Section III - Codes

A. Codes Common to Premium and Losses

Report Number and Valuation Date

Code	Description
01	Valued as of the 18th month after the month in which the policy became effective.
02	Valued 30 months after the policy effective date.
03	Valued 42 months after the policy effective date.
04	Valued 54 months after the policy effective date.
05	Valued 66 months after the policy effective date.
06	Valued 78 months after the policy effective date.
07	Valued 90 months after the policy effective date.
08	Valued 102 months after the policy effective date.
09	Valued 114 months after the policy effective date.
10	Valued 126 months after the policy effective date.

Correction Type
The alphabetic code that indicates the type of correction report being submitted. Applicable only to correction reports.

Code Description

H Header Record Correction

E Exposure Record Correction

L Loss Record Correction

T Total Record Correction

M Multiple Record Correction
Exposure State
The following state code number must be used. Pennsylvania — 37
Policy Type ID Code
Identifies the type of coverage, plan indicator and non-standard provisions of the policy. Type of Coverage

Code Description

01 Standard Workers Compensation Policy

05 Large Risk Rated Option / Large Risk Alternative Rating Option

09 Non-Standard Policy

Plan Type

Code Description

01 Voluntary Policy

02 Normal Assigned Risk Policy

Non-Standard Type

Code Description

01 Non-Standard Code Does Not Apply

08 Exclusion of Executive Officers

09 Voluntary Coverage Not Mandatory by State Act

Deductible Type Codes
Identifies the type of deductible being reported.

Losses Subject to Deductible Code

Code	Description
00	No Deductible
01	Medical Losses Only
02	Indemnity Losses Only
03	Medical & Indemnity Losses

Basis of Deductible Calculation Code

Code	Description
00	No Deductible
01	Per Claim Deductible Amount
02	Per Accident Deductible Amount
03	Per Policy Aggregate Limit
04	Percent of Claim Cost
05	Percent of Premium
06	Coinsurance Only Percent with Per Claim Amount Limit
07	Coinsurance Percent with Per Claim Deductible Amount and Coinsurance Limit
08	Coinsurance Percent with Per Accident Deductible Amount and Coinsurance Limit
09	Per Accident Deductible Amount with Per Policy Deductible Aggregate Limit
10	Per Claim Deductible Amount with Per Policy Deductible Aggregate Limit
11	Coinsurance Percent with Per Claim Deductible Amount Limit with Per Policy Aggregate Limit
12	Variable

Policy Conditions
Report the 1-position indicator or code for each policy condition.
1. Three Year Fixed Rate Indicator
  “Y” = Policy is a three-year fixed rate policy.
  “N” = Policy is not a three-year fixed rate policy.
2. Multistate Policy Indicator
  “Y” = Policy is a multistate policy.
  “N” = Policy is not a multistate policy.
3. Interstate Rated Indicator
  “Y” = Policy is interstate rated.
  “N” = Policy is not interstate rated.
4. Estimated Audit Code
  “Y” = Exposures expressed on the unit statistical report are estimated.
  “N” = Exposures expressed on the unit statistical report are the result of an audit.
  “U” = Insured has refused or not responded to requests to provide carrier with access to books and records. Audit has been closed as uncooperative. Exposures expressed on unit statistical report are estimated.
  Notes:
  1. When the Exposure on the 1st report includes Code 9757, report the Estimated Audit Code as “U” in the applicable Policy Conditions, Estimated Audit Code field.
    If subsequent to reporting Statistical Code 9757, and the final policy premium is determined in accordance with the Basic Manual rules, the statistical code and its accompanying charge must be removed. Additionally, the Estimated Audit Code must be changed to “N” and the exposure and premium must reflect the final audit.
  2. If final premium based on audited exposure cannot be reported due to federal, state and/or local emergency orders, laws, or regulations issued due to the COVID-19 (coronavirus) pandemic which impact an employer’s staffing or business operations report the applicable exposure and premium in the class code(s) and the Estimated Audit Code as an “N”, This code is effective March 1, 2020. The expiration date of this rule will be determined at a later date as circumstances warrant in consultation with Pennsylvania regulatory authorities.
5. Retrospective Rated Indicator
  “Y” = Policy is retrospective rated.
  “N” = Policy is not retrospective rated.
6. Canceled Mid-Term Indicator
  “Y” = Policy has been canceled mid-term.
  “N” = Policy has not been canceled mid-term.
7. Managed Care Organization Indicator
  “Y” = Policy has provisions for the administration of losses under an approved managed care organization.
  “N” = Policy does not have provisions for the administration of losses by an approved managed care organization.

B. Exposure Information Codes

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Update Type
Report the 1-position alphabetic code that identifies the activity of an exposure record.

Code Description

P Previously Reported

R Revised

Exposure Coverage
Report the code indicating the Act (Law) under which the exposure for this record’s class code is associated.

Code	Description
01	State Act or Federal Act Excluding USL&HW and Federal Mine Safety and Health Act
02	USL&HW “F” or USL&HW Coverage on non “F” Classes
03	Federal Mine Safety and Health Act Only
04	Federal Mine Safety and Health Act and/or the State Act
10	Voluntary Compensation Coverage

Premium Codes

Premium Subject to Experience Modification

Premium for Increased Limits

Limits of Liability (000's omitted)	Codes
100/100/1,000	9803
100/100/5,000	9805
100/100/10,000	9806
500/500/500	9807
500/500/1,000	9808
500/500/5,000	9810
500/500/10,000	9811
1,000/1,000/1,000	9812
1,000/1,000/5,000	9814
1,000/1,000/10,000	9815
Over 1,000/1,000/10,000	9816
All Other	9837

Note: The increased limits factors applied to non-ratable classification exposures should be reported as not subject to the experience modification

Amount Required to Balance to Increased Limits Minimum Premium Code 9848
Additional Premium from Flat Increase on Outstanding Policies Code 0998
Premium Credit Resulting from Flat Decrease on Outstanding Policies Code 0994
Deductible Applied to Manual Premium Before Experience Modification Code 9664
Waiver of Subrogation Code 0930

Premium Not Subject to Experience Modification
1. Loss Constant Code 0032
2. Short Rate Penalty Premium Code 0931
3. Risk Minimum Premium Code 0990
4. Optional Supplemental Loadings
  1. For Class 447 Code 0066
  2. For Class 445 Code 0067
  3. For Class 513 Code 0176
  4. For Black Lung Experience Code 0164
  5. For Carcinogen Experience Code 0133
  6. For Radiation Experience Code 9985
5. Mandatory Supplemental Loadings
  1. For Class 615 Code 0152
  2. For Class 810 Code 0162
  3. For Class 4771 Code 0771
  4. For Class 7405 Code 7445
  5. For Class 7413 Code 7453
6. Workfare Program Employees – Per person week Code 0982
7. Pennsylvania Construction Credit Premium Adjustment Program (PCCPAP) Code 9046
8. Certified Safety Committee Credit Program (CSCCP) Code 9890
9. Deductible Applied to Manual Premium After Experience Modification Deductible Code 9663
10. Merit Rating Plan Adjustment Neutral Code 9884
11. Merit Rating Plan Adjustment – 5% Credit Adjustment Code 9885
12. Merit Rating Plan Adjustment – 5% Debit Adjustment Code 9886
13. Schedule Rating Plan Credit Code 9887
14. Schedule Rating Plan Debit Code 9889
Premium Not Subject to Experience Modification and Not to be Included in Standard Premium.
1. Premium Discount Code 0063/Code 0064
2. Expense Constant Code 0900
3. Waiver of Subrogation – Flat Charge Code 9115
4. Terrorism Code 9740
5. Catastrophe (other than Certified Acts of Terrorism) Code 9741
6. Audit Noncompliance Charge Code 9757

4. Employer Assessment Surcharge Code

a. Employer Assessment Surcharge Code 0938

C. Loss Information Codes

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Injury Type

Code Description

01 Death

02 Permanent Total Disability

05 Temporary Total or Temporary Partial Disability

06 Medical Only Claims

07 Contract Medical

09 Permanent Partial Disability
Claim Status

Code Description

0 Open

1 Closed

Loss Conditions
Report the 2-digit code for each loss condition.
Loss Coverage Act

Code	Description
01	State Act or Federal Act Excluding USL&HW and Federal Mine Safety and Health Act
02	USL&HW “F” or USL&HW Coverage on non “F” Classes
03	Federal Mine Safety and Health Act Only
04	Federal Mine Safety and Health Act and/or the State Act

Type of Loss

Code	Description
01	Trauma
02	Occupational Disease (OD)
03	Cumulative Injury other than Disease

Type of Recovery

Code	Description
01	No Recovery
02	Second Injury Only
03	Subrogation Only (Third Party)
04	Subrogation with Second Injury

Type of Claim

Code	Description
01	Workers’ Compensation Only
02	Employers’ Liability Only
03	Workers’ Comp. & Employers’ Liability

Type of Settlement

Code	Description
00	Claim Not Subject to Settlement
03	Stipulated Award (Carrier/Claimant Settlement)
04	Findings and Award (Judicial Award)
05	Dismissal (Non-Compensable)
06	Compromise Settlement
09	All Other Settlements

Managed Care Organization Type

Code	Description
00	The claim is not administrated by an approved managed care organization.
01	The claim’s medical losses are administrated by an approved managed care organization not specifically listed in codes 02-05 below.
02	The claim’s medical losses are administrated by a health maintenance organization.
03	The claim’s medical losses are administrated by a preferred provider organization.
04	The claim’s medical losses are administrated by an exclusive provider organization.
05	The claim’s medical losses are administrated by an independent practice association.

Injury Description Code.
This code is made up of three separate components:
1. First two positions (XX ) identify the part of body injured.
2. Middle two positions ( — XX — ) identify the nature of the injury.
3. Last two positions ( XX) identify the specific cause of injury.
  Refer to page 8 for a list of the Injury Description Codes.
Vocational Rehabilitation Indicator

Indicator Description

Y Claim includes Vocational Rehabilitation Costs

N Claim does not include Vocational Rehabilitation Costs
Lump Sum Indicator
Report the value that identifies a lump sum agreement for the claim.

Indicator Description

Y Claim has been settled by an agreement to a lump sum amount.

N Claim has not been settled with a lump sum agreement.
Fraudulent Claim Codes

Code Description

00 Not Fraudulent

01 Partial Fraudulent

02 Fully Fraudulent

Injury Description Coding

Part of Body

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.

Injury Description Coding

Nature of Injury

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	*

Injury Description Coding

Cause of Injury

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.

* Intentionally left blank.

SCHEDULED INDEMNITY – MAXIMUM WEEKS

CODE	BODY MEMBER CODE	WEEKS	+ HEALING WEEKS
35	Hand	335	20
33	Forearm	370	20
31	Arm	410	20
56	Foot	250	25
54	Lower leg	350	25
52	Leg	410	25
14	Eye	275	10
13	Hearing (one ear)	60	10
13	Hearing (both ears)	260	10
37	Thumb	100	10
36	First finger	50	6
36	Second finger	40	6
36	Third finger	30	6
36	Fourth finger	28	6
37	One-half of thumb	50	10
36	One-half of first finger	25	6
36	One-half of second finger	20	6
36	One-half of third finger	15	6
36	One-half of fourth finger	14	6
36	Two or more members	aggregate	larger
57	Great toe	40	12
57	Other than great toe	16	6
57	One-half of great toe	20	12
57	One-half other than great toe	8	6
57	Two or more members	aggregate	larger
18	Facial disfigurement	275	-----

Code	Description
H	Header Record Correction
E	Exposure Record Correction
L	Loss Record Correction
T	Total Record Correction
M	Multiple Record Correction

Code	Description
01	Standard Workers Compensation Policy
05	Large Risk Rated Option / Large Risk Alternative Rating Option
09	Non-Standard Policy

Code	Description
P	Previously Reported
R	Revised

Code	Description
01	Death
02	Permanent Total Disability
05	Temporary Total or Temporary Partial Disability
06	Medical Only Claims
07	Contract Medical
09	Permanent Partial Disability