Below are frequently asked questions concerning indemnity transactional data reporting. Click on the questions to see the answers. For further assistance, please send an email to [email protected]
Overview and Participation
What is the WCIRB’s basis for determining Indemnity Data Call participation?
National Association of Insurance Commissioners (NAIC) groups that write at least 1 percent of the California workers’ compensation market, as determined by written pure premium in the most recent calendar year, are required to submit California indemnity transaction data to the WCIRB using the First and Subsequent Reports of Injury (FROI/SROI) record layouts. Once an NAIC group is required to submit indemnity transaction data, it will continue to be required to report data even if its California market share declines to less than 1 percent.
Should transactions on claims under USL&H or self-insured coverage be included in the Indemnity Data Call submissions?
No. USL&H and self-insured experience, as well as permissibly uninsured experience, should be excluded from the Indemnity Data Call reporting. Only claims resulting from direct California insurance coverage (reported with jurisdiction state code CA for California in DN0004) and the Self Insured Indicator field (FROI DN0024) marked as N should be reported to the WCIRB.
If any records are present in the file with the Self Insured Indicator field marked as Y, the entire file will reject.
Whom do I contact if I have questions about indemnity transaction data submissions to the WCIRB?
If one submitter is submitting for an insurer on a daily basis, does that mean that all of the other submitters for that insurer must also submit on a daily basis?
No, each submitter for each insurer may elect to submit on a daily, weekly, biweekly or monthly basis, as long as all of the data is received by the due date and as long as the submission frequency and number of files are consistent each quarter for the data reporting group.
Because the Indemnity Data Benchmark reports issue monthly, data reporting may not be less frequent than monthly.
Will there be a WCIRB Data Quality Program for indemnity transaction data?
Not immediately. The WCIRB intends to develop an Indemnity Transaction Data Quality Program that will be implemented for data submissions as of 1Q2021. The program will address criteria for monitoring of timeliness of data submissions, completeness of submissions and overall data quality and is expected to be similar in structure to the WCIRB Data Quality Program pertaining to medical transaction data.
Data Reporting Specifications
How does the WCIRB accept records?
The WCIRB accepts records via FTP to the WCIRB’s FTP server. Insurer groups will be provided with a specific location for file upload.
If a data submitter is submitting for multiple insurer groups, there will be different locations for each client.
How does the California Indemnity Data Call differ from California Workers’ Compensation Information System (WCIS) reporting?
The requirements for WCIS reporting are administered by the California Division of Workers’ Compensation (DWC). The information collected is used to oversee the state’s workers’ compensation system. WCIS reporting will continue to be administered by the DWC after the WCIRB’s Indemnity Data Call requirement commences.
The requirements for the WCIRB’s Indemnity Data Call reporting are administered by the WCIRB, and the data fields that are reported were selected to meet specific needs related to the WCIRB’s ratemaking responsibilities. While the requirements for the two systems are essentially the same, certain data fields must be redacted prior to submitting California indemnity transaction data to the WCIRB. There are no major inconsistencies in which a particular field has significantly different meanings between the two systems.
How does the California Indemnity Data Call differ from National Council on Compensation Insurance reporting?
The requirements for the WCIRB’s Indemnity Data Call reporting are administered by the WCIRB, and the data fields that are reported are based on WCIS reporting using the International Association of Industrial Accident Boards and Commissions’ (IAIABC’s) First and Subsequent Reports of Injury (FROI/SROI) record. FROI/SROI reporting to WCIS is administered by the DWC.
Because WCIS reporting has been required since March 2000 for all claims administrators who administrate more than 150 claims annually, the WCIRB’s Governing Committee elected to adopt this record for the WCIRB Indemnity Data Call rather than the Workers Compensation Insurance Organizations’ WCIND record, which was created in 2018. The IAIABC record layouts were selected to meet specific needs related to the WCIRB’s ratemaking responsibilities.
Will there be any changes to the annual Aggregate Indemnity and Medical Costs Call requirement or content now that the WCIRB collects indemnity transaction data via the Indemnity Data Call?
The WCIRB does not anticipate any changes to the content or requirement for submission of the annual Aggregate Indemnity and Medical Costs Call immediately. The WCIRB may consider modifications to the annual Aggregate Indemnity and Medical Costs Call content once the volume of indemnity transaction data collected via the Indemnity Data Call grows. It is unlikely that the Aggregate Indemnity and Medical Costs Call requirement will be eliminated completely.
Will there be any changes to the annual Permanent Disability Rating Survey or content now that the WCIRB collects indemnity transaction data via the Indemnity Data Call?
The WCIRB does not anticipate any changes to the content or requirement for submission of the annual Permanent Disability Rating Survey immediately. The WCIRB may consider modifications to the annual Permanent Disability Rating Survey content once the volume of indemnity transaction data collected via the Indemnity Data Call grows. It is unlikely that the Permanent Disability Rating Survey requirement will be eliminated completely.
Does the Indemnity Data Call also include the WCIS Annual file due at the end of January?
The Indemnity Data Call does not specifically require the AN report. However, the WCIRB will accept this data should an insurer or its data submitter wish to provide the WCIRB with its AN reports.
Record Layout and Definitions
Can the WCIRB provide us with the record layout for First and Subsequent Reports of Injury (FROI/SROI) submissions?
The record layouts for FROI/SROI are owned by the International Association of Industrial Accident Boards and Commissions (IAIABC) and are its intellectual property.
The record layouts can be acquired from IAIABC by purchasing the IAIABC EDI Implementation Guide for First, Subsequent, Acknowledgement Detail, Header and Trailer Record for the appropriate release version specified on the California Division of Workers’ Compensation’s (DWC’s) Workers’ Compensation Information System web page.
If a third party administrator uses its own claim numbering system that does not coincide with the insurer’s claim numbers that are reported in unit statistical records, what claim number must be reported for WCIRB indemnity transaction data submissions?
The Claim Administrator Claim Number (DN 0015) and Policy Number (DN 0028) reported for the Indemnity Data Call must match the claim number and policy number used for unit statistical reporting. The ability to match these values allows the WCIRB to use the statistical claim information and medical transaction data along with the indemnity transaction data in actuarial analysis.
Editing of Data
How will the WCIRB edit indemnity transaction data?
If the WCIRB is unable to process a record at the file processing stage because it has failed any of the file processing edits, the record will be moved to a stage environment, where it will be held for 30 days while the system monitors if a subsequent submission contained a repaired record. If, after 30 days, no repaired record is found in the subsequent submissions, the WCIRB will send the rejected records back to the submitter/insurer with an error reason.
For the most part, with the exception of these file processing edits, the WCIRB will not be issuing individual record queries.