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Revision History |
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Type |
Effective Date |
Circular |
Notes |
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Original |
4/1/2014 |
2014 North Carolina Workers Compensation Statistical Plan Manual | |
This numeric code indicates whether the USR is a first or a subsequent report. Refer to Part 6 - Coding Values for applicable Report Number codes.
The sequence number indicates the USR correction within a particular report level. For example, the third correction to a 1st report USR would be submitted as USR number1 and USR correction sequence number 3. USR corrections must be submitted as 1 through 9 and then, if necessary, A through Z. If the number of USR corrections exceeds Z within a particular report level, contact the Bureau for further data reporting instructions.
This code identifies the type of USR correction report. Refer to Part 6 - Coding Values for applicable Correction Type Codes.
This alpha code (R) indicates that the USR is a replacement for a USR in a rejected status.
The numeric code assigned to the data reporter by NCCI.
The alpha-numeric code that uniquely identifies the policy.
The date that the policy or period became effective.
The policy effective date reported for the USR must equal the effective date of the policy except as described below for extended-term and three-year variable rate policies.
Extended-Term Policy (Policy Term Greater than 1 year and 16 days but less than 3 years):
When reporting the USR for the first period of an extended-term policy, the policy effective date for the corresponding USR must equal the effective date of the policy.
When reporting the USR for the second or third period of an extended-term policy, the policy effective date for the corresponding USR must equal the date the second or third period began, respectively, as shown on the policy period endorsement. Do not report the effective date of the policy. The USR effective date for the second period must be a year after the policy effective date, and the USR effective date for the third period, when applicable, must be two years after the policy effective date.
Three-Year Variable Rate Policy:
When reporting the USR for the first period of a three-year variable rate policy, the policy effective date reported for the corresponding USR must equal the effective date of the policy.
When reporting the USR for the second or third period of a three-year variable rate policy, the policy effective date reported for the corresponding USR must equal the date the second or third period began, respectively, as shown on the policy period endorsement. Do not report the effective date of the policy. The USR effective date for the second period must be a year after the policy effective date, and the USR effective date for the third period, when applicable, must be two years after the policy effective date.
The date the policy or period expired or was cancelled.
Report the cancellation date for a policy that was cancelled.
Extended-Term Policy (Policy Term Greater than 1 year and 16 days but less than 3 years):
When reporting the USR for the first period of an extended-term policy, the policy expiration date reported for the corresponding USR must equal the date the first period of the policy ends as shown on the policy period endorsement. Do not report the expiration date of the policy.
When reporting the USR for the second or third period of an extended-term policy, the policy expiration date for the corresponding USR must equal the expiration date of the second or third period, respectively, as shown on the policy period endorsement. The last period expiration date for the corresponding USR should equal the expiration date of the policy.
Three-Year Variable Rate Policy:
When reporting the USR for first period of a three-year variable rate policy, the policy expiration date reported for the corresponding USR must equal the date the first period of the policy ends as shown on the policy period endorsement.
When reporting the USR for the second or third period of a three-year variable rate policy, the policy effective date reported for the corresponding USR must equal the date the second or third period began, respectively, as shown on the policy period endorsement. Do not report the expiration date of the policy. The USR expiration date for the first period must be a year after the actual policy effective date, and the USR expiration date for the third period, when applicable, must be two years after the policy effective date. The last period expiration date for the corresponding USR should equal the expiration date of the policy.
The numeric code (32) that identifies North Carolina coverage.
The date North Carolina coverage was added mid-term to a multi-state policy. Do not report if North Carolina was included at policy inception.
The name of the person or business entity with whom the insurance contract was made.
Indicates the policy conditions that applied to the policy. Refer to Part 6 - Coding Values for specific Policy Condition codes.
The different type of policy provisions consists of Coverage, Plan and Non-Standard. Refer to Part 6 - Coding Values for specific Policy Type ID codes.
Indicates the type of losses subject to the deductible plan that applies to the policy. Refer to Part 6 - Coding Values for specific Losses Subject to Deductible codes.
Indicates the type of deductible plan that applies to the policy. Refer to Part 6 - Coding Values for specific Basis of Deductible Calculation codes.
The loss amount per claim and per accident to be paid by the employer, if applicable, as defined by the policy's deductible program.
The maximum loss amount for all claims to be paid by the employer, if applicable, as defined by the policy's deductible program.
Report ‘A’ to indicate ASWG (Advisory Statistical Working Group) format.
NOTE: The following fields are to be used when correcting the link data record (WCIO WC STAT Record Type 1):
Submit the report number code that was previously submitted.
Submit the correction sequence number that was previously submitted.
Submit the carrier code that was previously submitted.
Submit the policy number identifier that was previously submitted.
Submit the policy effective date that was previously submitted.
Submit the exposure state code that was previously reported.
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