Employers’ Report of Injury

The Employer’s Report of Injury module is an optional, add-on module
designed to assist you in filing a First Report of Injury (FROI) with the State. The module
allows you to:

·
Create a new report according to the state’s
current specifications and format.

·
Print the report and/or write selected fields to
an export file to be sent electronically to the state.

·
Determine whether adequate safeguards and
equipment were provided and if the employees used the safety measures.

·
Promote the report when a claim has been filed
to eliminate having to retype the relevant information.

Entering a New Employers’ Report

Creating a report is a simple
process. To begin, select New
FROI from a menu or click the New
button on the Employer’s Report result list.
When the Select Employee screen appears, use any of the lookup options
to find the desired record.

A record for the employee must
exist before a report of injury can be entered. If a record is not found, the
Employee must be
added.

The next step is to indicate
the state of jurisdiction. The employee’s state is selected
by default, but you may change it to that of the employer or choose another
state from the list.

Click Select to display the
screens for the specified state. Although every state has its own form for
filing purposes, much of the information is the same. To simplify the input
process for those companies that deal with multiple states, ATS has used the
same general layout for the screens regardless of the state.

For documentation purposes, we
have selected the screens for Illinois since that state uses the IAIABC form which is considered the standard. The General
section is shown below with the personal information such as the address, phone
number, date of birth and hire date read from the
employee’s record.  The employee’s name is
displayed in the title bar for your convenience.

Figure 4‑1: Employer’s Report Page -
General Section

Typically, you will be asked to
enter the additional information described below. Other fields may be provided
depending on the state of jurisdiction.

Field Name

Description

State
of Hire

The
state in which the employee was hired.

Days per Week

The
average number of work days/week.

Hours
per Day

The
average number of hours worked/day.

Day
of Injury Paid

A
check indicates that the employee was paid for the day on which the
injury/illness occurred.

Salary
Continued

A
check indicates that the employee is receiving his/her regular salary in lieu
of worker’s compensation benefits.

Wage

The
program calculates and displays the employee’s weekly salary.

Period

The
pay period is always “Weekly”since the State wants
to know the AWW.

NCCI Class Code

The
NCCI classification code may be required if it’s
on the state’s FROI.

Press <Alt>+2 or scroll down to
position to the Employer section that contains the employer and level
information. Note the Dept, Division, and Sub in the following example. The labels used to
identify the levels will vary depending on how your system has been set up with
the Administration- Configuration-Application Parameters menu.

Any information that is not
required by the IAIABC will have to be entered manually, but the standard
information in the following example will be displayed automatically if it
exists.

Figure 4‑2: Employer’s Report Page -
Employer Section

It is important to understand how the program
searches for the person’s employer in case some information is missing.
First, it looks at the levels specified for the employee to find a record
where the Employer box is checked. If one is not found, the program will see
if the employee’s region or state is marked as the employer. The client is
assumed to be the employer if no other one is found.

·
Level
3 (starting with Sub 3 and Sub 2 if used)

·
Level
2

·
Level
1

·
Region

·
State

·
Client

Information about the injury or illness should be
entered in the Detail section. Since each State form is different, the fields
will vary. The ones on the IAIABC form are shown below.

Figure 4‑3: Employer’s Report Page -
Detail Section

The following fields are on the
IAIABC form.
Depending on the state, the program may prompt you to enter additional
information.

Field Name

Description

Injury
Date

The
date of injury is required. A dialog will appear if there is an existing
report for the person on the same date.
Depending on what you see, continue entering the new report or exit
the program.

Time Began Work

The
(military) time the employee started to work (e.g. 1430) on the day of the
injury. The colon will be inserted for you.

Time
of Injury

The
time of injury in a military format.

Last
Work Date

The
last day the employee was at work.

Knowledge
Date

The
date the employer learned of the injury.

Disability
Start Date

The
date disability payments began (i.e. the first day lost due to the injury or
illness).

Report
Purpose Code

The
state’s code that describes the reason for submitting the report.

Location/Dept.

The
location where the injury or illness occurred.

County

The
county where the injury occurred.

Employer’s
Premises

A
check indicates that the injury/illness occurred at the work place.

Safeguards/safety
equipment provided

A
check indicates that the employer provided safety measures.

Safety Measures Used

A
check indicates that the employee used the safety measures that were
provided.

Returned
to Work

Check
the box and enter the date if the employee is back at work.

Fatal
Injury

A
check indicates that the employee died as a result of the injury/illness. If
so, enter the date of death.

The
fields in the Details section that indicate whether safety measures were provided
and/or used may not be required by the State, but ATS considers these
standard fields since they can provide valuable information for reporting
purposes.

All States require you to describe the incident in
detail. The fields in the Loss Description section indicate where the
information should be entered so the Report of Injury will be filled out
correctly.

Figure 4‑4: Employer’s Report Page –
Loss Description Section

The Loss Codes section allows you to enter more details about
the injury. The screen shown below will appear regardless of which state was
specified.

Although a state may not
request this information on the report, the loss codes you enter will be transferred along with other
pertinent data if the report is promoted to a claim. These fields may also
provide valuable information for reporting purposes.

Figure 4‑5: Employer’s Report Page –
Loss Codes Section

The Medical section is provided
so you may enter information on the initial treatment that was provided along
with the physician, hospital, or off-site facility that was involved.

The information on the screen
shown below is requested on the IAIABC form. Since more and more states are adopting
this form, the Medical tab will display this screen regardless of which state
you have specified.

Also note the Initial Treatment
code.  If this is required, someone with
the authority to maintain the Loss Codes must enter these codes before they can be used
in a report of injury.

Figure 4‑6: Employer’s Report Page –
Medical Section

The Admin section is shown
below. Many states request information on the company which will be handling
the injury report. This is your company if you are adjudicating your own claims
or doing business as a third-party administrator (TPA). In either case, the program
will automatically fill in the information if it has been entered in the Agent record. A sample screen is shown below.

If required, the Date Notified
may be interpreted differently on your state form. Although this is usually the
date the claim administrator or insurance carrier received the First Report of
Injury, in Massachusetts it is the
date the injury or illness was reported as work related. Please refer to the
help message when in doubt as to what to enter.

Figure 4‑7: Employer’s Report Page –
Administrator Section

All of the insurance carrier
information on the IAIABC form may be entered in the Carrier section. If your company is self-insured in
the state or has only one carrier, a system administrator may use the Field
Properties feature to enter the pertinent information as default values so it
does not have to be typed into each new report.

If the Policy module is in use, one may be attached after
the report of injury has been saved.

Figure 4‑8: Employer’s Report Page –
Carrier Section

The special fields on this
screen are described as follows:

Field Name

Description

Self-Insured

A
check will indicate that carrier is the self-insured employer.

Policy

The
carrier's policy that will used, if the report becomes a claim, plus the
dates it is valid.

Agent

The
agent’s code and name.

Insured’s
Number

The
insured’s report number to display on the FROI if necessary.

OSHA Case Number

The
OSHA case number, if it is different than the ATS
claim number.

State
Claim Number

The
claim number assigned by the state of jurisdiction.

The last section, Summary, contains the information
shown in the example below.

Figure 4‑9: Employer’s Report Page –
Summary Section

The fields on the screen are
described as follows:

Field Name

Description

Promoted
to Claim

The
program will check this box if the report is promoted. (See a later section.)

Claim Number(s)

The
claim number assigned when the report is promoted.
Depending on how your system has been set up, an alternate claim number may
be assigned at the same time.

EDI Date

The
date the record was batched for transmission to the State.  This may not be the date it was actually
transmitted.

Completed
By

The
name of the person submitting the Employer’s Report to the State. (Required)

Title

The
title of the person submitting the Employer’s Report.

Phone

The
phone number of the person submitting the Employer’s Report.

Date

The
date the Employer’s Report was completed.

Saving an Employer’s Report

After entering the relevant
information, click the Save button. If the “Required Fields
Missing” message appears in the title bar, enter the data and click Save
again.

Although
a State may require certain information on the reports, there are very few required
fields on the ATS screens because we realize that an operator may not have
all the information at the time the report is created. We don’t want to
create a situation where contrived information might have to be entered in
order to save the record.

After the report has been saved, the employee’s masked SSN
(with the last four digits), an asterisk, and a counter
to indicate the number of injuries the person has reported will be displayed in
the window’s title bar. For example, “XXX-XX-8987*0004” is the employee’s
fourth report of injury.

At this time, the Print
buttons have been activated. The EDI Export feature is also available. These topics are
covered separately.

The Print Options

Before printing the State’s First Report of Injury, we recommend that you use
the blue Print button to view the information that you have
entered on the form.  If you find
anything that is missing or incorrect, we suggest that you return to the ATS
program, make the necessary corrections, and select the blue Print
button again.

The File-Print Page menu or the corresponding gray Print
button is available if you want to print the contents of the screens.

The Notes and
Diary Options

The ATS Diary and Notes features may be accessed using the associated
toolbar buttons. Please refer to the Claims chapter for details on using the Notes
feature. The Diary is covered in a separate chapter in this manual.

New First Report Option

The New button on the toolbar or <Alt>+N
will display the Select Employee screen so you can create a new report without
returning to the Console or Result List.

Open First Report Option

The Open button on the toolbar or <Alt>+O
will display the Select FROI criteria so you can look up an existing Report
of Injury without returning to the Console or Result List. The search criteria screen is
the same as in the snapshot shown below.

Editing an Existing Report

Authorized users may view
and/or edit Reports of Injury.  The Selected FROIs
menu item opens the Employer’s Report Search Criteria page that provides you
with a wide variety of search options.

Figure 4‑10: Employer’s Report Search Criteria

The following list shows
employees whose last names start with the letter “S” and have filed a report
for an injury that occurred between January 1, 2015 and December 31, 2015.

Figure 4‑11: Employer’s Report Result
List

Note that if the Region feature has been implemented and Region View has been set in your user record, you will
only be able to see a list of employees who have filed a Report of Injury in
your assigned region(s).

Other menu options provide you
with additional ways of looking for First Reports you have created.

They are:

Menu Option

Function

Recent

Lists
the First Reports completed in the last seven days.

Unpromoted

Lists
the First Reports that have not been promoted to a claim.  All but three have not been promoted on the
above list,

Promoted

Lists
the First Reports that have been promoted.  Note the blue arrow is used to identify the
promoted claim.

All

Lists
all the First Reports with the most recent at the top of the list.

Once you have selected the desired report, the program
will display the record so the required changes may be made.

All the operations covered in
the next sections can be performed as the report is created.  With the exception of changing the State of Jurisdiction, which can be done at any
time, the features will become available after the Employer Report is saved.

Batching the Employer’s Report Data

After saving the Employer’s Report, the EDI Batch menu option may be used to write selected data
to a text file for export purposes. This dialog will appear so you can indicate
the type of report you wish to send. The data will vary depending on which
report (MTC) code is chosen.

Figure 4‑12: Employer’s Report EDI Batch Dialog

The EDI process varies by state. Please refer to the
separate EDI Export Utility document for details.

Promoting a Report of Injury

Many of the incidents that are
reported never result in a claim action. If the employee does file a claim, the
report may be promoted to claim status so the pertinent data does not have to
be retyped.

To
promote an Employer’s Report of Injury to a claim use the Promote
button after the report has been saved.

The program will:

1.
Attach a policy (optional) and assign a claim
number.

If the Policy module is in use, there must be a policy that
covers the Injury Date. The program will check the From/Thru Dates for
the policies and display a message if one does not exist. Otherwise, select a
policy from the list of those that are available.

The program will automatically assign a claim number based on the value of the Next Claim Number, set using the Application
Parameters page. If the Next Claim Number field contains
a number (not all zeroes), the program will assign it to the claim. Otherwise,
the program will use the Fiscal Year from the client’s record and the Injury
Date in the
employer’s report to determine which year code to use at the beginning of the
claim number. For example, if the Fiscal Year is “0701” and the Injury Date is
“09/01/2010”, the claim number will start with “11”.

Retired people can develop an illness such as hearing loss and asbestosis
related to the work they did. If that situation exists in your company, you may
choose to base the first two digits of the claim number on the Open Date instead of the Injury Date by entering “OPEN” in the Next Claim Number field.

If policies are used, the first two digits of the number may be overwritten by
the policy’s Claim Number Prefix, if
one exists.

2.
Create a claim with the pertinent information
from the Employer’s Report. The program will transfer
any relevant information to the new claim.

3.
Write the claim number(s) on the Summary section of
the report along with a check in the Promote to Claim field. Also display the
new claim number in the title bar.

4.
A warning message will appear if there is
already a claim for the employee with the same date of injury.

All
reports are promoted with a Claim Type of “N” for notation. The claims adjuster
will need to decide whether the claim is a medical or indemnity case and
update the Claim Type accordingly.