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 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.

The Call includes all claims subject to WCIS reporting pursuant to California Code of Regulations, Title 8, Sections 9701 and 9702 where a claim of injury has been filed. The data to be reported includes medical only and lost time claims. Per Section 9701 (e), a claim is defined as an injury that has resulted in the receipt of one or more of the following by the claims administrator:

1. Employer's Report of Occupational Injury or Illness, as required by California Code of Regulations, Title 8, Sections 14004-14005.
2. Doctor's First Report of Occupational Injury or Illness, as required by California Code of Regulations, Title 8, Sections 14006-14007.
3. Application for Adjudication filed with the Workers' Compensation Appeals Board under Labor Code Section 5500 and California Code of Regulations, Title 8, Section 10408.
4. Any information indicating that the injury requires medical treatment by a physician as defined in Labor Code Section 3209.3.

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.

Inquiries regarding any Indemnity Data Call issues can be sent to transactiondata@wcirb.com.

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.

The Transaction Data Quality Program was implemented for data submissions as of Second Quarter 2021 and covers both indemnity and medical transaction data. The program includes criteria for monitoring of timeliness of data submissions, completeness of submissions and overall data quality.

For more information about the program please visit the WCIRB Transaction Data Quality Program page.

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.

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.

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.

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.

The annual Permanent Disability Rating Survey was retired as of October 2022.

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.

If an employer provides paid sick leave specifically in response to COVID-19 (such as under the Families First Coronavirus Response Act or Executive Order N-51-20), then TD is not owed until that sick leave is used. Employer-paid sick leave in lieu of TD benefits should be reported with Subsequent Reports of Injury (SROI) DN 0003 – Maintenance Type Code “FS” (Full Salary) and SROI DN 0085 – Payment/Adjustment Code “240” (Employer Paid).

As per the DWC eNews dated March 2, 2021, report the FROI record with new Nature of Injury Code 38 (Adverse reaction to vaccination or inoculation) and Cause of Injury Code 83 (Pandemic).

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.

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.

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 while the system monitors if a subsequent submission contained a repaired record. If, after the submission evaluation period 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.