This data management bulletin assists insurers with coding of injury nature, injury location and multiple injuries including the intent of the data usage.
The requirement to report injury nature and injury location is specified within the Workers' compensation insurers' interface data specifications (PDF, 1.7 MB) or the monthly insurer interface as per 4.2.16 – Injury location and 4.2.17 – Injury nature. All injuries, even where only one injury has been sustained, must be reported as per section 4.16 – Multiple injuries.
Business practice and guidance notes
The Workers' Compensation Regulator uses the Type of Occurrence Classification System (TOOCS) for the coding and validation of injury nature and injury location. We use three versions of the TOOCS, applied in the following order:
- claims intimated from 01/07/2006 use TOOCS v3.1
- claims intimated from 01/07/2005 to 30/06/2006 use TOOCS v3
Once a primary injury flag has been allocated to a multiple injury record it must not change, as it is used in the key to reference this data in any subsequent data transfers.
An exception to this rule is where further medical information indicates that the first identified injury is not the primary injury. For example; a claim is received with an injury to the right leg, further medical information advises that this is a secondary injury and the primary is an injury to the lower back.
The identifier should not change for purposes of the primary injury settling prior to a secondary injury. For example; a claim is received with a physical injury. As a result of this injury the worker sustains a psychological injury. The worker recovers from the physical injury but continues to be certified with a psychological injury. For the purposes of maintaining correct injury nature and location data, the physical injury is to remain as the primary injury and the psychological injury as secondary.
National Data Set requirements
The injury nature and injury location combination must comply with the coding standards as specified by Work Safe Australia. To assist with the coding methodology, we encourage insurers to review the TOOCS v3.1 manual from Work Safe Australia. In particular, section B – Coding guidelines of TOOCS v3.1 includes useful information to assist coding of the injury nature and injury location. The coding guidelines also assist with:
- identifying the most serious injury or disease and body location affected
- coding of multiple injuries and locations, including the Ranking of injuries table
- coding of repetitive strain and occupational overuse syndrome injuries
- coding of back injuries
- coding of soft tissue injuries.
More information on the workers compensation is available at Safe Work Australia.
For more information
Email Data and Evaluation Services on email@example.com