Individual claim reserve predictions shows you the most recent reserve predictions, and current medical and indemnity costs for a specific claim. You'll also see the past 16 quarter end dates with claim cost information as of that date.

The definitions below will help you better understand the contents of this service offering.

• Last prediction date - Shows the last date the system predicted the reserve. The last prediction date also is a link to the reserve prediction report as of that date.
  The reserve prediction report in portable document format (PDF) gives a comprehensive view of significant data elements used in determining the reserve. Note: Every claim will not have a new prediction, only when there is a change in one of the data elements.
• Total medical paid - Authorized risk medical payments as of the effective date
• Total indemnity paid - Authorized risk indemnity (compensation) payments as of the effective date
• Total reserve - Sum of the authorized reserves as of the effective date
• View quarter end dates - Offers a collapsible view of the past 16 quarter end dates
• Quarter end date - Shows claim costs - indemnity, medical, and reserves - as of that quarter end date. Each quarter end date links to the reserve prediction report for that date.
• Summary of reserve change report - Gives you the option to view all claims having changed within the most recent prediction.
  When all quarter ending dates are shown, the last column will display the reserve for that quarter. Every reserve is underlined, click the reserve to get to the report.

Reserve prediction report

This report will download when you click on either the most recent prediction date or a quarter end date. You'll see all relevant data elements, including important payment information. The significant data elements used to calculate the reserve are in bold and broken down into sections that are listed below.
Note: If a data field is blank, then we do not have any information.

Claim information
This section contains basic claim and injured worker information. The type accident field lists whether the claim was an accident, death or occupational disease.

Policy information
The industry code field will display whether the policy of record is a private or public employer. The number listed after employer type displays the industry group to which the employer belongs.

Injury information
For claims with dates of injury prior to July 1, 2020, this section contains important International Classification of Diseases (ICD-9) information. The ICD-9 information could vary from what is displayed on BWC's claim management system. A ranking system is used to figure out the primary, secondary and tertiary (third) ICD-9 codes. The catastrophic field lists whether the claim is for a catastrophic incident based on the claims team and if a catastrophic nurse has been assigned.

For claims with date of injury on or after July 1, 2020, this section contains the primary injury group. Each claim is assigned to 1 of the 59 Injury Groups based on the ICD-10 code. For claims with multiple ICD codes the injury group is selected as the prevailing injury group associated with the most severe ICD code.

Medical payments - This section contains total medical paid by category or bucket.

Indemnity payments - This section contains total indemnity paid by category or bucket.

Payment information - This section contains payment dates and various payment rates and plans.