medical Excludes:  Legal expenses incurred for the benefit of the carrier  Employers Liability losses  Allocated Loss Adjustment Expenses (ALAE)  Unallocated Loss Adjustment Expenses (ULAE)  Penalties for any reason within the carrier’s control that accrue as benefits to the injured worker or to his or her dependents  Deductible reimbursements Refer to the PCRB’s Statistical Plan Manual for information on allocating subrogation recoveries between indemnity and medical.

26. Indemnity Claim Code

Record Type:	Quarterly
Field(s):	43
Position(s):	220
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	1
Format:	N 1
Definition:	A code that can aid in identifying and deleting claims
Reporting Requirement:	Report the applicable code that identifies whether the claim is an applicable indemnity claim, became noncompensable or medical-only, or whether the Jurisdiction State is no longer applicable. Note: Codes 2-4 are to be used whenever a claim that was originally thought to be a compensable indemnity claim either becomes noncompensable, becomes medical-only, or the Jurisdiction State changes to a jurisdiction that is no longer applicable.

Code	Description
1	Compensable indemnity claim
2	Noncompensable indemnity claim
3	Medical-only claim
4	Jurisdiction State no longer applicable

27. Indemnity Paid-To-Date

Record Type:	Quarterly
Field(s):	31
Position(s):	136-144
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	9
Format:	N 9—Amount is rounded to the nearest whole dollar; data field is to be right-justified and left zero-filled
Definition:	The paid-to-date amount of all indemnity payments for the claim as of the quarter-end valuation date. This definition is equivalent to the rules for unit statistical reporting in accordance with PCRB’s Statistical Plan Manual.
Reporting Requirement:	Report the paid-to-date amount of all indemnity payments for the claim as of the quarter-end valuation date. Indemnity Paid-To-Date Includes:  All paid benefits for the employee’s lost wages or inability to work, including compensation paid to the deceased prior to death, burial expenses, payments to the state or to special funds, and claimant’s attorney fees  Vocational rehabilitation  Employer’s Liability losses including Allocated Loss Adjustment Expenses (ALAE)  Subrogation recoveries and special fund reimbursements  Awards  Penalties for delays in making compensation payments for reasons beyond the carrier’s control  Expenses incurred for the benefit of the claimant (must be reported as either an indemnity or medical loss depending upon the nature of the expense.  Salary in lieu of indemnity benefit payments Indemnity Paid-To-Date Excludes  Legal expenses incurred for the benefit of the carrier  ALAE, excluding Employers Liability ALAE  Unallocated Loss Adjustment Expenses (ULAE)  Penalties for any reason within the carrier’s control that accrue as benefits to the injured worker or to his or her dependents  Deductible reimbursements Refer to the PCRB’s Statistical Plan Manual for information on allocating subrogation recoveries between indemnity and medical.

28. Jurisdiction State Code

Record Type:	Quarterly and Transactional (Key)
Field(s):	8 (Quarterly) and 10 (Transactional)
Position(s):	62-63 (Quarterly) and 84-85 (Transactional)
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2
Definition:	The code that corresponds to the governing jurisdiction that would administer the claims and whose statutes will apply to the claim adjustment process. For additional details, refer to PCRB’s Statistical Plan Manual.
Reporting Requirement:	Report the code that corresponds to the state workers compensation law, employers liability law, or the federal law under which the claimants benefits are being paid. For the Transactional record, report the Jurisdiction State Code that underlies the transaction amount (i.e., benefit payable). The code could be a state jurisdiction in some instances and federal jurisdiction in others, For the Quarterly record, if the incurred losses include both state and federal benefits payable, report the Federal Jurisdiction State Code. If the claimant’s benefits are paid under a Federal Act (USL&HW Act, FELA, Jones Act, Admiralty Law, and Federal Mine Safety and Health Act), report the Transactional record and Quarterly record as Jurisdiction State Code 59. In the event that, after reporting one or more Transactional or Quarterly records to the PCRB, the Jurisdiction State for a claim changes and is no longer applicable to the Indemnity Data Call state, a new Quarterly record with the new Jurisdiction State should be submitted. No additional records, Quarterly or Transactional, would need to be reported. The Jurisdiction State may be different from the Accident State. The Jurisdiction State Code must be consistently reported across all PCRB data types for the life of the claim. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

Jurisdiction	State Code
Pennsylvania	37
Federal Act (USL&HW)	59

29. Lump-Sum Indicator

Record Type:	Transactional
Field(s):	15
Position(s):	116
Class:	Alpha (A)—Field contains only alphabetic characters
Bytes:	1
Format:	Y/N
Definition:	The code that identifies whether an indemnity lump-sum payment to the claimant has been made.
Reporting Requirement:	Report “Y” or “N” to indicate whether or not the benefit payment was made in the form of a lump sum. A “Y” represents all lump-sum payments. The Lump-Sum Indicator must be reported as “Y” when the Benefit Type Code is 49 or 79. Leave blank if unknown. Refer to the Transaction To Date section for an illustrative example of reporting Transaction To and From Dates for lump-sum payments.

Coding Values

Indicator	Description
Y	Indicates when an indemnity benefit payment to a claimant, or on the claimant’s behalf, is made in the form of a lump sum
N	Indicates when an indemnity benefit payment to a claimant, or on the claimant’s behalf, is not made in the form of a lump sum

Refer to the Transaction To Date definition in this section for an illustrative example of reporting Transaction To and From Dates for lump-sum payments.

30. Maximum Medical Improvement (MMI) Date

Record Type:	Quarterly
Field(s):	15
Position(s):	94-101
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The date after which further recovery from, or lasting improvements to, an injury or disease can no longer be anticipated based on reasonable medical probability, or as defined in the state by statute or case law.
Reporting Requirement:	This data element is a conditional field and is only required to be reported when applicable to the Quarterly record. Report the Maximum Medical Improvement (MMI) Date for those claims where permanent benefits (including lump-sum amounts) have been paid or are expected to be paid after final determination of MMI. Examples of permanent benefits include:  Permanent Total benefit (Benefit Type Code 02)  Permanent Partial benefit (Benefit Type Code 03 or 04) Zero-fill if not applicable or if MMI has not been determined as of the quarter-end valuation date.

31. Medical Extinguishment Indicator

Record Type:	Quarterly
Field(s):	29
Position(s):	134
Class:	Alpha (A)—Field contains only alphabetic characters
Bytes:	1
Format:	Y/N
Definition:	The code that indicates if future medical liabilities are extinguished based on a lump-sum settlement agreement.
Reporting Requirement:	This data element is a conditional field and is only required to be reported when a transaction with a Lump-Sum Indicator equal to “Y” has been reported as of the quarter-end valuation date and the Type of Settlement—Loss Condition Code is not equal to 00. When applicable, report “Y” or “N” to indicate whether medical liabilities are extinguished based on a lump-sum settlement agreement. This flag should be set to “Y” if there has been at least one lump sum settlement of benefits for the claim and the insurer has a reasonable explanation that it will not be obligated to make any further medical payments on the claim. In particular, if a medical settlement is made for a particular injury and, at the time of settlement, no other injuries to the claimant are known, this flag should be set to “Y.” Report “N” only when there has been a lump-sum settlement made and medical payments are still ongoing. Leave blank if unknown or not applicable. Note: Do not report N when medical benefits have not been extinguished; in this case, leave the field blank. Only report N when there has been a lump-sum settlement made and medical payments are still ongoing.
Example:	Reporting a Medical Extinguishment Indicator when medical payments are extinguished by a lump-sum settlement and subsequently reinstated An injured worker receives a permanent impairment rating, and the claim is settled by a full and final lump-sum agreement. This settlement includes the permanent impairment award and all expected future medical costs. Subsequently, the injured worker’s condition unexpectedly deteriorates and requires additional medical treatment. Regardless of whether the insurer makes additional payments for medical care after the settlement agreement, the Medical Extinguishment Indicator code should be set to “Y” because the lump-sum settlement included all further medical payments that the insurer reasonably expected.

Indicator	Description
Y	Medical payments are extinguished by a lump-sum settlement
N	Medical payments are not extinguished by a lump-sum settlement

32. Medical Paid-To-Date

Record Type:	Quarterly
Field(s):	32
Position(s):	145-153
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	9
Format:	N 9—Amount is rounded to the nearest whole dollar; data field is to be right-justified and left zero-filled
Definition:	The paid-to-date of all medical payments for the claim as of the quarter-end valuation date. This definition is equivalent to the rules for unit statistical reporting in accordance with the PCRB’s Statistical Plan Manual.
Reporting Requirement:	Report the paid-to-date amount of all medical payments for the claim as of the quarter-end valuation date. Medical Paid-To-Date Includes:  All payments to doctors and hospitals  Drugs  Physical rehabilitation  Impartial examinations  Clinical medical  Medical loss items, such as transportation expenses associated with medical treatment  Bonuses or return-to-work incentives paid by the carrier to the medical care provider when the policy is written with contract medical  Expenses incurred for the benefit of the claimant (must be reported as either an indemnity or medical loss depending upon the nature of the expense)  Subrogation recoveries and special fund reimbursements Medical Paid-To-Date Excludes:  Legal expenses incurred for the benefit of the carrier  Employers Liability losses  Allocated Loss Adjustment Expenses (ALAE)  Unallocated Loss Adjustment Expenses (ULAE)  Penalties for any reason within the carrier’s control that accrue as benefits to the injured worker or to his or her dependents  Deductible reimbursements Refer to the PCRB’s Statistical Plan Manual for information on allocating subrogation recoveries between indemnity and medical.

33. Method of Determining Pre-Injury/Average Weekly Wage Code

Record Type:	Quarterly
Field(s):	19
Position(s):	113
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	1
Format:	N 1
Definition:	The code that corresponds to the method used to determine the Pre-Injury/Average Weekly Wage.
Reporting Requirement:	Report the code that corresponds to the method used to determine the Pre-Injury/Average Weekly Wage Amount. Zero-fill if unknown. Refer to the Pre-Injury/Average Weekly Wage Amount section for examples

Code	Method	Description
1	Actual/Estimated Wage	When the claimant’s actual average weekly wage is known, report the actual wage amount in the Pre-Injury/Average Weekly Wage Amount. Also includes wages that have been estimated for the purpose of determining benefits; for example, wages reported on a first report of injury form.
2	Minimum Weekly Benefit	When the claimant’s average weekly wage is not known but is below the wage required by statute for receiving minimum benefits, report the wage required for the minimum weekly benefit in the Pre-Injury/Average Weekly Wage Amount.
3	Maximum Weekly Benefit	When the claimant’s actual average weekly wage is not known but is above the wage required by statute for receiving benefits, report the wage required for the maximum weekly benefit in the Pre-Injury/Average Weekly Wage Amount.

Refer to the Pre-Injury/Average Weekly Wage Amount section for examples

34. Nature of Injury Code—Injury Description

Record Type:	Quarterly
Field(s):	25
Position(s):	126-127
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2
Definition:	The code that corresponds to the nature of the injury sustained by the claimant.
Reporting Requirement:	Report the code that corresponds to the nature of the injury sustained by the claimant. For additional details, refer to PCRB's Statistical Plan Manual. This code must be reported consistently between Indemnity data and Unit Statistical data. Zero-fill if unknown.

Code	Narrative Description
I. Specific Injury	*
01. No Physical Injury	i.e., Glasses, contact lenses, artificial appliance, replacement of artificial appliance
02. Amputation	Cut off extremity, digit, protruding part of body, usually by surgery, i.e. leg, arm
03. Angina Pectoris	Chest pain
04. Burn	(Heat) Burns or scald. The effect of contact with hot substances. (Chemical) burns. tissue damage resulting from the corrosive action chemicals, fume, etc., (acids, alkalies)
07. Concussion	Brain, cerebral
10. Contusion	Bruise - intact skin surface hematoma
13. Crushing	To grind, pound or break into small bits
16. Dislocation	Pinched nerve, slipped/ruptured disc, herniated disc, sciatica, complete tear, HNP subluxation, MD dislocation
19. Electric Shock	Electrocution
22. Enucleation	Removal of organ or tumor
25. Foreign Body	*
28. Fracture	Breaking of a bone or cartilage
30. Freezing	Frostbite and other effects of exposure to low temperature
31. Hearing Loss or Impairment	Traumatic only. A separate injury, not the sequelae of another injury
32. Heat Prostration	Heat stroke, sun stroke, heat exhaustion, heat cramps and other effects of environmental heat. Does not include sunburn
34. Hernia	The abnormal protrusion of an organ or part through the containing wall of its cavity
36. Infection	The invasion of a host by organisms such as bacteria, fungi, viruses, mold, protozoa or insects, with or without manifest disease.
37. Inflammation	The reaction of tissue to injury characterized clinically by heat, swelling, redness and pain
38. Adverse reaction to a vaccination or inoculation.	*
40. Laceration	Cut, scratches, abrasions, superficial wounds, calluses. wound by tearing
41. Myocardial Infarction	Heart attack, heart conditions, hypertension. The inadequate blood flow to the muscular tissue of the heart.
42. Poisoning - General (Not OD or Cumulative Injury)	A systemic morbid condition resulting from the inhalation, ingestion, or skin absorption of a toxic substance affecting the metabolic system, the nervous system, the circulatory system, the digestive system, the respiratory system, the excretory system, the musculoskeletal system, etc. includes chemical or drug poisoning, metal poisoning, organic diseases, and venomous reptile and insect bites. Does not include effects of radiation, pneumoconiosis, corrosive effects of chemicals; skin surface irritations, septicemia or infected wounds.
43. Puncture	A hole made by the piercing of a pointed instrument
46. Rupture	*
47. Severance	To separate, divide or take off
49. Sprain or Tear	Internal derangement, a trauma or wrenching of a joint, producing pain and disability depending upon degree of injury to ligaments.
52. Strain or Tear	Internal derangement, the trauma to the muscle or the musculotendinous unit from violent contraction or excessive forcible stretch.
53. Syncope	Swooning, fainting, passing out, no other injury
54. Asphyxiation	Strangulation, drowning
55. Vascular	Cerebrovascular and other conditions of circulatory systems, NOC, exclude heart and hemorrhoids. Includes: strokes, varicose veins - non toxic
58. Vision Loss	*
59. All Other Specific Injuries, NOC	*
II. Occupational Disease or Cumulative Injury	*
60. Dust Disease, NOC	All other pneumoconiosis
61. Asbestosis	Lung disease, a form of pneumoconiosis, resulting from protracted inhalation of asbestos particles.
62. Black Lung	The chronic lung disease or pneumoconiosis found in coal miners
63. Byssinosis	Pneumoconiosis of cotton, flax and hemp workers
64. Silicosis	Pneumoconiosis resulting from inhalation of silica (quartz) dust.
65. Respiratory Disorders	Gases, fumes, chemicals, etc.
66. Poisoning - Chemical, (Other Than Metals)	Man made or organic
67. Poisoning - Metal	Man made
68. Dermatitis	Rash, skin or tissue inflammation including boils, etc., generally resulting from direct contact with irritants or sensitizing chemicals such as drugs, oils, biologic agents, plants, woods or metals which may be in the form of solids, pastes, liquids or vapors and which may be contacted in the pure state or in compounds or in combination with other materials. do not include skin tissue damage resulting from corrosive action of chemicals, burns from contact with hot substances, effects of exposure to radiation, effects of exposure to low temperatures or inflammation or irritation resulting from friction or impact
69. Mental Disorder	A clinically significant behavioral or psychological syndrome or pattern typically associated with either a distressing symptom or impairment of function. i.e., acute anxiety, neurosis, stress, non-toxic depression
70. Radiation	All forms of damage to tissue, bones or body fluids produced by exposure to radiation
71. All Other Occupational Disease Injury, NOC	*
72. Loss of Hearing	*
73. Contagious Disease	*
74. Cancer	*
75. AIDS	*
76. VDT - Related Diseases	Video display terminal diseases other than carpal tunnel syndrome
77. Mental Stress	*
78. Carpal Tunnel Syndrome	Soreness, tenderness and weakness of the muscles of the thumb caused by pressure on the median nerve at
79. Hepatitis C
80. All Other Cumulative Injury, NOC	the point at which it goes through the carpal tunnel of the wrist
83. COVID-19	Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a coronavirus.
III. Multiple Injuries	*
90. Multiple Physical Injuries Only	*
91. Multiple Injuries Including Both Physical and Psychological	*

35. Number of Dependents

Record Type:	Quarterly
Field(s):	41
Position(s):	216-217
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2—Data field is to be right-justified and left zero-filled
Definition:	The number of dependents the injured worker has at the time of the injury
Reporting Requirement:	Report the number of dependents eligible to receive compensation at time of injury. Note: Report a value of 00 through 20. If more than 20 dependents, then report 20.

36. Part of Body Code—Injury Description

Record Type:	Quarterly
Field(s):	24
Position(s):	124-125
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2
Definition:	The code that corresponds to the part of the claimant’s body that sustained the injury. For additional details, refer to PCRB’s Statistical Plan Manual.
Reporting Requirement:	Report the Part of Body Code that identifies the specific body part affected by the injury that is the most significant contributor to the expected overall cost of the claim. Part of Body Code changes (excluding Part of Body Code 65) are considered loss development and are reported on a going-forward basis. When the specific body part affected by the injury cannot be determined, Part of Body Code 65 (Insufficient Information to Properly Identify—Unclassified) must be reported. When the specific Part of Body Code is determined subsequently, report the appropriate Part of Body Code in the next Quarterly reporting. This code must be reported consistently between Indemnity data and Unit Statistical data. Report Code 65 (Insufficient Information to Properly Identify—Unclassified) if unknown.

Code	Narrative Description
I. Head	*
10. Multiple Head Injury	Any combination of below parts
11. Skull	*
12. Brain	*
13. Ear(s)	Includes: hearing, inside eardrum
14. Eye(s)	Includes: optic nerves, vision, eye lids
15. Nose	Includes: nasal passage, sinus, sense of smell
16. Teeth	*
17. Mouth	Includes: lips, tongue, throat, taste
18. Soft Tissue	*
19. Facial Bones	Includes: jaw
II. Neck	*
20. Multiple Neck Injury	Any combination of below parts
21. Vertebrae	Includes: spinal column bone, “cervical segment”
22. Disc	Includes: spinal column cartilage, “cervical segment”
23. Spinal Cord	Includes: nerve tissue, “cervical segment”
24. Larynx	Includes: cartilage and vocal cords
25. Soft Tissue	Other than larynx or trachea
26. Trachea	*
III. Upper Extremities
30. Multiple Upper Extremities	Any combination of below parts, excluding hands and wrists combined
31. Upper Arm	Humerus and corresponding muscles, excluding clavicle and scapula
32. Elbow	Radial head
33. Lower Arm	Forearm – radius, ulna and corresponding muscles
34. Wrist	Carpals and corresponding muscles
35. Hand	Metacarpals and corresponding muscles – excluding wrist or fingers
36. Finger(s)	Other than thumb and corresponding muscles
37. Thumb	*
38. Shoulder(s)	Armpit, rotator cuff, trapezius, clavicle, scapula
39. Wrist (s) & Hand(s)	*
IV. Trunk
40. Multiple Trunk	Any combination of below parts
41. Upper Back Area	(Thoracic Area) Upper back muscles, excluding, vertebrae, disc, spinal cord
42. Lower Back Area	(Lumbar Area and Lumbo Sacral) Lower back muscles, excluding sacrum, coccyx, pelvis, vertebrae, disc, spinal cord
43. Disc	Spinal column cartilage other than cervical segment
44. Chest	Including ribs, sternum, soft tissue
45. Sacrum and Coccyx	Final nine vertebrae-fused
46. Pelvis	*
47. Spinal Cord	Nerve tissue other than cervical segment
48. Internal Organs	Other than heart and lungs
49. Heart	*
60. Lungs	*
61. Abdomen Including Groin	Excluding injury to internal organs
62. Buttocks	Soft tissue
63. Lumbar & or Sacral Vertebrae	Bone portion of the spinal column
V. Lower Extremities	*
50. Multiple Lower Extremities	Any combination of below parts
51. Hip	*
52. Upper Leg	Femur and corresponding muscles
53. Knee	Patella
54. Lower Leg	Tibia, fibula and corresponding muscles
55. Ankle	Tarsals
56. Foot	Metatarsals, heel, Achilles tendon and corresponding muscles – excluding ankle or toes
57. Toes	*
58. Great Toe	*
VI. Multiple Body Parts	*
64. Artificial Appliance	Braces, etc.
65. Insufficient Info to Properly Identify – Unclassified	Insufficient information to identify part affected
66. No Physical Injury	Mental disorder
90. Multiple Body Parts (Including Body Systems & Body Parts)	Applies when more than one body part has been affected, such as an arm and a leg and multiple internal organs.
91. Body Systems and Multiple Body Systems	Applies to the functioning of an entire body system has been affected without specific injury to any other part, as in the case of poisoning, corrosive action, inflammation, affecting internal organs, damage to nerve centers, etc., does not apply when the systemic damage results from an external injury affecting an external part such as a back injury which includes damage to the nerves of the spinal cord.
99. Whole Body	A code referencing the anatomic classification of the injury.

37. Police Effective Date

Record Type:	Quarterly (Key), Transactional (Key), and Key Field Change
Field(s):	5 (Quarterly), 7 (Transactional), and 9 (Key Field Change)
Position(s):	34-41 (Quarterly), 56-63 (Transactional), and 77-84 (Key Field Change)
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The date that the policy under which the claim occurred became effective.
Reporting Requirement:	Report the effective date that corresponds to the date shown on the policy. The Policy Effective Date reported must be before, or the same as, the Accident Date. The Policy Effective Date must be before the quarter-end valuation date as determined by the Reporting Quarter and Reporting Year found in the File Control Record. The Policy Effective Date must be consistently reported across all NCCI data types for the life of the policy. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

38. Policy Number Identifier

Record Type:	Quarterly (Key), Transactional (Key), and Key Field Change
Field(s):	4 (Quarterly), 6 (Transactional), and 8 (Key Field Change)
Position(s):	16-33 (Quarterly), 38-55 (Transactional), and 59-76 (Key Field Change)
Class:	Alphanumeric (AN)—Field contains alphabetic and numeric characters
Bytes:	18
Format:	A/N 18—Letters A–Z and numbers 0–9 only (if the Policy Number Identifier is less than 18 bytes, this field must be left-justified and have blanks in all spaces to the right of the last character)
Definition:	The unique set of numbers and/or letters that identify the policy under which the claim occurred.
Reporting Requirement:	Report the unique set of numbers and/or letters that identify the policy under which the claim occurred. The Policy Number Identifier must be consistently reported across all NCCI data types for the life of the policy. The policy number identifier can neither be all zeros nor all blanks nor a combination of zeros and blanks. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

39. Pre-Existing Disability Percentage (For Federal Act Coverages Only)

Record Type:	Quarterly
Field(s):	23
Position(s):	121-123
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	3
Format:	N 3—Data field is to be right-justified and left zero-filled; enter the percentage as a whole number with a leading zero or zeros. Percentage is rounded to the nearest whole number (for example, 48.4% is reported as 048 and 48.5% is reported as 049).
Definition:	The pre-existing disability percentage that directly affects the amount of benefits payable and is contemplated in the determination of a claimant’s permanent disability benefits (i.e., compensation is reduced to reflect a pre-existing impairment or disability).
Reporting Requirement:	This data element is a conditional field and is only required to be reported when applicable to the Quarterly record. Report the percentage of the pre-existing disability when it directly impacts the disability rating for the claim. Zero-fill if not applicable. The Pre-Existing Disability Percentage field is to be reported on a whole-body basis.
Example: Reporting a Pre-Existing Disability Percentage (Disability/LOEC Basis)	An injured worker has a 12% permanent disability rating due to a compensable lower-back injury. However, the jurisdiction allows for the explicit reduction for pre-existing conditions in determining the compensation payable, and the claimant has a pre-existing lumbar degenerative joint disease which contributed to the compensable lower-back injury. If the physician determines that 4% of the permanent disability was due to the pre-existing condition, the permanent disability award would be based on the remaining disability rating of 8% (12% – 4% = 8%). The resulting quarterly fields would be reported as follows:  Disability/LOEC Percentage = 008  Pre-Existing Disability Percentage = 004

40. Pre-Injury/Average Weekly Wage Amount

Record Type:	Quarterly
Field(s):	37
Position(s):	190-194
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	5
Format:	N 5—Amount is rounded to the nearest whole dollar; data field is to be right-justified and left zero-filled; if greater than $99,999, report 99999
Definition:	The average weekly wage of the claimant or deceased worker prior to injury, as defined by state or federal law.
Reporting Requirement:	Report the pre-injury average weekly wage of the claimant or deceased worker computed in accordance with statutes and rules of the applicable jurisdiction. Zero-fill if unknown. This field should be reported in conjunction with the Method of Determining Pre-Injury/Average Weekly Wage Code.
Example:	Reporting the Pre-Injury/Average Weekly Wage when actual wages are known: An executive officer sustains a compensable workplace injury. The annual wage of the executive officer is $300,000. Per the statuses in the applicable jurisdiction, this is converted to a weekly wage by multiplying $300,000 by (1/52) which results in a weekly wage of $5,769. The resulting quarterly fields would be reported as follows: • Pre-Injury/Average Weekly Wage Amount = 05769 • Method of Determining Pre-Injury/Average Weekly Wage = 1 (Actual Wage) Note: Even if weekly benefits are limited by the statutory maximum weekly benefit, the actual wages should be reported if know. Reporting the Pre-Injury/Average Weekly Wage when actual wages are unknown: An executive officer sustains a compensable workplace injury. The average weekly wage of the executive officer is unknown, but it is assumed to exceed the wage required for the maximum weekly benefit. If the rate of compensation is 66 2/3% of the injured worker’s pre-injury average weekly wage, limited to a statutory maximum weekly benefit of $800, then the resulting quarterly fields would be reported as follows: • Pre-Injury/Average Weekly Wage Amount = 01200 ($800 / 66 2/3% = 1200) • Method of Determining Pre-Injury/Average Weekly Wage = 3 (Maximum Weekly Benefit)

41. Previous Accident Date

Record Type:	Key Field Change
Field(s):	6
Position(s):	46-53
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The previously reported Accident Date of the record being changed by the Key Field Change record. The Accident Date is the year, month, and day on which the injury occurred.
Reporting Requirement:	Report the previously reported Accident Date whether it is being changed by the Key Field Change record or not. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

42. Previous Carrier Code

Record Type:	Key Field Change
Field(s):	2
Position(s):	3-7
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	5
Format:	N 5
Definition:	The previously reported Carrier Code (assigned to the carrier by NCCI) of the record being changed by the Key Field Change Record
Reporting Requirement:	Report the previously reported Carrier Code whether it is being changed by the Key Field Change record or not. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

43. Previous Claim Number Identifier

Record Type:	Key Field Change
Field(s):	5
Position(s):	34-45
Class:	Alphanumeric (AN)—Field contains alphabetic and numeric characters
Bytes:	12
Format:	AN 12—Letters A-Z and numbers 0-9 only (If the Claim Number Identifier is less than 12 bytes, this field must be left-justified and have blanks in all spaces to the right of the last character)
Definition:	The previously reported Claim Number Identifier of the record being changed by the Key Field Change Record. The Claim Number Identifier is the unique set of numbers and/or letters that identify the specific claim that the report/transaction applies to.
Reporting Requirement:	Report the previously reported Claim Number Identifier whether it is being changed by the Key Field Change record or not. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

44. Previous Policy Effective Date

Record Type:	Key Field Change
Field(s):	4
Position(s):	26-33
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The previously reported Policy Effective Date of the record being changed by the Key Field Change record. The Policy Effective Date is the date that the policy under which the claim occurred became effective.
Reporting Requirement:	Report the previously reported Policy Effective Date whether it is being changed by the Key Field Change record or not. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

45. Previous Policy Number Identifier

Record Type:	Key Field Change
Field(s):	3
Position(s):	8-25
Class:	Alphanumeric (AN)—Field contains alphabetic and numeric characters
Bytes:	18
Format:	AN 18—Letters A-Z and numbers 0-9 only (If the Policy Number Identifier is less than 18 bytes, this field must be left-justified and have blanks in all spaces to the right of the last character)
Definition:	The previously reported Policy Number Identifier of the record being changed by the Key Field Change record. The Policy Number Identifier is the unique set of numbers and/or letters that identify the policy under which the claim occurred.
Reporting Requirement:	Report the previously reported Policy Number Identifier whether it is being changed by the Key Field Change record or not. Refer to Section II—Indemnity Data Call Structure for more information on the consistent reporting of multi-data type fields.

46. Record Total

Record Type:	File Control
Field(s):	9
Position(s):	58-68
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	11
Format:	N 11
Definition:	The total number of records (Transactional, Quarterly, or Key Field Change records) in the file.
Reporting Requirement:	Report the total number of records in the file, excluding the File Control Record. Note: Blank rows will be removed during processing and not counted. If blank rows are included in the Record Total, the file will appear out of balance and reject.

47. Record Type Code

Record Type:	Quarterly, Transactional (Processing), Key Field Change, and File Control Record
Field(s):	1 (Quarterly), 1 (Transactional), 1 (Key Field Change) and 1 (File Control Record)
Position(s):	1–2 (Quarterly), 1–2 (Transactional), 1-2 (Key Field Change), and 1–2 (File Control Record)
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2
Definition:	The code that identifies the record being submitted as a Transactional, Quarterly, Key Field Change, or File Control record.
Reporting Requirement:	Report the code that identifies the record being submitted as a Quarterly, Transactional, Key Field Change or File Control Record.

Coding Values

Code	Description
1	Transactional
2	Quarterly
3	File Control
4	Key Field Change

48. Reopen Date

Record Type:	Quarterly
Field(s):	14
Position(s):	86-93
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The date a claim is reopened as defined by the carrier.
Reporting Requirement:	This data element is a conditional field and is only required to be reported when applicable to the Quarterly record. When applicable, report the date that a closed claim was last reopened for additional benefits. Payments made after the closing date that purely reflect adjustments or modifications to prior benefit paid amounts would not be considered a claim reopening. When a claim closes again, leave the Reopen Date field filled with the most recent Reopen Date and update the Closing Date field accordingly. Refer to the Closing Date section for an example of how the Closing Date and Reopen Date are used to derive claim status.

49. Reported to Insurer Date

Record Type:	Quarterly
Field(s):	16
Position(s):	102-109
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The date that a claim was originally reported by the insured.
Reporting Requirement:	Report the date that the claim was originally reported to the insurer. If the claim is first reported to a third-party claim administrator, then this is the Reported To Insurer Date. The Reported To Insurer Date must be on or after the Accident Date. Zero-fill if unknown.

50. Reporting Quarter Code

Record Type:	File Control
Field(s):	4
Position(s):	9
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	1
Format:	N 1
Definition:	The code that corresponds to the quarter when the claim activity being reported occurred.
Reporting Requirement:	Report the code that corresponds to the quarter using the code values below. Note: Only one quarter’s worth of records can be submitted per file.

Coding Values

Code	Description
1	First Quarter
2	Second Quarter
3	Third Quarter
4	Fourth Quarter

51. Reporting Year

Record Type:	File Control
Field(s):	5
Position(s):	10-13
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	4
Format:	CCYY
Definition:	The code that identifies the year in which the payments or claim changes occurred.
Reporting Requirement:	Report the year in which the payments or claim changes occurred.

52. Return to Work Date

Record Type:	Quarterly
Field(s):	39
Position(s):	199-206
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The date of the claimant's most recent return to work.
Reporting Requirement:	Report the most recent date on which the claimant returned to work.

53. Submission Date

Record Type:	File Control
Field(s):	7
Position(s):	44-51
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The date that the file was generated and/or submitted.
Reporting Requirement:	Report the date that the file was generated and/or submitted. For files containing Quarterly records, the submission date must be greater than the Quarterly records valuation date.

54. Submission File Identifier

Record Type:	File Control
Field(s):	6
Position(s):	14-43
Class:	Alphanumeric (AN)—Field contains alphabetic and numeric characters
Bytes:	30
Format:	A/N 30—Letters A–Z and numbers 0–9 only (if the Submission File Identifier is less than 30 bytes, this field must be left-justified and have blanks in all spaces to the right of the last character)
Definition:	A unique identifier created by the data provider that is used to distinguish the file being submitted from previously submitted files.
Reporting Requirement:	Report the unique identifier created by the data provider to distinguish the file being submitted from previously submitted files.

55. Submission File Type Code

Record Type:	File Control
Field(s):	2
Position(s):	3
Class:	Alpha (A)—Field contains only alphabetic characters
Bytes:	1
Format:	A 1
Definition:	The code that identifies the type of file being submitted. Note: All Key Field Change files must be reported as "O" (Original). Replacement files are not allowed for Key Field Change files.
Reporting Requirement:	Report the unique identifier created by the data provider to distinguish the file being submitted from previously submitted files.

Coding Values

Code	Description
O	Original
R	Replacement

56. Submission Time

Record Type:	File Control
Field(s):	6
Position(s):	52-57
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	6
Format:	HHMMSS (HH = Hours, MM = Minutes, SS = Seconds)
Definition:	The time that the file was generated noted in military time.
Reporting Requirement:	Report the time that the file was generated in military time.

57. Temporary Disability Benefit Extinguishment Code

Record Type:	Quarterly
Field(s):	30
Position(s):	135
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	1
Format:	N 1
Definition:	The code that corresponds to the reason why temporary disability benefits were terminated.
Reporting Requirement:	Report the code that corresponds to the reason why temporary disability benefits were terminated. If temporary benefits are still being paid or this is not applicable (e.g. the claimant died from injuries and only death benefits have been paid), report zero. If benefits are reinstated at a later date (i.e., a future quarter), the value reported in this field should be reported as zero for the quarter in which benefits are reinstated and in all subsequent quarterly reports until such benefits are once again extinguished. Switching from Temporary Total Disability to Temporary Partial Disability (or vice versa) would not result in the reporting of this data element, only when both temporary disability benefit types are extinguished would this field be required to be reported. When multiple codes apply, report the lowest in the hierarchy. If temporary benefits are terminated because an injured worker is released to return to work, but the worker does not actually resume employment, report Temporary Disability Extinguishment Code 2. When multiple codes apply, report the lowest in the hierarchy. Zero-fill if unknown.

Example: An injured worker reaches MMI and is released to return to work on 7/1/2018. On 7/14/2018, the injured worker returns to work.

• If RTW is used to terminate temporary benefits on 7/14/2018, report Temporary Disability Benefit Extinguishment Code 1 (RTW).
• If release to return to work is used to terminate temporary benefits on 7/1/2018, report Temporary Disability Benefit Extinguishment Code 2 (Release RTW).
• If MMI is used to terminate temporary benefits on 7/1/2018, report Temporary Disability Benefit Extinguishment Code 3 (MMI).
• If the earliest of RTW, Release to RTW and MMI are used, based on statutory requirements, to terminate temporary benefits on 7/1/2018, two benefit codes would apply. When two codes apply, use the lowest code value of the hierarchy. In this case, report Temporary Disability Benefit Extinguishment Code 2 (Release RTW) and not Code 3 (MMI).

Coding Values

Code	Description	Hierarchy	Applicable in PA
1	Return to Work (RTW)	1	Yes
2	Release RTW	2	Yes
3	Maximum Medical Improvement (MMI)	3	Yes
4	Maximum Statutory Duration	4	Yes
5	Medical Noncompliance (e.g., missed medical appointments or refusal to be examined)	5	Yes
6	Other	6	Yes

58. Transaction Amount

Record Type:	Transactional
Field(s):	13
Position(s):	102-113
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	12
Format:	N 12—Amount includes dollars and cents and may represent a positive or negative transaction amount
Definition:	The amount of the financial transaction being submitted
Reporting Requirement:	Report the amount of the financial transaction being submitted. The amount reported includes dollars and cents and may represent a positive or negative transaction amount. If a negative transaction amount is reported (e.g., to correct overpayments by using Option 2, see Section V—Reporting Requirements), the negative (–) sign must be reported in position 102 prior to the transaction amount. This field must be right-justified and left zero-filled. There is an implied decimal between positions 111 and 112. If the reported amount does not include digits after the decimal, add 00 to the right of the reported amount. Reporting examples:  $123.45 is reported as 000000012345  Negative (-) $123.45 is reported as -00000012345  $123 is reported as 000000012300 If the claimant’s wage is being garnished for any reason, e.g., spousal support or child support, the portion being garnished will need to be reported to PCRB using the same Key Fields and Benefit Type Code as the portion being paid to the claimant. The Transaction Amount will represent the garnished amount. Note: Benefit Type Codes 30 and 31 must be reported as positive amounts.

59. Transaction Code

Record Type:	Transactional (Processing)
Field(s):	2
Position(s):	3-4
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2—Data field is to be right-justified and left zero-filled.
Definition:	The code that identifies the type of transaction being submitted (e.g., Original, Cancellation/Void, or Replacement). Zero-fill if unknown.
Reporting Requirement:	Report the code that identifies the type of transaction of the record being submitted. This code should always be reported as 01 (Original) if you are not reporting the Transaction Identifier.

Coding Values

Code	Description
1	Original
2	Cancellation/Void
3	Replacement

60. Transaction Date

Record Type:	Quarterly and Transactional (Processing)
Field(s):	2 (Quarterly) and 3 (Transactional)
Position(s):	3-10 (Quarterly) and 5-12 (Transactional)
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	Transactional Record: The date that the payment (check) was made or the recovery received. Quarterly record: The date that the transaction was established by the source system of the claim administrator or the date that the Quarterly record was created.
Reporting Requirement:	The Transaction Date must be reported as follows: Transactional record—Report the date that the payment (check) was made or the recovery received. In the case of a cancellation or replacement, the Transaction Date would reflect the date the changes were made to the source system. Quarterly record—The date the record was created. The Transaction Date cannot be prior to the valuation date for the quarter.

61. Transaction From Date

Record Type:	Transactional
Field(s):	11
Position(s):	86-93
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The first date of the uninterrupted period corresponding to the paid indemnity amount for a particular Benefit Type Code.
Reporting Requirement:	Report the first date of the uninterrupted period corresponding to the paid indemnity amount for a particular Benefit Type Code. The Transaction From Date represents the first day of the specific period of the transaction. For example, if a data provider is paying Temporary Total Disability (TTD) benefit payments every two weeks, the Transaction From Date for these periodic payments would be the first day of the specific two-week period. Refer to the Transaction To Date section below for an example. Zero-fill if unknown.

62. Transaction Identifier

Record Type:	Transactional (Processing)
Field(s):	4
Position(s):	13-32
Class:	Alphanumeric (AN)—Field contains alphabetic and numeric characters
Bytes:	20
Format:	A/N 20—Letters A–Z and numbers 0–9 only (if the Transaction Identifier is less than 20 bytes, this field must be left-justified and have blanks in all spaces to the right of the last character)
Definition:	The Transaction Identifier is a unique identifier created by the data provider when using Option 1. It is a unique alphanumeric identifier for each transaction within a claim.
Reporting Requirement:	The Transaction Identifier is reported as follows:  Option 1—Data providers reporting a Transaction Identifier for all Original transactions are able to report corresponding Cancellation and Replacement records. The Transaction Identifier must be unique for each transaction for a claim. • Example 1: Because the field is 20 bytes and alphanumeric, the data provider can create unique Transaction Identifiers so that no two transactions for a claim will ever have the same identifier. • Example 2: For each claimant, every Transaction Identifier is different but the identifiers are reusable; i.e., for every claim the identifier for the first transaction is 00000000000000000001, the second is 00000000000000000002, etc.  Option 2—This option does not use the Transaction Identifier or the Cancellation and Replacement Transaction Codes; rather, it requires the data provider to report multiple Original records to allow DCRB to correctly process the changes to previously reported transactions. The Transaction Identifier should be left blank for this option. Refer to Section V—Reporting Rules of this manual for examples on how the Transactional Identifier is used to report a cancelled or replaced transaction.

63. Transaction To Date

Record Type:	Transactional
Field(s):	12
Position(s):	94-101
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	8
Format:	CCYYMMDD
Definition:	The last date of the uninterrupted period corresponding to the paid indemnity amount for a particular Benefit Type Code.
Reporting Requirement:	Report the last date of the uninterrupted period corresponding to the paid indemnity amount for a particular Benefit Type Code. The Transaction To Date represents the last day of the specific period of the transaction. For example, if a data provider is paying Temporary Total Disability (TTD) benefit payments every two weeks, the Transaction To Date for these periodic payments would be the last day of the specific two-week period. Zero-fill if the Transaction To Date is not available. If the payment represents a single day, then the Transaction From and To Dates will be the same.

Example 1: Reporting Transaction To and From Dates for a lump-sum payment

An injured worker reaches maximum medical improvement (MMI) and receives a permanent impairment rating on March 30, 2020. The insurer makes a lump-sum payment of $54,600 on April 1, 2020, to settle the claim. If the lump-sum payment is based on 104 weeks for which benefits are payable post-MMI (i.e., the time period from March 30, 2020, to March 30, 2022), then the resulting transactional fields would be reported as follows:

• Lump-Sum Indicator = Y
• Transaction Amount = 00005460000
• Transaction Date = 20200401
• Transaction From Date = 20200330
• Transaction To Date = 20220330

If the lump-sum payment is not based on a specific number of weeks for which benefits are payable, then the Transaction From Date and the Transaction To Date should have the same value as the Transaction Date (i.e., the date that the lump-sum payment was made).

Example 2: Reporting Transaction To and From Dates for vocational rehabilitation—education benefit costs

An injured worker, who is participating in a vocational rehabilitation program, attends a six-week job retraining course January 6, 2020, to February 18, 2020. The cost of this course, including tuition, books, and tools, is $5,000. The insurer pays for the cost of this rehabilitation program up-front on January 1, 2020. The resulting transactional fields would be reported as follows:

• Benefit Type Code = 61 (Vocational Rehabilitation—Education Benefit Costs)
• Transaction Amount = 000000500000
• Transaction Date = 20200101
• Transaction From Date = 20200106
• Transaction To Date = 20200218

Example 3: Reporting Transaction To and From Dates for Noncontinuous Payments

An injured worker reaches maximum medical improvement (MMI) and receives a permanent impairment rating on August 12, 2020. The insurer makes a payment of $1,180 on August 21, 2020, to cover the following noncontinuous payments:

• $480 to cover 3 days of Temporary Total Disability benefits before MMI was established (August 10-12)
• $200 to cover 2 days of unscheduled Permanent Partial Disability benefits after MMI was established (August 13-14)
• $500 to cover 1 week of unscheduled Permanent Partial Disability benefits the week after MMI was established (August 17-21)

If the insurer’s payment system captures the details related to each specific periodic payment underlying the noncontinuous payment, each specific period payment would be reported with a separate transaction. The resulting transactional fields would be reported as follows:

Transactional Field	3 days of Temporary Total Disability (TTD)	2 days of Permanent Partial Disability	1 week of Permanent Partial Disability
Benefit Type Code
Lump-Sum Indicator	N	N	N
Transaction Amount	48000	20000	50000
Transaction Date	20200821	20200821	20200821
Transaction From Date	20200810	20200813	20200817
Transaction To Date	20200812	20200814	20200821

If the insurer’s payment system does not capture the details related to each specific periodic payment underlying the noncontinuous payment, then one transaction would be reported. The resulting transactional fields would be reported as follows:

• Lump Sum Indicator = Y
• Benefit Type Code = 79 (Lump Sum Including Multiple Indemnity)
• Transaction Amount = 00000118000
• Transaction Date = 20200821
• Transaction From Date = 20200810
• Transaction To Date = 20200821

64. Type of Settlement—Loss Condition Code

Record Type:	Quarterly
Field(s):	28
Position(s):	132-133
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	2
Format:	N 2—Data field is to be right-justified and left zero-filled
Definition:	The code that identifies the type of claim settlement, if applicable. For additional details, refer to PCRB’s Statistical Plan Manual
Reporting Requirement:	Report the code that identifies the type of claim settlement, if applicable. Zero-fill if unknown.

Coding Values

Code	Type of Settlement	Description
0	Claim Not Subject to Settlement	The claim does not involve a settlement.
3	Stipulated Award (Data Provider/Claimant Settlement)	An award that has been agreed to between the carrier and claimant and submitted for approval to the applicable state workers compensation.
4	Findings and Award (Judicial Award)	An award that has been issued by a judge based on evidence presented in the process of litigation.
5	Dismissal or Take Nothing (Noncompensable)	The claim meets one or more of the following: Official ruling denying benefits Claimant’s failure to file for benefits Claimant’s failure to prosecute claim following carrier’s denial of the claim
6	Compromise Settlement	Compromise and release. A settlement over the issues of applicability, extent of injury, and future benefits.
9	All Other Settlements	The claim involves a settlement other than Codes 03-06. This code can also be used when it is known that the claim involves a settlement, but the type of settlement is not known.

65. Weekly Benefit Amount

Record Type:	Transactional
Field(s):	18
Position(s):	129-137
Class:	Numeric (N)—Field contains only numeric characters
Bytes:	9
Format:	N 9—Amount includes dollars and cents; data field is to be right-justified and left zero-filled
Definition:	The weekly benefit amount, per the applicable state’s approved minimums and maximums, underlying the periodic payment to the claimant, or on the claimant’s behalf for the corresponding Benefit Type Code.
Reporting Requirement:	Report the weekly benefit amount, per the applicable state’s approved minimums and maximums, underlying the periodic payment to the claimant, or on the claimant’s behalf, for the corresponding Benefit Type Code. The amount reported includes dollars and cents. This field must be right-justified and left zero-filled. There is an implied decimal between positions 135 and 136. If the reported amount does not include digits after the decimal, add 00 to the right of the reported amount.  $123.45 is reported as 000012345  $123 is reported as 000012300 If a transaction includes multiple rates at which weekly benefits are paid, then report the transaction as a lump-sum payment (Lump Sum Indicator = Y) and report the most recent weekly benefit rate underlying the reported transaction amount as the weekly benefit amount.

Example: Reporting the Weekly Benefit Amount for part-time employment

A part-time employee sustains an injury due to a work-related accident. Based on the applicable state statutes, the pre-injury/average weekly wage for part-time work is computed as the average daily wage ($75.00 per day) times the average number of days worked per week (3) which results in a pre-injury/average weekly wage of $225 ($75 x 3 = $225). The weekly rate of compensation for temporary total disability benefits for this employee in this jurisdiction is $150 ($225 x 66 2/3% = $150), which is not limited by the state minimum or maximum weekly benefit. The resulting transactional fields would be reported as follows:

• Benefit Type Code = 05 (Temporary Total Disability Benefits)
• Employment Status Code = 2 (Part Time)
• Pre-Injury/Average Weekly Wage Amount = 00225
• Method of Determining Pre-Injury/Average Weekly Wage Amount = 1 (Actual Wage)
• Weekly Benefit Amount = 000015000

66. ZIP Code of Injury Site

Record Type:	Quarterly
Field(s):	40
Position(s):	207-215
Class:	Alphanumeric (AN)—Field contains alphanumeric and numeric characters
Bytes:	9
Format:	A/N 9, This field must be left justified and contain blanks in all spaces to the right of the last character if the Provider Postal Code is less than 9 digits.
Definition:	The postal or United States Postal Service ZIP+4 Code of the location where the injury occurred.
Reporting Requirement:	If the 9-digit ZIP+4 Code is known, then report the 9-digit ZIP+4 Code. If only the standard 5-digit ZIP Code is known, then report the 5-digit ZIP Code. If the claimant was injured outside the United States, then report blanks. Note: The ZIP Code of Injury Site should correspond to the Accident State.