Iowa EDI Claim and Reporting Compliance Handbook IOWA DIVISION OF WORKERS’ COMPENSATION July 2001 Iowa Division of Workers' Compensation EDI Release 2 Handbook This publication is the sole property of the International Association of Industrial Accident Boards and Commissions and the Iowa Division of Workers’ Compensation © International Association of Industrial Accident Boards and Commissions, 1998 © Iowa Division of Workers’ Compensation, 2000 I. TABLE OF CONTENTS II. INTRODUCTION .............................................................................................................4 General Overview .................................................................................................................................................................4 Iowa EDI Claim and Reporting Compliance Handbook ...............................................................................................4 Iowa EDI Objectives .....................................................................................................................................................4 Letter from the Commissioner ............................................................................................................................................5 Contact List.............................................................................................................................................................................6 Iowa Division of Workers’ Compensation.................................................................................................6 III. REPORTING REQUIREMENTS ......................................................................................7 Reporting Injuries in Iowa ......................................................................................................................................................7 Electronic Data Interchange ..........................................................................................................................................7 Why EDI? ...............................................................................................................................................................................7 Reporting Injuries in Iowa ......................................................................................................................................................7 Iowa, First in the Nation .........................................................................................................................................................8 Reporting Criteria ...................................................................................................................................................................9 Reports of Injuries 86.11..............................................................................................................................................9 Failure to Report 86.12.................................................................................................................................................9 86.10 Records of employer--right to inspect.................................................................................................................9 Electronic Data Interchange (EDI)…IAC Chapter 11.................................................................................................10 Representative within the state…IAC Chapter 2.........................................................................................................10 Who is responsible ......................................................................................................................................................11 Insurance of Liability 87.1 .........................................................................................................................................11 Relief from Insurance 87.11.......................................................................................................................................11 Professional Fire Fighters and Police Officers............................................................................................................11 Method of Transmission..............................................................................................................................................11 Format .........................................................................................................................................................................11 Forms...........................................................................................................................................................................11 Acknowledgements .....................................................................................................................................................11 Iowa DWC Criteria .....................................................................................................................................................12 Employee Identification Number.......................................................................................................................12 Employee Names ...............................................................................................................................................12 Postal Codes and Addresses...............................................................................................................................12 Rate Calculation.................................................................................................................................................12 Rate of Weekly Benefits....................................................................................................................................12 Commencement of Payment..............................................................................................................................13 Denial of Liability..............................................................................................................................................13 Names of Employers..........................................................................................................................................13 FEIN's ................................................................................................................................................................13 Medical Reports.................................................................................................................................................13 Burial Expense (85.28, 85.31, 85.42, 85.43, 85.44).........................................................................................13 Second Injury Fund Benefits (85.63 – 85.69)..................................................................................................14 Iowa Division of Labor/OSHA Criteria.............................................................................................................14 Time Limitations ...............................................................................................................................................14 Notice of Injury (85.23) ..........................................................................................................................14 Reporting of Claims (86.11)....................................................................................................................14 2 Iowa Division of Workers' Compensation EDI Release 2 Handbook Two-Year Statute of Limitation (85.26)..................................................................................................14 Three-Year Statute of Limitation (85.26)................................................................................................14 Confidentiality & Security.................................................................................................................................14 Denials and the EDI Standards ..........................................................................................................................14 Definitions...................................................................................................................................................................15 Forms ....................................................................................................................................................................................16 Instructions for Completing Iowa’s Revised First Report of Injury (FROI) ...............................................................17 GENERAL INFORMATION............................................................................................................................18 CLAIM ADMINISTRATOR.............................................................................................................................18 EMPLOYER......................................................................................................................................................18 POLICY.............................................................................................................................................................18 EMPLOYEE......................................................................................................................................................19 WAGE ...............................................................................................................................................................19