Chapter 91. Claims Reporting
16VAC30-91-10. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Claims reports" means FROI and SROI reports concerning an injury filed by or on behalf of an insurer or self-insurer with the commission pursuant to the requirements set forth in the implementation guide.
"Commission" means the Virginia Workers' Compensation Commission.
"EDI" or "electronic data interchange" means the method used to exchange data electronically between the commission and those organizations submitting claims reports to the commission.
"Filed electronically" means filed with the commission through EDI or through the Internet portal established by the commission for submission of claims reports, pursuant to the requirements set forth in the implementation guide.
"First report of injury" or "FROI" means the initial claims report filed with the commission concerning an injury.
"Implementation guide" means the Electronic Data Interchange (EDI) Implementation Guide, May 1, 2008 Edition, which contains requirements published and updated by the commission to be followed when claims reports are filed electronically with the commission.
"Insurer" means a company licensed to write workers' compensation coverage in Virginia.
"Minor injury" means an injury that meets none of the following seven reporting criteria:
1. Lost time or partial disability exceeding seven days.
2. Medical expenses exceeding $1,000.
3. Any denial of compensability.
4. Any disputed issues.
5. An accident that results in death.
6. Any permanent disability or disfigurement.
7. Any specific request made by the commission.
"Self-insurer" means an entity providing workers' compensation coverage directly to its employees based on formal approval by either the Virginia Workers' Compensation Commission or the State Corporation Commission.
"Subsequent report of injury" or "SROI" means a claims report filed with the commission after a FROI, which reports medical or indemnity payment activity about an injury or a decision to deny or no longer make payment on an injury.
Statutory Authority
§§ 65.2-201 and 65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 25, Issue 11, eff. March 4, 2009.
16VAC30-91-20. Procedures for filing claims reports.
A. By no later than July 1, 2009, all claims reports must be filed electronically with the commission.
B. The commission shall publish an implementation guide describing the requirements to be followed when claims reports are filed electronically with the commission. Any changes or updates to the implementation guide shall be published by the commission on an annual basis on or about September 1.
C. A FROI must be filed on all injuries in accordance with the implementation guide.
D. SROI reports concerning denials, indemnity payments, medical payments, and suspensions must be filed on all injuries that do not meet the definition of a minor injury in accordance with the implementation guide.
E. An injury that meets the definition of a minor injury may be reported as such to the commission on a FROI in accordance with the implementation guide. If an injury that is reported to the commission as being a minor injury subsequently fails to meet the definition of a minor injury, then an updated FROI on that injury, followed by required SROI reports, must be filed with the commission immediately, in accordance with the implementation guide.
Statutory Authority
§§ 65.2-201 and 65.2-900 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 25, Issue 11, eff. March 4, 2009.
Forms (16VAC30-91)
First Report of Injury (rev. 5/1/08).
Documents Incorporated by Reference (16VAC30-91)
Electronic Data Interchange (EDI) Implementation Guide, Virginia Workers' Compensation Commission, May 1, 2008 Edition.