Workers compensation insurer data reporting requirements

General introduction

The Workers Compensation Insurer Data Reporting Requirements (Requirements) describes the rules and the process workers compensation insurers must follow to submit their workers compensation insurance data.

Purpose of the Requirements

The Requirements support delivery of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) and the Workers Compensation Regulation 2016 by establishing clear processes and procedures around the submission of claims data to SIRA.

The accurate and timely collection of notification of injuries and claims data is essential to assist in the service delivery to people with a work-related injury, affordability and the effective management and sustainability of the system.

The data collected is used by SIRA in achieving its function as the regulator for example: ensure stakeholders comply with legislation and guidelines and to monitor their performance, identify areas of high risk and the publication of reports.

For the purposes of these Requirements, a notification of injury and a claim are hereinafter referred to as a claim, unless otherwise specified.

Publication notes

These Requirements are published by the State Insurance Regulatory Authority (SIRA) and replace the following documents:

• Claims technical manual nominal insurer V 4.14 (published in 2016)
• Claims technical manual self and specialised insurers V 5.10 (published in 2016)

An independent agency located within the NSW Customer Service Cluster, the Authority is constituted under the State Insurance and Care Governance Act 2015 and is responsible for regulating workers compensation insurance, motor accidents compulsory third party (CTP) insurance and home building compensation insurance in NSW.

Replacement and transition

The following publications are repealed:

• the Claims technical manual nominal insurer V 4.14
• the Claims technical manual self and specialised insurers V 5.10

and are replaced by these Requirements.

These Requirements apply to all claims data submitted by workers compensation insurers.

Legislative framework

The data described in these Requirements is collected under:

• the conditions of the insurer’s licence and/or in accordance with Section 23(1)(m) and Section 40C of the 1998 Act and
• Section 40B of the 1998 Act

Requirement making power

These Requirements are made under Section 40C of the 1998 Act.

Interpretation of the Requirements

These Requirements should be interpreted in a manner that supports the achievement of the objectives and general functions of SIRA under the workers compensation legislation as described in section 22 of the 1998 Act.

In order of hierarchy, if there is any conflict between the claims technical manual, guidance specification and the relevant legislation, the legislation takes precedence.

Commencement of the Requirements

The Workers compensation claims technical manual (WCIDRR01) is published by SIRA on 31 May 2019.

The Workers compensation claims data item guidance specification (WCIDRR02) is published by SIRA on 31 May 2019.

These Requirements are effective from the publication date until SIRA amends, revokes or replaces them in whole or in part. These Requirements supersede the previous requirements which were in place until 31 May 2019.

Parts of the Requirements

The information described in this document will assist insurers to improve the quality and timeliness of their data:

The Requirements are divided into the following parts:

Claims

Part 1: Claims technical manual: details the technical requirements for submitting workers compensation data

Part 2: Claims data item guidance specification: helps to explain how the data needs to be reported to SIRA.

Reference Data

Part 3: Claims technical manual claims state and events reference: details which data items are mandatory to report, which data items are optional to report, and when the data item must be reported.

Part 4: Claims technical manual validations reference: provides a validation matrix which lists all validations, their severity and the data items impacted.

Part 5: Claims technical manual code set reference: details all codes and code sets applicable to specific data items and provides a detailed description of each code and its use.

Part 6: Claims technical manual payment classification reference: provides a simplified list of payment classifications that can be reported by insurers.

Part 7: Claims technical manual payment classification and estimates reference, details:

• all payment classifications that can be reported by insurers
• the revised list of Medical services and fees published by the Australian Medical Association (AMA) payable to medical practitioners, providing medical or related treatment under the Workers Compensation Act 1987, and
• a list of all estimate types and their descriptions.

Policy

Part 8: Workers compensation policy technical manual: details the technical requirements for submitting workers compensation data.

Part 9: Workers compensation policy data item guidance specification: helps to explain how the data needs to be reported to SIRA.

Part 10: Workers compensation policy technical manual validations reference: provides a validation matrix which lists all validations, their severity and the data items impacted.

Part 11: Workers compensation policy technical manual code set reference: details all codes and code sets applicable to specific data items and provides a detailed description of each code and its use.

Compliance with the Requirements

SIRA will monitor and review compliance with the Requirements. Compliance and enforcement will be undertaken in accordance with SIRA’s Compliance and enforcement policy (July 2017)

Penalties for not meeting reporting Requirements

It is the responsibility of the insurer to ensure the accuracy, quality and timeliness of the data provided.

Failure to comply with these Requirements may result in regulatory sanctions being imposed including imposition of penalties, civil penalties or loss of licence if applicable.

Requirement identifiers

Each requirement component has been allocated a unique identifier (for example: WCIDRR01-01) to make it traceable. This will assist when:

• searching for a requirement
• linking requirements
• advising relevant stakeholders when a requirement has been revised, and
• to assist insurers when they request advice or suggest improvements.

Part 1: Claims technical manual

Data submission

SIRA assistance

WCIDRR01-01        For queries, suggested changes or enhancements about any aspect of these requirements, please contact the Data Quality and Exchange Team on email: [email protected]

Insurer types

WCIDRR01-02       These are allocated by SIRA and advised to the insurers. Insurers are to provide data in accordance with their allocated insurer type.

Data submission

WCIDRR01-03       In preparing a claim submission, insurers must report all new claims and all activity on a claim since its last successful report.

WCIDRR01-04       SIRA may validate claims data submissions prior to loading to ensure compliance with reporting requirements.

WCIDRR01-05       A claim is considered to have been successfully reported when the data submitted does not trigger any critical errors.

Record descriptions

WCIDRR01-06       The submitted file contains the following record types.

WCIDRR01-06.1     Header record

Record Set 1. Must be the first record on the submission. There must only be one of these in the submission.

WCIDRR01-06.2     Submission trailer record

Record Set 9. Must be the last record on the submission. There must only be one of these in the submission.

WCIDRR01-06.3     Basic claim detail record (1) & (2)

The Basic claim detail records 1 and 2 are considered part of the same record and must not be submitted in isolation.

Record Set 2 - Record Identifier 1. There can be at most one of these for each claim. This record must be reported for every new claim. This record must always be accompanied by a Basic claim detail record (2). If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

Record Set 2 - Record Identifier 7. There can be at most one of these for each claim. This record must be reported for every new claim. This record must always be accompanied by a Basic claim detail record (1). If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

WCIDRR01-06.4    Claim activity record

Record Set 2 - Record Identifier 2. This record must be reported for every new claim and every time there is a change in Liability status code (C: 2.2.9) on a claim. When there is no change in Liability status code and any other data item in the record is different to last successful report then only one record is to be reported with the latest data available as at Submission end date (C: 1.6).

If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

WCIDRR01-06.5     Time lost record

Record Set 2 - Record Identifier 3. There can be at most one of these for each claim reported. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

If the worker has not resumed employment as at the submission end date (C: 1.6) then this record must be reported to update the Number of days off work (C: 2.3.8).

WCIDRR01-06.6    Service provision record

Record Set 2 - Record Identifier 4. There can be any number of these for each claim reported. A service referral must only be reported once unless required to update any of the data describing that service referral, e.g. reporting the Service provision end date (C: 2.4.7).

WCIDRR01-06.7     Compensation payment and recovery record

Record Set 2 - Record Identifier 5. There can be any number of these for each claim reported.

WCIDRR01-06.8     Estimate record

Record Set 2 - Record Identifier 6. Required for open claim only. There must be only one record per applicable estimate type for each claim reported.

WCIDRR01-06.9    Work capacity record

Record Set 2 - Record Identifier 8. There can be any number of these for each claim reported. The Original decision date (C: 2.8.4) and work capacity decision type (C: 2.8.5) are used to identify a unique decision.

WCIDRR01-06.10   Claim control record

Record Set 2 - Record Identifier 9. There must be one of these for each claim reported.

Record dependencies

WCIDRR01-07       The first time a claim is reported, it must as a minimum include:

• Basic claim detail record (1)
• Basic claim detail record (2)
• Claim activity record
• Claim control record.

An Estimate record must also be reported if the claim is open and the Liability status code (C: 2.2.9) is not 01 (Notification of work related injury).

Submission record sorting

WCIDRR01-08.1     The submission records must be sorted in ascending sequence on the first 31 ASCII characters in each record.

WCIDRR01-08.2     In addition, work capacity records have a secondary sort in order of work capacity activity date (C: 2.8.8) from oldest activity date to latest activity date.

Submission frequency

WCIDRR01-09       Unless otherwise directed by SIRA each insurer must provide a minimum of one acceptable submission per month on or before the required delivery date. If there is no activity in a month, a Null submission, i.e. a header and trailer record only, must be submitted.

Insurer Type Required delivery date

Specialised                               15^th calendar day of the month

Group-self                                15^th calendar day of the month

Self-Insurer                               15^th calendar day of the month

TMF (Treasury Managed Fund)  15^th calendar day of the month

UL (Uninsured Liability)             15^th calendar day of the month

NI (Nominal Insurer)                  6^th business day of the month

Submission characteristics

WCIDRR01-010      The records in the submission must have the following characteristics:

• ASCII format. Refer to table below.
• All fields must be fixed length (zero or space filled as appropriate)
• All records are fixed length of 900 characters
• The submission file name must be formatted as
  CLMnnn.WCA where nnn is the insurer number allocated
  by SIRA.
• The submission must be zipped prior to upload.

WCIDRR01-010.1              Acceptable ASCII characters

Submission structure

WCIDRR01-011       This section gives the size and structure for the data items contained in each record of a submission.

WCIDRR01-011.1    Claim header record

WCIDRR01-011.2              Basic claim detail No. 1 record

WCIDRR01-011.3              Claim activity record

WCIDRR01-011.4              Time lost record

WCIDRR01-011.5              Service provision record

WCIDRR01-011.6              Compensation payment and recovery record

WCIDRR01-011.7              Estimate record

WCIDRR01-011.8              Basic claim detail no 2 record

WCIDRR01-011.9              Work Capacity Record

WCIDRR01-011.10    Claim Control Record

WCIDRR01-011.11    Claim submission trailer record

Data quality

Data Acceptance Criteria

WCIDRR01-012      There are 3 classes of validation rules applied across 4 data acceptance validation layers. The 3 classes of validations are:

• Abort – if triggered the entire submission will be rejected. The insurer must correct the error and resubmit.
• Critical – A claim triggering a critical error will not be loaded. A claim must not have any critical errors aged 2 months or greater.
• Suspect – if triggered the claim will be loaded if it did not trigger any critical errors. A claim must not have any suspect errors aged 3 months or greater.

WCIDRR01-012.1 SIRA may add, remove or revise validations as required to ensure the quality of data provided.

WCIDRR01-013      SIRA may add, remove or revise validations as required to ensure the quality of data provided.

WCIDRR01-014      For a list of all current validations, refer to the SIRA Workers Compensation Claims Technical Manual Validations Reference.

Validation Layer 1 - Abort

WCIDRR01-015      This validation layer will identify if the submission is formatted correctly and acceptable for further validation criteria. If an Abort error is identified, further validation layers will not be run on the submission. The submission will be rejected and the insurer will be required to correct and re-submit.

Validation Layer 2 – Critical – Data Completeness

WCIDRR01-016      This validation layer will review the claims records; identify triggered claim states and events and reject claims that have incomplete data reported for that state or event.  Critical error number C5000 will identify all data completeness errors for an individual claim.  If a claim triggers data completeness errors, further validation layers will not be run for that claim and the associated claims data will be rejected.

WCIDRR01-017      Any data items included in the submission that do not fall within a triggered claim state or event will not be validated or loaded.

Validation Layer 3 – Critical – Technical Errors

WCIDRR01-018      This validation layer will review the content in the individual data fields and ensure the format is correct. Critical error number C6000 will identify all technical errors for an individual claim.  If technical errors are triggered, the claim will be rejected and further validation layers will not be run for that claim. The technical errors include:

Validation Layer 4 – Critical and Suspect -Business Rules

WCIDRR01-019      This validation layer will review the data that passed validation layer 1, 2 and 3 and report on all triggered critical and suspect errors.

Reporting

WCIDRR01-020     SIRA produces several reports resulting from the validation or load of a data submission:

• CLM401: Claims Submission Validation Report – Layer 1 – Submission Abort (PDF)
• CLM402: Claims Submission Validation Report – Layer 2 – Data Completeness errors in the submission (CSV)
• CLM402CUM: Claims Submission Validation Report – Layer 2 – All outstanding Data Completeness errors (CSV)
• CLM403: Claims Submission Validation Report – Layer 3 – Technical Errors in the submission (CSV)
• CLM403CUM: Claims Submission Validation Report – Layer 3 – All outstanding Technical Errors (CSV)
• CLM404: Claims Submission Validation Report – Layer 4 – Business Errors in the submission (CSV)
• CLM404CUM: Claims Submission Validation Report – Layer 4 – All outstanding Business Errors (CSV)
• CLM406: Claims Submission Validation Financial & Process Statistics (PDF)
• CLM407: Claims Submission Validation Error Analysis

WCIDRR01-021      The following file format is applied to all generated reports:

• nnn_333333_CLM4##_YYYYMMDD_val.pdf where
• nnn – Insurer Number
• 333333 – Submission number
• 4## – Report number (EG: 401 or 406)
• YYYYMMDD – Date that the submission file was run
• Validation reports end with ‘val’
• Load report submission names end with ‘ld’

Claim states and events

WCIDRR01-022     Claim states and events have been developed based on the life cycle of a claim.

WCIDRR01-023     Refer to Workers compensation claims technical manual claims state and events reference for a list of the mandatory and optional data items applicable to claim state or event for each insurer type.  It is important to note that some data items are not applicable to all insurer types.

WCIDRR01-024     Only when the conditions for a claim to be made have been met is the Date claim made (C: 2.1.9) data item to be populated with a date.  This will trigger the claim made state.

WCIDRR01-025     The absence of a Date claim made indicates a notification of injury.

WCIDRR01-026     Additional data is reported progressively as the claim moves through its life cycle and triggers events.

WCIDRR01-027     Any data item reported that is not part of a triggered claim state, liability status or other event is ignored.  This means that the data is not validated or loaded.

WCIDRR01-028     SIRA may add, remove or revise claim states and events as required to ensure the quality and completeness of the data provided.

Claims data definitions

WCIDRR01-029     This section details each data item required. The data items are documented in record and reference number order. Each data item includes most of the following metadata where applicable, but some data items have unique information.

• Reference Number: The reference number allocated to the data item by SIRA.
• Description: A textual description of the data item that expresses the essential nature of the data item.
• Record Set: The record that the data item appears within the submission structure.
• Start Position: The position of the first character of the data item in the record structure.
• End Position: The position of the last character of the data item in the record structure.
• Length: The number of characters allocated to the data item in the record structure.
• Size: The minimum number of characters to be completed for the data item.
• Applies To: The insurer type/s that must provide this data in their submission. The value can be one of the following:
  • All
  • Specialised
  • Group-self
  • Self-Insurer
  • TMF (Treasury Managed Fund)
  • UL (Uninsured Liability)
  • NI (Nominal Insurer)
• Representational Layout: The layout of characters in a data item expressed by a character string representation.
  • Number

fill with leading zeros OR all zeros if not applicable OR a ‘No longer in use’ numeric data item

Hour numbers are represented as hours and minutes e.g. HHMM

• Text

fill with ending spaces OR all spaces if not applicable OR a ‘No longer in use’ text data item

• Date

YYYYMMDD OR all zeros if not applicable OR a ‘No longer in use’ date data item

• Value

must have a leading sign + if zero or positive or – for negative values

fill with leading zeros after the sign where appropriate OR all zeros after sign if not applicable OR a ‘No longer in use’ value data item

Hour values are represented as hours and minutes e.g. HHMM

Dollar values have an implied decimal before last two digits

• Representational Format: The format of presentation for the data item: Number, Text, Date, Value
• Code Value Set: The code values and their applicable descriptions for the data item.
• Statutory Legislation: The specific piece of legislation, Act OR SIRA issued guideline that this data item relates to.
• Notes: Notes applicable to the data item.

Record Set 1  WCIDRR01-030     Claim Header Record

Header record: Must be the first record on the submission. There can be only one of these on the submission. The Submission start date (C: 1.5) in this record must be one day later than the Submission end date (C: 1.6) of the last successfully loaded submission.

This record contains:

• C: 1.1 Record Set
• C: 1.2 Insurer number
• C: 1.3 Submission type
• C: 1.4 Claims system release number
• C: 1.5 Submission start date
• C: 1.6 Submission end date

C: 1.1         Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Claim Header"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '1' for a Submission Header Record.

C: 1.2        Insurer number

Description

A unique three-digit number allocated by SIRA used to identify an insurer or the insurer’s data provider

Record set

"Claim Header"

Start position

2

End position

4

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Number

Notes

C: 1.3                Submission type

Description

Identifies the type of data in the submission as either claims or policy.

Record set

"Claim Header"

Start position

5

End position

10

Length

6

Size

6

Applies to

All

Representational Layout

Spaces

Representational Format

Text

Notes

Must contain the word 'Claims'.

C: 1.4        Claims system release number

Description

Identifies the version of the claims system under which the data are being submitted to SIRA

Record set

"Claim Header"

Start position

11

End position

12

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Number

Notes

Claims system release number must be

04 for the Nominal insurer (NI) excluding UL

05 for all other insurers including UL

C: 1.5                Submission start date

Description

The start date (or from date) of the submission period

Record set

"Claim Header"

Start position

13

End position

20

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

C: 1.6                Submission end date

Description

The end date of the submission period.

Record set

"Claim Header"

Start position

21

End position

28

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Record set 2 WCIDRR01-031 Record Identifier 1: Basic Claim Detail No. 1 Record

There can only be one Basic Claim Detail No. 1 record for each claim reported on the submission. This record must be reported for every new claim. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

This record contains:

• C: 2.1.1 Record Set
• C: 2.1.2 Claim Identifier
• C: 2.1.3 Record identifier
• C: 2.1.4 No longer in use
• C: 2.1.5 Shared claim code
• C: 2.1.6 Error report target
• C: 2.1.7 Insurer branch
• C: 2.1.8 Date claim entered on insurer's system
• C: 2.1.9 Date claim made
• C: 2.1.10 Policyholder identification number
• C: 2.1.11 Period commencement date
• C: 2.1.12 Tariff rate number
• C: 2.1.13 Employer name
• C: 2.1.14 Employer ACN or ARBN
• C: 2.1.15 No longer in use
• C: 2.1.16 Worker’s address - Street information
• C: 2.1.17 Worker’s address - Locality name
• C: 2.1.18 Worker’s address - Postcode
• C: 2.1.19 Worker's gender code
• C: 2.1.20 Worker's date of birth
• C: 2.1.21 No longer in use
• C: 2.1.22 Worker's language code
• C: 2.1.53 No longer in use
• C: 2.1.54 Agency of injury/disease
• C: 2.1.55 Significant injury date
• C: 2.1.56 Contact complete date
• C: 2.1.57 No longer in use
• C: 2.1.58 Worker (Home) telephone number
• C: 2.1.59 TOOCS Breakdown agency
• C: 2.1.60 TOOCS Agency of injury/disease
• C: 2.1.23 No longer in use
• C: 2.1.24 Worker's occupation code
• C: 2.1.25 Worker's dependent children
• C: 2.1.26 Worker's other dependents
• C: 2.1.27 No longer in use
• C: 2.1.28 Permanent employment code
• C: 2.1.29 Training status code
• C: 2.1.30 Hours worked per week
• C: 2.1.31 Pre-injury average weekly earnings/ Current weekly wage rate
• C: 2.1.32 Duty status code
• C: 2.1.33 Workplace address - Street information
• C: 2.1.34 Workplace address - Locality name
• C: 2.1.35 Workplace address - Postcode
• C: 2.1.36 Workplace industry (ASIC)
• C: 2.1.37 Workplace industry (ANZSIC)
• C: 2.1.38 Workplace size
• C: 2.1.39 Incident location code
• C: 2.1.40 Incident location description
• C: 2.1.41 Incident locality name
• C: 2.1.42 Incident location postcode
• C: 2.1.43 Date of injury
• C: 2.1.44 Time of injury
• C: 2.1.45 Nature of injury/disease code
• C: 2.1.46 Bodily location of injury/disease code
• C: 2.1.47 TOOCS Mechanism
• C: 2.1.48 Breakdown agency
• C: 2.1.49 Result of injury code
• C: 2.1.50 Date deceased
• C: 2.1.51 Employer ABN (Australia Business Number)
• C: 2.1.52 Workers Compensation Industry Classification (WIC) code

C: 2.1.1      Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Basic Claim Detail No. 1"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.1.2     Claim identifier

Description

The identifier allocated to the claim by the insurer.

Record set

"Basic Claim Detail No. 1"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Notes

Must be specified.

The Claim identifier reported on the insurers submission must be identical to that used by the insurer in all correspondence.

The following is applicable to the Nominal Insurer only (this excludes UL):

The Claim identifier must not be changed once reported to SIRA.

The last 3 digits of the Claim identifier must be the unique number used to identify the Insurer number (C: 1.2) that first registered the claim.

C: 2.1.3     Record identifier

Description

The identifier code of the record within the data submission

Record set

"Basic Claim Detail No. 1"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '1'

C: 2.1.5     Shared claim code

Description

Identifies whether the financial responsibility for a claim is being shared with another insurer

Record set

"Basic Claim Detail No. 1"

Start position

41

End position

41

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Notes

C: 2.1.6     Error report target

Description

The insurer’s reference that allows error reports to be aggregated for a particular person or office

Record set

"Basic Claim Detail No. 1"

Start position

42

End position

48

Length

7

Size

7

Applies to

All

Representational Format

Text

Notes

If not applicable set to NA.

C: 2.1.7     Insurer branch

Description

Insurer branch responsible for handling the claim

Record set

"Basic Claim Detail No. 1"

Start position

49

End position

68

Length

20

Size

20

Applies to

All

Representational Format

Text

Notes

Must be supplied for all claims.

C: 2.1.8     Date claim entered on insurer's system

Description

The date the claim was first entered into the insurer's computer system

Record set

"Basic Claim Detail No. 1"

Start position

69

End position

76

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.1.9     Date claim made

Description

The date that a claim is made with the insurer in accordance with the SIRA Guidelines for claiming workers compensation.

Record set

"Basic Claim Detail No. 1"

Start position

77

End position

84

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

SIRA Guidelines

Notes

If not applicable set to 00000000.

C: 2.1.10    Policyholder identification number

Description

A unique identification number for each policyholder (employer) in NSW.

Record set

"Basic Claim Detail No. 1"

Start position

85

End position

103

Length

19

Size

19

Applies to

Specialised, TMF, UL and NI

Representational Format

Text

Notes

Identifies the policy against which the claim is made.

C: 2.1.11     Period commencement date

Description

The period commencement date of the policy term covering the claim.

Record set

"Basic Claim Detail No. 1"

Start position

104

End position

111

Length

8

Size

8

Applies to

Specialised

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.1.12    Tariff rate number

Description

The relevant tariff industry rate number covering the claim for the appropriate policy renewal year.

Record set

"Basic Claim Detail No. 1"

Start position

112

End position

114

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Statutory Legislation

Workers compensation market practice and premiums guidelines

Notes

Only applicable to claims with a Date of injury (C: 2.1.43) prior to 4pm 30/6/2001 (Self and Group Self Insurers)

For specialised insurers, only applicable to Policy period commencement date (2.1.11) prior to 4pm 30/6/2001. If not applicable set to 000.

Where the policy activity is classified by the NSW Workers Compensation Industry Classification (WIC) code (C: 2.1.52), this field must be set to zero.

C: 2.1.13    Employer name

Description

The legal name of the employer

Record set

"Basic Claim Detail No. 1"

Start position

115

End position

189

Length

75

Size

75

Applies to

Specialised, TMF and UL

Representational Format

Text

Notes

C: 2.1.14    Employer ACN or ARBN

Description

The Australian Company Number or Australian Registered Body Number of the employer.

Record set

"Basic Claim Detail No. 1"

Start position

190

End position

198

Size

9

Applies to

Group Self

Representational Layout

NNNNNNNNN

Representational Format

Number

Notes

If not applicable, set to 000000000

C: 2.1.16    Worker’s address - Street information

Description

The street details of the worker’s current residential address.

Record set

"Basic Claim Detail No. 1"

Start position

239

End position

358

Length

120

Size

120

Applies to

All

Representational Format

Text

Notes

For overseas addresses report the full address in this street information item.

Do not report the locality or postcode in this field unless it is an overseas address.

C: 2.1.17    Worker’s address - Locality name

Description

The locality or suburb of the worker’s current residential address

Record set

"Basic Claim Detail No. 1"

Start position

359

End position

388

Length

30

Size

30

Applies to

All

Representational Format

Text

Notes

For overseas addresses specify "OS" as the locality name.

C: 2.1.18    Worker’s address – Postcode

Description

The postcode of the locality or suburb of the worker’s current residential address

Record set

"Basic Claim Detail No. 1"

Start position

389

End position

392

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

Enter ‘0000’ for overseas addresses, i.e. addresses where the Worker’s address - Locality name (C: 2.1.17) is specified as ‘OS’. This is the only case where ‘0000’ will be accepted as a postcode.

C: 2.1.19    Worker's gender code

Description

The gender of the worker

Record set

"Basic Claim Detail No. 1"

Start position

393

End position

393

Length

1

Size

1

Applies to

All

Representational Format

Code

C: 2.1.20   Worker's date of birth

Description

The date of birth of the worker

Record set

"Basic Claim Detail No. 1"

Start position

394

End position

401

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Notes

May be reported as 00000000 on an initial notification where date of birth is unknown.

C: 2.1.22   Worker's language code

Description

The language spoken at home by the worker

Record set

"Basic Claim Detail No. 1"

Start position

406

End position

409

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

If not applicable set to 0000.

C: 2.1.24   Worker's occupation code

Description

The occupation of the worker at the date of the injury

Record set

"Basic Claim Detail No. 1"

Start position

411

End position

414

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

Optional for claims reported prior to 30 June 1988, when Classification and Classified List of Occupations (CCLO) was the classification used.  CCLO codes must not be reported in this field.

If not applicable set to 0000.

C: 2.1.25   Worker's dependent children

Description

The number of dependent children.

Record set

"Basic Claim Detail No. 1"

Start position

415

End position

416

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Number

Statutory Legislation

Section 3 (1A), 25, 29, 30, 31, 32, 37(1)(c) Workers Compensation Act 1987 No 70

Notes

Set to 00 if no dependants.

C: 2.1.26   Worker’s other dependants

Description

The number of dependants other than children

Record set

"Basic Claim Detail No. 1"

Start position

417

End position

418

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Number

Statutory Legislation

Section 3, 25, 29, 30, 31, 32, 37(1)(b) Workers Compensation Act 1987 No 70

Notes

Set to zero (00) if no dependants.

C: 2.1.28   Permanent employment code

Description

The worker’s type of employment at the date of the injury

Record set

"Basic Claim Detail No. 1"

Start position

420

End position

420

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Notes

C: 2.1.29   Training status code

Description

The worker’s training status at the date of the injury

Record set

"Basic Claim Detail No. 1"

Start position

421

End position

421

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

C: 2.1.30   Hours worked per week

Description

The worker’s weekly ordinary hours or average weekly hours at the date of injury

Record set

"Basic Claim Detail No. 1"

Start position

422

End position

425

Length

4

Size

4

Applies to

All

Representational Layout

HHMM

Representational Format

Number

Statutory Legislation

s44H Workers Compensation Act 1987 and s42 Workers Compensation Act 1987 prior to the 2012 Legislative Reform.

Notes

C: 2.1.31    Pre-injury average weekly earnings/  Current weekly wage rate

Description

The average weekly earnings as calculated in accordance with the legislation for exempt and non-exempt workers.

Record set

"Basic Claim Detail No. 1"

Start position

426

End position

433

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Worker: sections 44C to 44I of the Workers
Compensation Act 1987 in addition to schedule 3

Exempt worker: Section 42 of the Workers Compensation Act 1987 (prior to 2012 legislative reform)

Notes

The Defined limit can be sourced from the Workers Compensation Benefits Guide (refer to Maximum weekly payment section)

C: 2.1.32   Duty status code

Description

The worker’s duty status
at the date of the injury

Record set

"Basic Claim Detail No. 1"

Start position

434

End position

434

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Statutory Legislation

Workers Compensation Act 1987

Section 10 Journey Claims

Section 11 Recess Claims

Section 9A Employment must be a substantial contributing factor

Notes

C: 2.1.33   Workplace address - Street information

Description

The street address of the employer’s base of operations for the worker at the date of injury.

Record set

"Basic Claim Detail No. 1"

Start position

435

End position

554

Length

120

Size

120

Applies to

All

Representational Format

Text

Notes

C: 2.1.34   Workplace address - Locality name

Description

The locality or suburb of the employer’s base of operations for the worker at the date of injury

Record set

"Basic Claim Detail No. 1"

Start position

555

End position

584

Length

30

Size

30

Applies to

All

Representational Format

Text

Notes

For overseas addresses specify 'OS' as the locality name.

C: 2.1.35   Workplace address – Postcode

Description

The postcode of the employer’s base of operations for the worker at the date of injury

Record set

"Basic Claim Detail No. 1"

Start position

585

End position

588

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

C: 2.1.36   Workplace industry (ASIC)

Description

The primary industry activity undertaken at the employer’s base of operation for the worker at the date of injury.

Record set

"Basic Claim Detail No. 1"

Start position

589

End position

592

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Code Value Set

Coded according to the Australian Standard Industrial Classification, ABS Catalogue No. 1201.0

Notes

C: 2.1.37   Workplace industry (ANZSIC)

Description

The primary industry activity undertaken at the employer’s base of operations for the worker at the date of injury.

Record set

"Basic Claim Detail No. 1"

Start position

593

End position

596

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

C: 2.1.38   Workplace size

Description

The employer's estimate of the number of employees normally working at the employer’s base of operations for the worker at date of injury.

Record set

"Basic Claim Detail No. 1"

Start position

597

End position

601

Length

5

Size

5

Applies to

All

Representational Layout

NNNNN

Representational Format

Number

Notes

Zero can be reported where Workplace Size is not known and claim is in the Initial Claim state.

C: 2.1.39   Incident location code

Description

The type of incident location

Record set

"Basic Claim Detail No. 1"

Start position

602

End position

603

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Notes

C: 2.1.40   Incident location description

Description

A description of the incident location in circumstances where the worker was away from their normal workplace or base of operations.

Record set

"Basic Claim Detail No. 1"

Start position

604

End position

723

Length

120

Size

120

Applies to

All

Representational Format

Text

Notes

Set to NA if the accident occurred at the worker's normal place of work or base of operations (Incident location code C: 2.1.39 = 01) or if Date claim entered on insurer’s system is prior to 1 Jan 1998 (Incident location code C: 2.1.39 = 00).

For overseas address, report 'OS'.

C: 2.1.41    Incident locality name

Description

The locality or suburb of the incident location.

Record set

"Basic Claim Detail No. 1"

Start position

724

End position

753

Length

30

Size

30

Applies to

All

Representational Format

Text

Notes

Must be a valid locality or suburb as specified by Australia Post.

C: 2.1.42   Incident location postcode

Description

The postcode of the incident location.

Record set

"Basic Claim Detail No. 1"

Start position

754

End position

757

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Code Value Set

See Australia Post address standards

Notes

Set to '0000' if the accident occurred at the worker's normal place of work or base of operations (Incident location code C: 2.1.39 = 01) or if Date claim entered insurer system (C: 2.1.8) is prior to 1 January 1998 (Incident location code C: 2.1.39 = 00).

C: 2.1.43   Date of injury

Description

The date of the injury or disease

Record set

"Basic Claim Detail No. 1"

Start position

758

End position

765

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Workers Compensation Act 1987 and Workplace Injury Management and Workers Compensation Act 1998

Notes

C: 2.1.44   Time of injury

Description

The time of the injury or disease.

Record set

"Basic Claim Detail No. 1"

Start position

766

End position

769

Length

4

Size

4

Applies to

All

Representational Layout

HHMM

Representational Format

Time

Notes

To be specified according to the 24-hour clock

The HH component must be in the range 00 to 23

The MM component must be in the range 00 to 59

C: 2.1.45   Nature of injury/disease code

Description

Identifies the most serious injury or disease type of the worker.

Record set

"Basic Claim Detail No. 1"

Start position

770

End position

772

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Notes

C: 2.1.46   Bodily location of injury/disease code

Description

Identifies the part of the body affected by the most serious injury or disease

Record set

"Basic Claim Detail No. 1"

Start position

773

End position

775

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Notes

C: 2.1.47   TOOCS Mechanism

Description

Identifies the action, exposure or event that triggered the incident/injury.

Record set

"Basic Claim Detail No. 1"

Start position

776

End position

777

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Notes

C: 2.1.48   Breakdown agency

Description

Identifies the object, substance or circumstance that was principally involved in causing the incident.

Record set

"Basic Claim Detail No. 1"

Start position

778

End position

780

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Notes

C: 2.1.49   Result of injury code

Description

A code to indicate the result of the injury

Record set

"Basic Claim Detail No. 1"

Start position

781

End position

781

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Notes

C: 2.1.50   Date deceased

Description

The date of death of the worker where the death arises from the incident.

Record set

"Basic Claim Detail No. 1"

Start position

782

End position

789

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

Required where the result of injury indicates death (fatality).

C: 2.1.51    Employer ABN (Australian Business Number)

Description

The Australian Business Number (ABN) issued to the employer by the Australian Business Register.

Record set

"Basic Claim Detail No. 1"

Start position

790

End position

800

Length

11

Size

11

Applies to

All except NI

Representational Layout

NNNNNNNNNNN

Representational Format

Number

Notes

When reporting this field, you must not include any spaces.

C: 2.1.52   Workers Compensation Industry Classification (WIC) code

Description

The relevant NSW Workers Compensation Industry Classification (WIC) code covering the claim for the appropriate policy renewal year

Record set

"Basic Claim Detail No. 1"

Start position

801

End position

806

Length

6

Size

6

Applies to

All

Representational Layout

NNNNNN

Representational Format

Code

Statutory Legislation

Workers compensation market practice and premiums guidelines or relevant Insurance Premiums Order

Notes

Required for all claims where the commencement date of the policy is greater than or equal to 30 June 2001.

If not applicable, set to 000000.

C: 2.1.54  Agency of injury/disease

Description

Identifies the object, substance or circumstance directly involved in causing the most serious injury or disease

Record set

"Basic Claim Detail No. 1"

Start position

826

End position

828

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Code

Notes

For claims with a Date entered insurer's system prior to 1 July 2002, and after 30 June 2011, report this code to '000'.

C: 2.1.55 Significant injury date

Description

The date on which the insurer first becomes aware of the likelihood of the worker being incapacitated for a continuous period of more than 7 days.

Record set

"Basic Claim Detail No. 1"

Start position

829

End position

836

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Chapter 3 of Workplace Injury Management & Workers Compensation Act 1998

Notes

C: 2.1.56   Contact complete date

Description

The date the insurer completes initial contact with the worker, the employer and treating doctor (if required).

Record set

"Basic Claim Detail No. 1"

Start position

837

End position

844

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Chapter 3 of Workplace Injury Management & Workers Compensation Act 1998

Notes

If not applicable set to 00000000.

C: 2.1.58   Worker (Home) telephone number

Description

The contact Home telephone number of the worker

Record set

"Basic Claim Detail No. 1"

Start position

853

End position

866

Length

14

Size

14

Applies to

All

Representational Format

Text

Notes

For Australian landline report only area code and phone number only. Do not include international codes.

International telephone numbers require the international country code included.

If not applicable set to NA

C: 2.1.59   TOOCS Breakdown agency

Description

Identifies the object, substance or circumstance that was principally involved causing the incident.

Record set

"Basic Claim Detail No. 1"

Start position

867

End position

870

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

For claims with a date entered insurer's system prior to 1 July 2011, report this code as '0000'.

This code may need to be updated if there is a change in coding for the Nature of injury/disease code (C: 2.1.45).

C: 2.1.60   TOOCS Agency of injury/disease

Description

Identifies the object, substance or circumstance directly involved in causing the most serious injury or disease.

Record set

"Basic Claim Detail No. 1"

Start position

871

End position

874

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

For claims with a date entered insurer's system prior to 1 July 2011, report this code as '0000'.

Record Set 2 WCIDRR01-032 Record Identifier 2: Claim Activity Record

There can be any number of these records in a submission if there has been any activity in the reporting period. This record must be reported along with the Basic claim detail record (1) and (2) for every new claim.

Each change of liability status must be reported unless they occur in the same day.

If there is activity since the time the claim was successfully reported but no change to the liability status then only one record is to be reported.

If two or more sets of data are processed on one claim on the same day (that is with the same liability status date), only the latest set of data for that day is to be reported. If more than one set of data is sent for the same claim, with the same liability status date, the claim will be rejected. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

This record contains:

• C: 2.2.1 Record Set
• C: 2.2.2 Claim identifier
• C: 2.2.3 Record identifier
• C: 2.2.4 Liability status date
• C: 2.2.5 Claim closed flag
• C: 2.2.6 Date claim closed
• C: 2.2.7 Date claim re-opened
• C: 2.2.8 Reason for re-opening claim code
• C: 2.2.9 Liability status code
• C: 2.2.10 No longer in use
• C: 2.2.11 Date of claim review
• C: 2.2.12 No longer in use
• C: 2.2.13 Work status code
• C: 2.2.14 No longer in use
• C: 2.2.15 Second injury claim flag
• C: 2.2.16 Initial notifier code
• C: 2.2.17 Reasonable excuse code
• C: 2.2.18 No longer in use
• C: 2.2.19 No longer in use
• C: 2.2.20 Action date Section 66
• C: 2.2.21 Action type Section 66
• C: 2.2.22 Common law action date
• C: 2.2.23 Initial notifier name
• C: 2.2.24 Initial notifier telephone number
• C: 2.2.25 Description of incident
• C: 2.2.26 Description of Injury/illness
• C: 2.2.27 Work status date
• C: 2.2.28 Type of dispute
• C: 2.2.29 Date of claim screening
• C: 2.2.30 Claim screening action code
• C: 2.2.31 Result of the permanent impairment assessment (PI %).
• C: 2.2.32 Date claim recovery action commenced
• C: 2.2.33 Percentage of estimated recovery
• C: 2.2.34 Recovery investigation indicator
• C: 2.2.35 SIRA NSW Certificate of Capacity period start date
• C: 2.2.36 SIRA NSW Certificate of Capacity period end date
• C: 2.2.37 SIRA NSW Certificate of Capacity fitness
• C: 2.2.38 WCC matter number
• C: 2.2.39 Section 52A code
• C: 2.2.40 Common law action type
• C: 2.2.41 Common law action outcome
• C: 2.2.42 Work capacity transition date
• C: 2.2.43 Work capacity transition outcome
• C: 2.2.44 Estimated permanent impairment (EPI%)
• C: 2.2.45 Assessed percentage of permanent impairment for paid S66 benefits

C: 2.2.1             Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Claim Activity"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.2.2    Claim identifier

Description

The identifier allocated to the claim by the insurer.

Record set

"Claim Activity"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Notes

Must be specified.

C: 2.2.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Claim Activity"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim activity record.

C: 2.2.4    Liability status date

Description

The date of the Liability Status decision.

Record set

"Claim Activity"

Start position

22

End position

29

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.5    Claim closed flag

Description

A flag to indicate if the claim is closed.

Record set

"Claim Activity"

Start position

30

End position

30

Length

1

Size

1

Applies to

All

Representational Format

Code

C: 2.2.6    Date claim closed

Description

The most recent date that the claim was closed

Record set

"Claim Activity"

Start position

31

End position

38

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.7    Date claim re-opened

Description

The most recent date that the claim was re-opened

Record set

"Claim Activity"

Start position

39

End position

46

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

If not applicable, set to 00000000

C: 2.2.8    Reason for re-opening claim code

Description

Identifies why the insurer has re-opened the claim

Record set

"Claim Activity"

Start position

47

End position

47

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Code

Notes

C: 2.2.9    Liability status code

Description

The current status of liability for a notification or claim, as determined by the insurer.

Record set

"Claim Activity"

Start position

48

End position

49

Length

2

Min Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Workers Compensation Act 1987 & Workplace Injury Management & Workers Compensation Act 1998

Notes

C: 2.2.11    Date of claim review

Description

The date of the latest claim review conducted by the insurer.

Record set

"Claim Activity"

Start position

52

End position

59

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.13   Work status code

Description

The current work status of the worker.

Record set

"Claim Activity"

Start position

62

End position

63

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

s48 and s49 Workplace Injury Management and Workers Compensation Act 1998. s32A, 36, 37, 38, 39, of Workers Compensation Act 1987.

Notes

C: 2.2.15   Second injury claim flag

Description

A flag indicating if the claim is a second injury claim as defined under section 54 of the Workplace Injury Management and Workers Compensation Act 1998

Record set

"Claim Activity"

Start position

64

End position

64

Length

1

Size

1

Applies to

All

Representational Format

Code

Statutory Legislation

s54 Workplace Injury Management & Workers Compensation Act 1998.

Notes

C: 2.2.16   Initial notifier code

Description

Identifies the category of the initial notifier of an injury

Record set

"Claim Activity"

Start position

65

End position

66

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Notes

May be set to 00 where date of first notification is less than 1 January 2002.

C: 2.2.17   Reasonable excuse code

Description

The reason for not commencing provisional payments.

Record set

"Claim Activity"

Start position

67

End position

68

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

C: 2.2.20  Action date Section 66

Description

The date the insurer made a reasonable offer of settlement or disputed liability for lump sum compensation.

Record set

"Claim Activity"

Start position

79

End position

86

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Refer to Section 281 of the Workplace Injury Management and Workers Compensation Act 1998 No 86.

Notes

If not applicable, set to 00000000

C: 2.2.21   Action type Section 66

Description

Identifies the type of action taken by the insurer in response to a lump sum compensation claim.

Record set

"Claim Activity"

Start position

87

End position

88

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Refer to Section 281 of the Workplace Injury Management and Workers Compensation Act 1998 and SIRA Guidelines for claiming workers compensation.

Notes

If not applicable set to 00

Must not be specified if Action date - Section 66 is not specified.

C: 2.2.22  Common law action date

Description

The date a statement of claim for a Common Law Claim is filed with the Court or the date the insurer receives a pre-filing statement for the recovery of Work Injury Damages.

Record set

"Claim Activity"

Start position

89

End position

96

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Workers Compensation Act 1987 Part 5

Workplace Injury Management and Workers Compensation Act 1988

Part 3 - Division 4 and Part 6

SIRA Guidelines for claiming workers compensation

Notes

C: 2.2.23  Initial notifier name

Description

The name of the person who first notified the insurer of the incident.

Record set

"Claim Activity"

Start position

97

End position

136

Length

40

Size

40

Applies to

All

Representational Format

Text

Notes

If date of first notification is less than 01 September 2003 set to NA.

C: 2.2.24  Initial notifier telephone number

Description

The contact telephone number of the person who first notified the Insurer of the incident

Record set

"Claim Activity"

Start position

137

End position

150

Length

14

Size

14

Applies to

All

Representational Format

Text

Notes

For Australian landline report only area code and phone number only. Do not include International codes.

International telephone numbers require the international country code included.

If not applicable set to NA

C: 2.2.25  Description of incident

Description

A clear and concise description of how the incident occurred.

Record set

"Claim Activity"

Start position

151

End position

350

Length

200

Size

200

Applies to

All

Representational Format

Text

Notes

Must not be NA if Date of first notification is equal to or greater than 01/09/2003

C: 2.2.26  Description of Injury/illness

Description

A description of all the injuries/illnesses and parts of the body affected.

Record set

"Claim Activity"

Start position

351

End position

550

Length

200

Size

200

Applies to

All

Representational Format

Text

Notes

Must not be NA if Date of first notification is equal to or greater than 01/09/2003.

C: 2.2.27  Work status date

Description

The date when the worker’s work status changed.

Record set

"Claim Activity"

Start position

551

End position

558

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.28  Type of dispute

Description

Identifies the reason why an insurer disputes a claim.

Record set

"Claim Activity"

Start position

559

End position

560

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

If not applicable set to 00

When the dispute is resolved, reset to 00

C: 2.2.29  Date of claim screening

Description

The date a claim is screened by the insurer to assess whether an Injury management plan (IMP) is required, or the date of a review of an Injury management plan.

Record set

"Claim Activity"

Start position

561

End position

568

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.2.30  Claim screening action code

Description

Describes the action taken by the insurer about an Injury management plan following the screening of a claim.

Record set

"Claim Activity"

Start position

569

End position

570

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.31   Result of the permanent impairment assessment (PI %)

Description

Result of the most recent permanent impairment assessment (PI %).

Record set

"Claim Activity"

Start position

571

End position

573

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Number

Statutory Legislation

s66 Workers Compensation Act 1987

s263 & s322A Workplace injury management and workers compensation Act 1998

Notes

This is the greater of either:

a) the worker’s level of permanent  
impairment in the:

complying agreement, or

Medical Assessment Certificate, or

outcome of the Medical
Assessment Panel

b) the worker’s level of permanent impairment where the assessment was undertaken for threshold purposes.

C: 2.2.32  Date claim recovery action commenced

Description

The date that claim recovery action is commenced against the other liable party/Insurer

Record set

"Claim Activity"

Start position

574

End position

581

Length

8

Size

8

Applies to

NI

Representational Layout

YYYYDDMM

Representational Format

Date

Notes

C: 2.2.33  Percentage of estimated recovery

Description

The estimated percentage of recovery

Record set

"Claim Activity"

Start position

582

End position

584

Length

3

Size

3

Applies to

NI

Representational Layout

NNN

Representational Format

Number

Notes

C: 2.2.34  Recovery investigation indicator

Description

Indicates if a claim has been investigated for recovery payments potential

Record set

"Claim Activity"

Start position

585

End position

586

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.35  SIRA NSW Certificate of Capacity period start date

Description

The start date for the period covered by a SIRA Certificate of Capacity/ certificate of fitness

Record set

"Claim Activity"

Start position

587

End position

594

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Accuracy Level % 100

Notes

If not applicable, set to 00000000. For example, payment classification codes WPT003, WPT004 WPP003 or WPP004.

C: 2.2.36  SIRA NSW Certificate of Capacity period end date

Description

The end date for the period covered by a SIRA Certificate of Capacity/certificate of fitness.

Record set

"Claim Activity"

Start position

595

End position

602

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

If not applicable set to 00000000.

C: 2.2.37  SIRA NSW Certificate of Capacity/ fitness

Description

Capacity for work as specified on the SIRA Certificate of Capacity/certificate of fitness

Record set

"Claim Activity"

Start position

603

End position

604

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Accuracy Level % 100

Notes

If not applicable, set to 00.

C: 2.2.38  WCC matter number

Description

The Workers Compensation Commission reference number allocated for a dispute

Record set

"Claim Activity"

Start position

605

End position

612

Length

8

Size

8

Applies to

All

Representational Format

Text

C: 2.2.39  Section 52A code

Description

The reason for discontinuation of weekly payments for partial incapacity after 2 years.

Record set

"Claim Activity"

Start position

613

End position

614

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.40  Common law action type

Description

Identifies the legislative basis upon which a claim for work injury damages (WID) has been made.

Record set

"Claim Activity"

Start position

615

End position

616

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.41   Common law action outcome

Description

The outcome of the Work Injury Damages or Common Law action.

Record set

"Claim Activity"

Start position

617

End position

618

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

C: 2.2.42  Work capacity transition date

Description

The date that a work capacity transition outcome was made.

Record set

"Claim Activity"

Start position

619

End position

626

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Section 43 Workers Compensation Act 1987

Notes

C: 2.2.43  Work capacity transition outcome

Description

The outcome of a work capacity transition assessment conducted by the insurer.

Record set

"Claim Activity"

Start position

627

End position

628

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Refer to Subdivision 3 of Workers Compensation Act 1987

Notes

C: 2.2.44  Estimated permanent impairment (EPI%)

Description

The insurers estimate of the permanent impairment (PI%) of the worker based on available information.

Record set

"Claim Activity"

Start position

629

End position

630

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

s66 Workers Compensation Act 1987

s263 & 322a WIMWCA Act 1998

Notes

C: 2.2.45  Assessed percentage of permanent impairment for paid S66 benefits

Description

The permanent impairment assessment (PI%) applicable to the payment of permanent impairment compensation.

Record set

"Claim Activity"

Start position

631

End position

633

Length

3

Size

3

Applies to

All

Representational Layout

NNN

Representational Format

Number

Statutory Legislation

s66 Workers Compensation Act 1987

Notes

Record Set 2 WCIDRR01-033 Record Identifier 3: Time Lost Record

There can be at most one of these for each claim reported on the submission. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

If the worker has not resumed work as at the submission end date then the time lost record is to be reported so that the Number of days off work (C: 2.3.8) is updated.

Rules:

1. If worker has no capacity, then a Time lost record must be reported

2. If worker has current capacity but is not working (ie suitable employment not performed), then a Time lost record must be reported

3. If a worker has only been in the following situations, then a time lost record must not be reported:

i. If worker has current capacity and is working (i.e. suitable employment) pre- injury hours and days

ii. If worker has current capacity and is working (i.e. suitable employment) reduced hours or reduced days.

iii. Where a worker has less than one full shift or one full day (part day) off work

iv. When the worker dies on the same day as the incident.

This record contains:

• C: 2.3.1 Record Set
• C: 2.3.2 Claim identifier
• C: 2.3.3 Record identifier
• C: 2.3.4 Date ceased work
• C: 2.3.5 Estimated date fit to resume employment
• C: 2.3.6 No longer in use
• C: 2.3.7 Actual date resumed work
• C: 2.3.8 Number of days off work

C: 2.3.1     Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Time Lost"

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.3.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Time Lost"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C 2.3.3     Record identifier

Description

The identifier code of the record within the data submission

Record set

"Time Lost"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '3' for a time lost record.

There must be no more than one time lost record for any claim in the submission. Note if there is more than one period of time lost since the last report, only the latest information is required.

C: 2.3.4 Date ceased work

Description

The date of the last day the worker attended work prior to commencing their first period of absence from the workplace due to their work capacity.

Record set

"Time Lost"

Start position

22

End position

29

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

Must be specified if a time lost record is reported.

C: 2.3.5    Estimated date fit to resume employment

Description

The date when it is expected that the worker will resume work in any capacity, as at the submission end date

Record set

"Time Lost"

Start position

30

End position

37

Length

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

If at the Submission end date, the worker has resumed work, or is deemed fit to resume work, enter 00000000 in this item.

If the worker is not expected to have any future work capacity for any employment then report the expected date of cessation of weekly payments.

C: 2.3.7 Actual date resumed work

Description

The date the worker resumed work in any capacity with any employer.

Record set

"Time Lost"

Start position

46

End position

53

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

Report 00000000 if claimant has not resumed work.

C: 2.3.8    Number of days off work

Description

The total number of days, measured in whole calendar days (including holidays and weekend days) that the worker has been off work due to the injury/ illness.

Record set

"Time Lost"

Start position

54

End position

58

Length

5

Size

5

Applies to

All

Representational Layout

NNNNN

Representational Format

Number

Notes

Record Set 2 WCIDRR01-034 Record Identifier 4: Service Provision Record

There can be any number of these for each claim reported on the submission. Any service referral must only be reported once to SIRA, unless the insurer is changing some of the data describing that service referral, e.g. reporting the service provision end date (C: 2.4.7).

This record contains:

• C: 2.4.1 Record Set
• C: 2.4.2 Claim identifier
• C: 2.4.3 Record identifier
• C: 2.4.4 No longer in use
• C: 2.4.5 Rehabilitation provider code
• C: 2.4.6 Service provision start date
• C: 2.4.7 Service provision end date
• C: 2.4.8 Service provision type
• C: 2.4.9 Service provision sub type
• C: 2.4.10 Service provision null date
• C: 2.4.11 Work trial host employer ABN

Notes

Service Provision records are required for claims where the claimant is undergoing a vocational rehabilitation program or referred to an approved workplace rehabilitation provider for workplace rehabilitation.

Each service provision record is considered unique by the following data items:

• Workplace Rehabilitation Event

­ C: 2.4.5 Rehabilitation provider code

­ C: 2.4.6 Service provision start date

­ C: 2.4.8 Service provision type

• Vocational rehabilitation program Event

­ C: 2.4.6 Service provision start date

­ C: 2.4.8 Service provision type

­ C: 2.4.9 Service provision sub type

• Work Trial Event

­ C: 2.4.5 Rehabilitation provider code

­ C: 2.4.6 Service provision start date

­ C: 2.4.8 Service provision type

­ C: 2.4.9 Service provision sub type

C: 2.4.1     Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Service Provision"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.4.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Service Provision"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C: 2.4.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Service Provision"

Start position

21

End position

21

Length

1

Min Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '4' for a Service provision record.

C: 2.4.5    Rehabilitation provider code

Description

The approved workplace rehabilitation provider number as specified by SIRA

Record set

"Service Provision"

Start position

25

End position

28

Length

4

Size

4

Applies to

All

Representational Layout

NNNN

Representational Format

Code

Notes

C: 2.4.6    Service provision start date

Description

The commencement date of a vocational rehabilitation program OR the insurer approval date for workplace rehabilitation.

Record set

"Service Provision"

Start position

29

End position

36

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

s52 and s53 of the Workplace Injury Management and Workers Compensation Act 1998

Notes

C: 2.4.7    Service provision end date

Description

The end date of the workplace rehabilitation referral OR the vocational rehabilitation program.

Record set

"Service Provision"

Start position

37

End position

44

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

s52 and s53 Workplace Injury Management & Workers Compensation Act 1998

Notes

C: 2.4.8    Service provision type

Description

Identifies the type of rehabilitation service.

Record set

"Service Provision"

Start position

45

End position

46

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Workplace Injury Management and Workers Compensation Act 1998

Notes

C: 2.4.9    Service provision sub type

Description

Identifies the category of vocational rehabilitation program.

Record set

"Service Provision"

Start position

47

End position

48

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Workplace Injury Management and Workers Compensation Act 1998

Notes

Only applicable when Service provision type (C: 2.4.8) of '02', vocational rehabilitation program is reported.

C: 2.4.10   Service provision null date

Description

The date the service provision record was identified as being reported in error.

Record set

"Service Provision"

Start position

49

End position

56

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

s52 and s53 Workplace Injury Management and Workers Compensation Act 1988

Notes

If not applicable set to 00000000.

C: 2.4.11    Work trial host employer ABN

Description

The ABN of the work trial host employer

Record set

"Service Provision"

Start position

57

End position

67

Length

11

Size

11

Applies to

All

Representational Layout

NNNNNNNNNNN

Representational Format

Number

Notes

For employers without an ABN set this item to ‘00000000000’. Note that this includes foreign owned companies who do not hold an ABN or are not entitled to an ABN.

When reporting this field, you must not include any spaces.

Record Set 2 WCIDRR01-035 Record Identifier 5: Compensation Payment and Recovery Record

There will be one of these for each payment or recovery transaction for each claim reported on the submission. Insurers must ensure that a transaction is only reported once to SIRA.

This record contains:

• C: 2.5.1 Record Set
• C: 2.5.2 Claim identifier
• C: 2.5.3 Record identifier
• C: 2.5.4 No longer in use
• C: 2.5.5 Payment transaction date
• C: 2.5.6 Adjustment transaction flag
• C: 2.5.7 Payment/recovery amount
• C: 2.5.8 Payment period start date
• C: 2.5.9 Payment period end date
• C: 2.5.10 Hours paid for total incapacity
• C: 2.5.11 Hours paid for partial incapacity
• C: 2.5.12 Reimbursement schedule code
• C: 2.5.13 No longer in use
• C: 2.5.14 No longer in use
• C: 2.5.15 Payee ID
• C: 2.5.16 Service provider ID
• C: 2.5.17 Payment classification number
• C: 2.5.18 Date of service
• C: 2.5.19 Determined weekly benefit amount
• C: 2.5.20 Invoice number
• C: 2.5.21 Hours lost
• C: 2.5.22 Earnings
• C: 2.5.23 Deductibles

C: 2.5.1             Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Compensation Payment and Recovery"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.5.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Compensation Payment and Recovery"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C: 2.5.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Compensation Payment and Recovery"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Notes

Must contain '5' for a compensation payment and recovery record.

C: 2.5.5    Payment transaction date

Description

The date the insurer makes the payment or receives a recovery payment.

Record set

"Compensation Payment and Recovery"

Start position

24

End position

31

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.5.6    Adjustment transaction flag

Description

A flag to indicate, for weekly payments, that the transaction being submitted is an adjustment to a previously submitted transaction

Record set

"Compensation Payment and Recovery"

Start position

32

End position

32

Length

1

Size

1

Applies to

All

Representational Format

Code

Notes

C: 2.5.7    Payment/recovery amount

Description

The amount of the payment or recovery transaction, inclusive of GST

Record set

"Compensation Payment and Recovery"

Start position

33

End position

43

Length

11

Size

11

Applies to

All

Representational Layout

+/-NNNNNNNNNN

Representational Format

Value

Notes

Where an amount is being recovered it should be reported as a positive amount.

Alterations to previously reported payment or recovery transactions can be reported as positive or negative as appropriate.

When an adjustment to an existing weekly payment is being reported, the Adjustment transaction flag (C: 2.5.6) must be set to 'Y'.

C: 2.5.8    Payment period start date

Description

The start date of the period of incapacity for the weekly payment.

Record set

"Compensation Payment and Recovery"

Start position

44

End position

51

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.5.9    Payment period end date

Description

The end date of the period of incapacity for the weekly payment.

Record set

"Compensation Payment and Recovery"

Start position

52

End position

59

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.5.10   Hours paid for total incapacity

Description

The hours paid for total incapacity, within the payment period.

Record set

"Compensation Payment and Recovery"

Start position

60

End position

66

Length

7

Size

7

Applies to

All

Representational Layout

+/-HHHHMM

Representational Format

Value

Statutory Legislation

S36, 37 Workers Compensation Act 1987

Notes

The figure in this field must be reported in hours and minutes.

The layout cannot be more than 7 digits and if it is, the insurer must split down the payment transactions into multiple transactions and allocate the relevant hours across the relevant transactions.

C: 2.5.11    Hours paid for partial incapacity

Description

The hours paid for partial incapacity, within the payment period.

Record set

"Compensation Payment and Recovery"

Start position

67

End position

73

Length

7

Size

7

Applies to

All

Representational Layout

+/-HHHHMM

Representational Format

Value

Statutory Legislation

S 38 and 40 Workers Compensation Act 1987

Notes

The layout cannot be more than 7 digits and if it is, the insurer must split down the payment transactions into multiple transactions and allocate the relevant hours across the relevant transactions.

C: 2.5.12   Reimbursement schedule code

Description

Identifies the wage payment agreement between an insurer and employer OR an insurer and worker

Record set

"Compensation Payment and Recovery"

Start position

74

End position

75

Length

2

Size

2

Applies to

NI

Representational Layout

NN

Representational Format

Code

Notes

If not applicable or no reimbursement schedule exists, enter 00

C: 2.5.15   Payee ID

Description

This identifies the entity receiving payment for services provided.

Record set

"Compensation Payment and Recovery"

Start position

86

End position

105

Length

20

Size

20

Applies to

All

Representational Format

Text

Notes

When reporting this field, you must not include any spaces.

C: 2.5.16   Service provider ID

Description

Identifies the entity that provided the service.

Record set

"Compensation Payment and Recovery"

Start position

106

End position

125

Length

20

Size

20

Applies to:

All

Representational Format

Text

Notes

When reporting this field, you must not include any spaces.

C: 2.5.17   Payment classification number

Description

Identifies the type of payment being made by an insurer.

Record set

"Compensation Payment and Recovery"

Start position

126

End position

140

Length

15

Size

15

Applies to:

All

Representational Format

Text

Code Value Set

AMA SIRA allocated number including legal cost regulation

Notes

C: 2.5.18   Date of service

Description

The date the service was provided.

Record set

"Compensation Payment and Recovery"

Start position

141

End position

148

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Notes

C: 2.5.19   Determined weekly benefit amount

Description

The maximum weekly benefit entitlement amount for one week relating to the payment period.

Record set

"Compensation Payment and Recovery"

Start position

149

End position

156

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Divisions 1, 2, 3 and 4, particularly sections 34, 35, 36, 37, 38, 39, 40, 41, 42, 44C and 44G of the Workers Compensation Act 1987 No70.

Notes

C: 2.5.20  Invoice number

Description

The unique identifier on the tax invoice or receipt for reimbursements.

Record set

"Compensation Payment and Recovery"

Start position

157

End position

176

Length

20

Size

20

Applies to

NI

Representational Format

Text

Notes

If not reported, set to NA.

C: 2.5.21   Hours lost

Description

The number of hours and minutes in the weekly benefit payment period during which the worker was absent from work.

Record set

"Compensation Payment and Recovery"

Start position

177

End position

183

Length

7

Size

7

Applies to

All

Representational Layout

+/-HHHHMM

Representational Format

Value

Statutory Legislation

s36, 37, 38 Workers Compensation Act 1987

Notes

The figure in this field must be reported in hours and minutes.

Where Hours Lost (C: 2.5.21) is zero, report as +000000

C: 2.5.22  Earnings

Description

The worker’s earnings or deemed earnings in the weekly benefit payment period.

Record set

"Compensation Payment and Recovery"

Start position

184

End position

194

Length

11

Size

11

Applies to

All

Representational Layout

+/-NNNNNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, section 44l of the Workers Compensation Act 1987.

Notes

Where the earnings are determined to be an amount of zero, report as +0000000000.

C: 2.5.23  Deductibles

Description

The monetary value that a worker receives as ‘payment in kind’ in the weekly benefit payment period.

Record set

"Compensation Payment and Recovery"

Start position

195

End position

205

Length

11

Size

11

Applies to

All

Representational Layout

+/-NNNNNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, section 44C, 44D, 44E, 44F, 44G and 44H of the Workers Compensation Act 1987

Notes

Where the deductibles are determined to be an amount of zero, report as +0000000000.

Record Set 2 WCIDRR01-036     Record Identifier 6: Estimate Record

There will be an estimate record for each applicable estimate type within each claim where an estimate is required. This is reported on the submission. Estimate amounts do not carry forward from previous submissions. Where an estimate amount has not changed from a previous submission, the same value must be reported. Estimate records are not to be reported for closed claims.

This record contains:

• C: 2.6.1 Record Set
• C: 2.6.2 Claim identifier
• C: 2.6.3 Record identifier
• C: 2.6.4 Estimate type
• C: 2.6.5 Estimate amount

C: 2.6.6 Estimated future weeks off employment

Notes

Estimate data is provided as at the submission end date. Report all estimates for each claim on the submission.  If they haven’t changed since the previous submission they must still be reported if the claim is otherwise reported (i.e. for changes in some other data).

Estimates represent the estimate of outstanding liability and shouldn’t include payments already made.  Similarly, estimated recoveries represent the estimated amount to be recovered and shouldn’t include recoveries already made.

The sum of the estimates of outstanding liability and estimated recoveries reported on estimate records for a claim will be checked against the total estimate figure and total estimated recovery figure respectively, reported in the claim control record. Any inconsistency will cause the claim to be rejected.

Do not report zero estimate values.  Where zero is reported in the total estimate figure and total estimated recovery figure reported in the claim control record then there must not be any estimate or estimated recovery records for that claim on the submission.

There must be only one estimate record for each estimate type applicable to a claim.

Estimate records should not be reported where the Liability Status Code is equal to 01, 06, 09, or 12.

C: 2.6.1    Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Estimate"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.6.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Estimate"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C: 2.6.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Estimate"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '6' for an estimate record.

C: 2.6.4    Estimate type

Description

Identifies the type of estimate of future liability.

Record set

"Estimate"

Start position

22

End position

23

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Notes

C: 2.6.5    Estimate amount

Description

The amount of the estimate, reported in dollars and cents.  Reported as at the submission end date

Record set

"Estimate"

Start position

24

End position

35

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

Where an estimate type is not reported, the value for that estimate type is deemed as being zero.

C: 2.6.6    Estimated future weeks off employment

Description

The number of future weeks that the worker is expected to have off work

Record set

"Estimate"

Start position

36

End position

41

Length

6

Size

6

Applies to

All

Representational Layout

+/-NNNNN

Representational Format

Value

Accuracy Level % 100

Notes

Report weeks to one decimal place, e.g. 1 day is 0.2 weeks and reported as +00002.

If not applicable set to 000000.

Record Set 2  WCIDRR01-037 Record Identifier 7: Basic Claim Detail No 2 Record

There can only be one Basic claim detail No. 2 record for each claim reported on the submission. This record must be reported for every new claim. If there has been no change in the data since the previous submission, then it is not necessary to re-report this record unless a new claim state or event has been triggered.

This record contains:

• C: 2.7.1 Record Set
• C: 2.7.2 Claim identifier
• C: 2.7.3 Record Identifier
• C: 2.7.4 Worker’s surname
• C: 2.7.5 Worker’s given name/s
• C: 2.7.6 Accident location - Street information
• C: 2.7.7 Worker (mobile) telephone number
• C: 2.7.8 Worker (work) telephone number
• C: 2.7.9 Ordinary earnings
• C: 2.7.10 Shift allowance
• C: 2.7.11 Overtime
• C: 2.7.12 Worker's email address

C: 2.7.1      Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Basic Claim Detail No 2"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for claim

C: 2.7.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Basic Claim Detail No 2"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Accuracy Level % 100

Notes

Must be specified.

C: 2.7.3    Record Identifier

Description

The identifier code of the record within the data submission

Record set

"Basic Claim Detail No 2"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '7' for a Basic Detail (2).

C: 2.7.4    Worker’s surname

Description

The surname of the worker.

Record set

"Basic Claim Detail No 2"

Start position

22

End position

41

Length

20

Size

20

Applies to

All

Representational Format

Text

Notes

Full Surname required.

Must not be spaces or zeros.

'Care of' names are not to be included.

No digits are to be included.

Special characters (for example: hyphens, apostrophes) that form part of the names must be included; no other special characters are to be recorded in the name field.

C: 2.7.5    Worker’s given name/s

Description

The given names of the worker.

Record set

"Basic Claim Detail No 2"

Start position

42

End position

61

Length

20

Applies to

All

Representational Format

Text

Notes

Full Given Names required.

Title is not to be supplied.

Multiple given names must only be separated by a single space.

No digits are to be included.

Special characters (for example: hyphens, apostrophes) that form part of the names must be included; no other special characters are to be recorded in the name field.

C: 2.7.6    Incident location - Street information

Description

Incident location - street information

Record set

"Basic Claim Detail No 2"

Start position

62

End position

181

Length

120

Size

120

Applies to

All

Representational Format

Text

Notes

Where the injury occurred at the normal workplace, set to NA.

C: 2.7.7    Worker (Mobile) telephone number

Description

The worker's mobile telephone number.

Record set

"Basic Claim Detail No 2"

Start position

182

End position

195

Length

14

Size

14

Applies to

All

Representational Format

Text

Notes

Mobile number must be reported as NA where worker does not have mobile phone.

C: 2.7.8    Worker (Work) telephone number

Description

The worker's work (place of employment) telephone number.

Record set

"Basic Claim Detail No 2"

Start position

196

End position

209

Length

14

Applies to

All

Representational Format

Text

Notes

For Australian landline report only the area code and phone number. Do not include International codes.

International telephone numbers require the international country code included.

If not applicable set to NA

C: 2.7.9    Ordinary earnings

Description

The average of the worker's ordinary earnings before the injury expressed as a weekly sum.

Record set

"Basic Claim Detail No 2"

Start position

210

End position

217

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, sections 44C, 44E, 44F, 44G, 44H and Schedule 3 of the Workers Compensation Act 1987

Notes

C: 2.7.10   Shift allowance

Description

Shift allowance paid or payable before the injury, expressed as a weekly sum.

Record set

"Basic Claim Detail No 2"

Start position

218

End position

225

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, section 44C of the Workers Compensation Act 1987

Notes

This data item is not to be set to zero or removed once the first 52 weeks of payable weekly payments has occurred.

Where the Shift Allowance is determined to be an amount of zero, report as +0000000.

C: 2.7.11    Overtime

Description

Overtime paid or payable to the worker, expressed as a weekly.

Record set

"Basic Claim Detail No 2"

Start position

226

End position

233

Length

8

Size

8

Applies to

All

Representational Layout

+/-NNNNNNN

Representational Format

Value

Statutory Legislation

Part 3, Division 2, sub Division 4, section 44C of the Workers Compensation Act 1987

Notes

This data item is not to be set to zero or removed once the first 52 weeks of payable weekly payments has occurred.

Where the Overtime is determined to be an amount of zero, report as +0000000.

C: 2.7.12   Worker's email address

Description

The worker's email address

Record set

"Basic Claim Detail No 2"

Start position

234

End position

487

Length

256

Applies to

All

Representational Format

Text

Notes

If not applicable leave blank

Record Set 2 WCIDRR01-038     Record Identifier 8: Work Capacity Record

There can be multiple Work Capacity Decision records reported on a claim, with the Original decision date (C: 2.8.4) and Work capacity decision type (C: 2.8.5) being the key to identifying a unique decision.

There may be multiple Work capacity decisions reported for each Work capacity decision type (C: 2.8.5). The different Original decision date (C: 2.8.4) identifies each decision set as unique.

Where multiple records (set) exist in a submission for the same claim then after the first 31 characters have been sorted, the records must be in order of activity with the last in the set displaying the latest view of that decision.

This record contains:

• C: 2.8.1 Record Set
• C: 2.8.2 Claim identifier
• C: 2.8.3 Record identifier
• C: 2.8.4 Original decision date
• C: 2.8.5 Work capacity decision type
• C: 2.8.6 Work capacity review stage
• C: 2.8.7 Work capacity date type
• C: 2.8.8 Work capacity activity date
• C: 2.8.9 Work capacity outcome

C: 2.8.1             Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Work Capacity"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record

C: 2.8.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Work Capacity"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Notes

Must be specified.

C: 2.8.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Work Capacity"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '8' for a work capacity record.

C: 2.8.4    Original decision date

Description

The date the insurer issued the original decision notice to the worker.

Record set

"Work Capacity"

Start position

22

End position

29

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Section 43 Workers Compensation Act 1987

Notes

C: 2.8.5    Work capacity decision type

Description

Identifies the type of Work Capacity Decision.

Record set

"Work Capacity"

Start position

30

End position

31

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Section 43 Workers Compensation Act 1987

Notes

C: 2.8.6   Work capacity review stage

Description

Identifies the stage of the work capacity decision.

Record set

"Work Capacity"

Start position

32

End position

33

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Section 43 Workers Compensation Act 1987

C: 2.8.7    Work capacity date type

Description

Type of activity that relates to the date reported

Record set

"Work Capacity"

Start position

34

End position

35

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Section 44A Workers Compensation Act 1987

Notes

C: 2.8.8   Work capacity activity date

Description

The date the work capacity activity occurs

Record set

"Work Capacity"

Start position

36

End position

43

Length

8

Size

8

Applies to

All

Representational Layout

YYYYMMDD

Representational Format

Date

Statutory Legislation

Section 44B Workers Compensation Act 1987

Notes

C: 2.8.9    Work capacity outcome

Description

The result of the work capacity assessment or work capacity assessment review

Record set

"Work Capacity"

Start position

44

End position

45

Length

2

Size

2

Applies to

All

Representational Layout

NN

Representational Format

Code

Statutory Legislation

Section 44B Workers Compensation Act 1987

Notes

Record Set 2 WCIDRR01-039     Record Identifier 9: Claim Control Record

There must be one Claim control record for each claim reported on the submission.

This record contains:

• C: 2.9.1 Record Set
• C: 2.9.2 Claim identifier
• C: 2.9.3 Record identifier
• C: 2.9.4 Claim payments to date
• C: 2.9.5 Claim recoveries to date
• C: 2.9.6 Total claim estimated liability
• C: 2.9.7 Total claim estimated recoveries
• C: 2.9.8 Hours paid total incapacity to date
• C: 2.9.9 No longer in use
• C: 2.9.10 No longer in use
• C: 2.9.11 Decreasing adjustment on settlement payments
• C: 2.9.12 Input tax credit on non-settlement payments
• C: 2.9.13 Estimate of decreasing adjustment
• C: 2.9.14 Estimated input tax credits
• C: 2.9.15 Hours lost to date

C: 2.9.1             Record set

Description

Identifies the type of data in the record as either claims or policy.

Record set

"Claim Control"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '2' for a claim record.

C: 2.9.2    Claim identifier

Description

The identifier allocated to the claim by the insurer

Record set

"Claim Control"

Start position

2

End position

20

Length

19

Size

19

Applies to

All

Representational Format

Text

Notes

Must be specified.

C: 2.9.3    Record identifier

Description

The identifier code of the record within the data submission

Record set

"Claim Control"

Start position

21

End position

21

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '9' for a claim control record.

C: 2.9.4    Claim payments to date

Description

The total payments on the claim as at the submission end date.

Record set

"Claim Control"

Start position

22

End position

33

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

C: 2.9.5    Claim recoveries to date

Description

The total amount of recoveries on the claim as at the submission end date.

Record set

"Claim Control"

Start position

34

End position

45

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

C: 2.9.6    Total claim estimated liability

Description

The total of estimates of outstanding liability on the claim as at the submission end date.

Record set

"Claim Control"

Start position

46

End position

57

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

Where there are no estimates on a claim, insurer's must enter zero in this field.

C: 2.9.7    Total claim estimated recoveries

Description

The total of estimated recoveries on the claim as at the submission end date.

Record set

"Claim Control"

Start position

58

End position

69

Length

12

Size

12

Applies to

All

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

Where there are no estimated recoveries on a claim, insurer's must enter 000000000000 in this field.

C: 2.9.8    Hours paid total incapacity to date

Description

The total of hours paid for total incapacity on the claim as at the submission end date.

Record set

"Claim Control"

Start position

70

End position

78

Length

9

Size

9

Applies to

All

Representational Layout

+/-HHHHHHMM

Representational Format

Value

Notes

C: 2.9.11    Decreasing adjustment on settlement payments

Description

The total amount of decreasing adjustment payments that the insurer has claimed against settlement payments on the claim at the submission end date.

Record set

"Claim Control"

Start position

91

End position

102

Length

12

Size

12

Applies to

NI

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

C: 2.9.12   Input tax credit on non-settlement payments

Description

The total amount of all input tax credits that the insurer has claimed against non-settlement payments on the claim at the submission end date.

Record set

"Claim Control"

Start position

103

End position

114

Length

12

Size

12

Applies to

NI

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes

C: 2.9.13   Estimate of decreasing adjustment

Description

The estimate of the decreasing adjustment which will be claimed on the GST which will be paid on the Outstanding Liabilities relating to the settlement of the claim.

Record set

"Claim Control"

Start position

115

End position

126

Length

12

Size

12

Applies to

NI

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

C: 2.9.14   Estimated input tax credits

Description

An estimate of the Input Tax Credits that will be claimed for the GST which will be paid on the Outstanding Liabilities relating to non-settlement (or management costs) of the claim.

Record set

"Claim Control"

Start position

127

End position

138

Length

12

Size

12

Applies to

NI

Representational Layout

+/-NNNNNNNNNNN

Representational Format

Value

Notes:

C: 2.9.15   Hours lost to date

Description

The total sum of hours lost on the claim as at the submission end date.

Record set

"Claim Control"

Start position

139

End position

147

Length

9

Size

9

Applies to

All

Representational Layout

+/-HHHHHHMM

Representational Format

Value

Notes

The figure in this field must be reported in hours and minutes.

Record Set 9 WCIDRR01-040     Claim Submission Trailer Record

Must be the last record on the submission.

This record contains:

• C: 9.1 Record Set
• C: 9.2 Basic claim detail (1) record count
• C: 9.3 Claim activity record count
• C: 9.4 Time lost record count
• C: 9.5 Service provision record count
• C: 9.6 Compensation payment and recovery record count
• C: 9.7 Estimate record count
• C: 9.8 Claim control record count
• C: 9.9 Total payment/recovery amount
• C: 9.10 Basic claim detail record 2 record count
• C: 9.11 Work capacity record count

C: 9.1                Record set

Description

Identifies the record as a Submission Trailer Record

Record set

"Claim Submission Trailer"

Start position

1

End position

1

Length

1

Size

1

Applies to

All

Representational Layout

N

Representational Format

Number

Notes

Must contain '9' for a Submission Trailer Record.

C: 9.2       Basic claim detail (1) record count

Description

The count of the number of the Basic claim detail records (Record Set 2 - Record identifier 1) on the submission

Record set

"Claim Submission Trailer"

Start position

2

End position

8

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

Notes

Must be the count of the number of Basic claim detail records (Record Set 2 - Record identifier 1) on the submission.

C: 9.3       Claim activity record count

Description

The count of the number of claim activity records (Record Set 2 - Record identifier 2) on the submission

Record set

"Claim Submission Trailer"

Start position

9

End position

15

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

Notes

Must be the count of the number of claim activity records (Record Set 2 - Record identifier 2) on the submission.

C: 9.4       Time lost record count

Description

The count of the number of time lost records (Record Set 2 - Record identifier 3) on the submission

Record set

"Claim Submission Trailer"

Start position

16

End position

22

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.5       Service provision record count

Description

The count of the number of Service provision records (Record Set 2 - Record identifier 4) on the submission

Record set

"Claim Submission Trailer"

Start position

23

End position

29

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.6       Compensation payment and recovery record count

Description

The count of the number of compensation and recovery records (Record Set 2 - Record identifier 5) on the submission

Record set

"Claim Submission Trailer"

Start position

30

End position

36

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.7       Estimate record count

Description

The count of the number of estimate records (Record Set 2 - Record identifier 6) on the submission

Record set

"Claim Submission Trailer"

Start position

37

End position

43

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.8       Claim control record count

Description

The count of the number of claim control records (Record Set 2 - Record identifier 9) on the submission

Record set

"Claim Submission Trailer"

Start position

44

End position

50

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.9       Total payment/recovery amount

Description

The total of all the payment/recovery amounts specified in all the compensation payment and recovery records on the submission

Record set

"Claim Submission Trailer"

Start position

51

End position

65

Length

15

Size

15

Applies to

All

Representational Layout

+/-NNNNNNNNNNNNNN

Representational Format

Value

C: 9.10 Basic claim detail record 2 record count

Description

The count of the number of the Basic claim detail 2 records (Record Set 2 - Record identifier 7) on the submission

Record set

"Claim Submission Trailer"

Start position

66

End position

72

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

C: 9.11       Work capacity record count

Description

The count of the number of the Work capacity records (Record Set 2 - Record Identifier 8) on the submission.

Record set

"Claim Submission Trailer"

Start position

73

End position

79

Length

7

Size

7

Applies to

All

Representational Layout

NNNNNNN

Representational Format

Number

Reference data

WCIDRR01-041      SIRA relies on externally and internally sourced reference data to verify the information submitted by insurers and stored in the SIRA Corporate Data Repository. Insurers and SIRA will be required to collaboratively utilise the same reference data to ensure consistent data quality and content in related systems.

WCIDRR01-042     Reference data can be regarded as tables that provide a valid source of information that can be used to validate information gathered and maintained within the system. Some form of reference data will be available to insurers for population into their own claims and policy system. SIRA will verify data reported by insurers with these reference tables.

WCIDRR01-043     The application of reference data can be found within the reporting requirements section of this document.

WCIDRR01-044     The following table is an example of the reference data; the rationale and responsibilities involved for successful implementation and ongoing management.