Highlights of Indemnity Transaction Data reporting, also referred to as the Indemnity Data Call, are as follows:
Indemnity Transaction Data on California workers’ compensation claims will be collected in accordance with the reporting requirements and record structure specified in the current version of Workers’ Compensation Information System (WCIS) California EDI Implementation Guide for First and Subsequent Reports of Injury (FROI/SROI). This implementation guide is posted on the California Division of Workers Compensation website.
For transactions as of July 1, 2022, National Association of Insurance Commissioners (NAIC) Groups that write at least 0.5 percent of the California workers’ compensation market, as determined by written pure premium, are required to submit Indemnity Transaction Data to the WCIRB. Market share is determined based on calendar year written premium at the pure premium rate level at the NAIC level. Once required to submit Indemnity Transaction Data, an NAIC Group is required to report that data even if its California market share declines to less than 0.5 percent. Insurers whose share of the California workers’ compensation market is less than 0.5 percent are also encouraged to submit Indemnity Transaction Data.*
Data submissions will be required and subject to audit beginning with FROI and SROI transactions occurring as of April 1, 2020.
Insurer groups may report Indemnity Transaction Data to the WCIRB on either a daily, weekly or monthly basis. The due date for Indemnity Data Call transactions is the last calendar day two months after the transaction month. Indemnity data transactions on a claim are required to be reported until transactions no longer occur for the claim in which a Final Transaction (FN) is generated with the Claim Status (DN73) set to "closed" as specified in the WCIS EDI reporting requirements.
Each insurer group must complete a certification process in order to be ready to submit production indemnity data. The certification process begins by the insurer submitting a test plan to the WCIRB. If the insurer is using multiple submitters, the certification process must encompass each submitter. The WCIRB’s Indemnity Data Call team will work closely with insurer groups and their submitter(s) throughout the data certification process.
Indemnity Data Call transactions are to be submitted electronically to the WCIRB via secure transfer to the WCIRB’s Secure File Transfer Protocol (sFTP) server as a flat file.
An insurer group may exclude data for claims that represent up to 15 percent of its gross premium for the state of California from the WCIRB indemnity data reporting requirement, but only in rare circumstances and subject to WCIRB approval. The exclusion may be utilized for small subsidiaries or business segments for the Insurer asserts that it would be an extreme hardship to develop the necessary infrastructure to create the necessary record(s). The exclusion option must be by business segment and not on claim type or characteristics. For additional information on the process by which an insurer may request to exclude the reporting of a portion of its California business, refer to WCIRB Form 104 California Indemnity Data Call – Business Exclusion Request Form or contact the Indemnity Data Call team at [email protected].
Submissions of Indemnity Transaction Data by Third Party Entities (TPEs) that have been approved for data submission by the WCIRB are allowed. However, the insurer group for which the data is being submitted is responsible for the quality of the data. For additional information on the process by which an insurer may request approval for a TPE to be used to submit its California Indemnity Transaction Data, refer to WCIRB Form 104 Indemnity Transaction Data Submission Enrollment – Section C or contact the Indemnity Data Call team at [email protected].
Rather than auditing each data record individually, the WCIRB will review an insurer’s entire submission for completeness and accuracy as specified in the WCIRB Transaction Indemnity Data Quality Program.
* For transactions prior to July 1, 2022, the eligibility threshold was 1 percent of the California workers’ compensation market, as determined by written pure premium.