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OhioBWC - Employer - Service:  (Detail claim data) - Details

Detail claim data

The detail claim data report allows BWC personnel and Ohio employers to view individual claim information to help better manage workers’ compensation claims. Claim numbers listed include all claims associated with an individual policy as a result of combination, transfer or merger of accounts. This report is downloadable as a comma separated value file.

To take advantage of the most complete claims information available to you, we recommend you also download its companion report, the claim costs detail report. This report provides additional cost and reserve data relevant to your claims.

The detail claim data report provides detailed information about each claim listed. The definitions below will help you better understand those details.

Definitions

  • Claim number — A numeric identifier assigned to any new claim
  • Benefit type — Identifies a claim as medical only (MO) or lost time (LT).
  • IW (Injured worker) name — Identifies the name of the injured worker
  • Date of injury (DOI) — Identifies the date on which the industrial injury or occupational disease occurred
  • Claim status — The stage a claim is in at any given time, i.e., new, allowed, etc.
  • Claim status date — Identifies the effective date of the current claim status
  • Filing lag — The number of calendar days that have passed between the date of injury and the date of claim filing. For example, a claim filed on Jan. 19 for an injury which happened on Jan. 14 would have a filing lag of five days.
  • MO to LT conversion lag — This applies only to claims which have been reclassified from medical only to lost time. This is the number of calendar days that have passed between the date a claim was filed and the date on which the reclassification occurred. This field will be blank if the claim has been disallowed or dismissed.
  • Latest actual return-to-work date — Identifies the most recent RTW date. The field will be blank if return to work has not occurred, if the date is unknown, or if the date is in the future. This field will also be blank if the claim has been disallowed or dismissed.
  • Number of disability episodes — The number of times where the last day worked (LDW) and RTW date pairs indicate one or more calendar days absent. This field will be blank if the claim has been disallowed or dismissed.
  • Calendar days absent — The number of calendar days between LDW and RTW. If a claim has more than one LWD (e.g. LDW = 1/5, RTW = 1/8, LDW = 1/15, RTW = 1/20), calendar days absent will not include those days between a RTW and the next LDW. When an injured worker is deceased and the date of death is on (or one day after) the date of injury, the calendar days absent will be blank. If the date of death is more than one day after the date of injury, calendar days absent will equal the number of calendar days between LDW and date of death. Similarly, if a claim reaches settlement of both indemnity and medical or indemnity alone, calendar days absent will equal the number of calendar days between LDW and the claim status date.

    Examples:
    LDW = 2/5; RTW = 2/7; days absent = one
    LDW = 2/5; RTW = 2/6; days absent = zero
    LDW = 2/5; death (or settlement) = 2/15; days absent = nine
    This field will be blank if we have disallowed or dismissed the claim.

  • ICD-9 code — The code associated with the injury most likely to keep an injured worker off work (i.e. primary ICD-9 code). ICD-9 codes are the result of a statistical classification system (International Classification of Diseases, 9th Edition) that arranges diseases and injuries into groups according to established criteria.

    Note: The unique combination of injury and occupation that results in the longest expected period of time off work determines the primary ICD-9 code as identified by Ohio’s return-to-work benchmarks. Occupation is determined by the National Council on Compensation Insurance manual number or Standard Occupational Classification (SOC) code listed in the claim. Ohio only has expected periods of time off work for a select combination of injuries and occupations.

  • ICD-9 description - Text that defines the primary ICD-9 code associated with a claim. In addition to descriptions of specific injuries and diseases, you may see the following:

    • Catastrophic injury claim - Identifies a claim where the nature of the injuries makes return to work improbable;
    • Potentially severe complications – Identifies a claim which includes one or more injuries which make return to work within the optimal time frame improbable;
    • Primary injury not identified – Identifies a claim in which we cannot identify the primary ICD-9 code.

  • Manual number — An NCCI code used for premium rate making. The code defines the degree of risk associated with a particular industry and its germane occupations. Manual numbers will not appear if the employer is a state agency or public taxing district.
  • SOC code — The federal government uses this occupational code to categorize occupations. SOC codes will only appear if the employer is a state agency or public taxing district. BWC updates SOC data quarterly. Therefore, you may see claims on the claim detail report for which no SOC data is present.
  • Optimal days to RTW (ORTW) — The number of calendar days associated with the unique combination of injury and occupation that results in the longest expected period of time off work, as identified by Ohio’s return-to-work benchmarks.
  • Optimal days absent — The number of days absent associated with the ORTW. Since the ORTW counts days until the expected RTW, the optimal days absent will generally be one day less than the ORTW standard. For example, if the ORTW for a particular injury and occupation is three days, the injured worker who last worked on Jan. 5 would be expected to return to work on Jan. 8 (three days later). These two dates, however, represent only two days absent (Jan. 6 and 7).
  • Variance in days absent — The difference between calendar days absent and optimal days absent. Negative numbers indicate injured workers have returned to work more quickly than anticipated.



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