Data Management – Are you receiving claims from an insurer?
If you have commenced a self-insurance licence or have acquired a new business, you are responsible for the liability of all outstanding workers' compensation claims of that entity.
Some data management steps to assist you with managing the transfer of claims and the data entry requirements of claims previously managed by another insurer are:
- Obtain a list of all active claims from the previous insurer at the time of transfer.
- Agree to a date to receive the physical files of all active claims.
Workers' compensation system data requirements
- Ensure your workers' compensation system includes the new Licence and/or Employer Number for the new licence or acquired business.
- Ensure your workers' compensation system includes the valid WorkCover Industry Codes for each Employer Number under Licence.
- Ensure your workers' compensation system includes the ability to select the previous insurer code for the insurer who had liability for the claim prior to your acquisition.
Adding a previous insurer claim to your system?
Our data requirement for transferred claims at the time of Licence and/or Employer commencement is for the insurer to only enter 'active' claims into their workers' compensation system. When adding previous insurer claims to your system, there are some additional data steps required for the first data submission:
- Claim Number – insurers should continue to utilise your own claim numbering system when entering previous insurer claims.
- There is no requirement to include the previous insurer code as a prefix to your own claim number for the purposes of the data submission. We recommend insurers report the same claim number to the Workers' Compensation Regulator as used by the insurer within their claims management system.
- Previous Insurer Details – claims previously managed by another insurer should be indicated by completion of both the Previous Insurer Code and Previous Insurer's Claim Number. For further information, please refer to sections 4.2.25 and 4.2.26 of the workers' compensation insurer interface data specification.
- The data entry of a previous insurer claim should replicate the data as reported by the previous insurer. This includes using the same Lodgement Date, Claim Status changes and change dates, payment summary and compensation periods.
- Do not record the Lodgement or Claim Status dates as the date the new licence commencement or when the claim received by the new insurer.
If your system provider has arranged an electronic upload of the previous insurer active claims, please ensure that all records are activated for the reporting month. This is to ensure that data is not missing from the next data submission, such as injured worker, lodgements or claim status records.
We include additional validation as part of reporting previous insurer claims. This includes:
- if another insurer managed this claim, both previous insurer code and previous insurer claim number must be reported
- date of injury on the previous insurer claim must be the same as reported by the previous insurer
- injured worker date of birth on the previous insurer claim must be the same as reported by the previous insurer
- number of workdays lost on the current claim must be the same as or greater than those reported by the previous insurer
- the total payments by category and type on the current claim must be the same as or greater than those reported by the previous insurer.
If the previous insurer has not provided sufficient information to complete the data entry process, please request a complete claim extract of the previous insurer licence and member/policy from the Data and Evaluation Branch.
For more information
Email Data and Evaluation Services on email@example.com