WCIS e.News
#8    November 8, 2000

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Occasional announcements and technical updates regarding
California's Workers' Compensation Information System (WCIS),
from the California Division of Workers' Compensation
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Reporting Variance Period Data: First Report of Injury and Subsequent Report of Injury

All Variances for submitting FROI and SROI data end on December 31, 2000. At the end of any variance, data delayed pursuant to the variance must be submitted to WCIS. Variance period data should include all FROI data with date of injury of March 1, 2000 and beyond and all SROI data with date of injury of July 1, 2000 and beyond.

To start reporting variance period FROI and SROI data, Trading Partners should be in the Pilot or Production phase in reporting current data using the respective report: i.e. FROI or SROI.

Reporting FROI is straightforward - just send the same FROI transactions as would have been sent in the absence of a variance.

However, in reporting variance period SROI data, extra care needs to be taken so that the WCIS system can accurately interpret the benefits that have been paid for the claim. To maintain this interpretability, WCIS has designed benefit sequencing rules to insure that reported benefits make sense. For example, our sequencing rules would reject a "suspension" transaction for a claim, if the claim administrator had not previously reported that payment for the benefit type being made.

One way to report interpretable variance-period benefit data would be to send separate transactions for every start and stop of indemnity benefits that occurred during the variance. The Division of Workers Compensation understands that this would be cumbersome for complex claims, and that most claim administrators will not have sufficient data available to provide such detailed information retroactively.

In order to streamline the provision of variance-period benefit data, DWC has devised a method for providing this variance data using a single SROI transaction. This can be accomplished as follows:

  1. As is the case for non-variance data, prior to sending SROI data, Trading Partners should have submitted the corresponding FROI data.
  2. When reporting SROI data for variance period, Trading Partners do not need to report the stops and starts of each benefit period. Instead Trading Partners should send just one SROI transaction reporting the most recent Benefit period information for each Benefit Type paid. The Maintenance Type Code to be used will be UR (Upon Request). An example is provided below to illustrate:

    3. Sequence of events

    Date of Injury

    07/01/2000

    TD (Temporary Disability) paid

    07/03/2000-07/31/2000

    Employee returned to work: TD benefit suspended

    08/01/2000

    TD resumed and paid

    08/15/2000-09/30/2000

    PD (Permanent Disability): Benefit changed from TD to PD

    10/01/2000- Still being paid at end of variance

    How to report the above variance-period benefit sequence using one MTC = UR transaction with two benefit blocks:

    MTC Date is 12/31/2000

    MTC

    BTC

    Start Date

    Thru Date

    BTAP

    UR

    050

    20000815

    20000930

    2000

    030

    20001001

    20001231

    3600

  3. WCIS will use the Maintenance Type Code Date and Benefit Period Through Date to interpret whether a benefit period is open or closed. This is done in the following manner. If the Benefit Period Through Date for the particular Benefit Type Code is the same as the Maintenance Type Code Date then WCIS will consider that benefit type as "open" (benefits are still being paid). On the other hand, if the Benefit Period Through Date is prior to the MTC Date, WCIS will interpret this as a closed benefit period. In the above example Benefit Type 030 (PD) is considered an open benefit period, and Benefit Type 050 (TD) is considered a closed benefit period. The interpretation of MTC= UR is important in order to avoid benefit sequencing problems later.
  4. The Maintenance Type Code Date and the Benefit Period Through Date together act as a sort of "flag" to identify benefit periods as open or closed. Please recall that this usage of the "UR" transaction is provided as a convenience for the regulated community in transmitting variance period data that is due. Trading partners who do not wish to utilize this mechanism are always welcome to instead submit the complete series of benefit starts and stops that occurred during the variance period.

Please recall that this usage of the "UR" transaction is provided as a convenience for the regulated community in transmitting variance period data that is due. Trading partners who do not wish to utilize this mechanism are always welcome to instead submit the complete series of benefit starts and stops that occurred during the variance period.

<End of this WCIS e.News>
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Contents of this bulletin do not change existing regulatory requirements; they provide additional or revised detail about the technical implementation of those requirements. All technical changes will subsequently be reflected in other WCIS documentation. Any bulletin can be forwarded as needed, but should be forwarded in its entirety and without modification. If you have received a forwarded copy of this bulletin and are concerned about its authenticity, you can view this and previous bulletins on our WCIS web site: www.dir.ca.gov/dwc/wcis.htm.

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