Part 4 - Losses and Expense Information

A.  Incurred Indemnity Losses

 

These losses consist of all paid and outstanding benefits, as defined below; including compensation paid to the deceased prior to death, burial expenses, payments to the state, employer’s liability losses and related expenses. Allocated loss adjustment expenses must be included in incurred indemnity for employer’s liability losses.

1. Death and Permanent Disability Claims
   
   Report each death claim unless the carrier has not incurred any liability. If payment is made prior to the death of a claimant and the carrier has not incurred liability on the death, report the loss on the basis of the injury prior to death.
   
   The amount reported as incurred indemnity must include all paid and outstanding benefits, including compensation prior to death, at the time of death (such as burial expenses) and following the death (such as to survivors and/or the North Carolina Second Injury Fund)
   
   The outstanding costs will be the carrier’s estimates of future payments with the following exceptions:

   1. The surviving spouse’s benefits that are not limited by duration or aggregate amount but are payable to the surviving spouse until death or remarriage must be calculated by using the appropriate table. Refer to Part 7-Pension Tables.

   2. The portion of the reserve representing the lump-sum dowry payable to the surviving spouse upon remarriage in death claims where benefits are not limited by duration or aggregate amount must be calculated by using the appropriate table. Refer to Part 7-Pension Tables.

   3. The portion of the reserve where there is no surviving spouse, but a parent, brother or sister receives lifetime benefits, must be calculated by using the appropriate table. Refer to Part 7-Pension Tables.

   4. For USL & HW claims, when valuing a surviving spouse's benefits when benefits are payable to the surviving spouse (widow or widower) until death or remarriage and are not limited by duration or aggregate; when a lump-sum dowry is payable to the surviving spouse upon remarriage and the benefits are not limited by duration or aggregate; or when benefits are payable for life and there is no surviving spouse but there is a parent, brother or sister, use the appropriate table. Refer to Part 7-Pension Tables.
       

2. North Carolina Second Injury Fund Reporting
   
   The North Carolina Workers Compensation Act specifies that, in connection with certain types of injury, a specified amount shall be paid into the North Carolina Second Injury Fund. The amounts paid into the fund are in addition to the compensation payable to the injured worker or the dependents and must be reported as incurred indemnity losses.
   
   Examples are: (1) payments in no dependent death claims and (2) a specified percentage of the permanent partial award.
   
   Any special payments assessed on the total premium writings or total losses paid or incurred must not be reported under this Plan. This includes North Carolina Second Injury Fund assessments paid to the state and not paid on a per claim basis.
   
   In all cases where a claim has been determined to be eligible for reimbursement to the carrier from the North Carolina Second Injury Fund, the gross incurred cost of the claim and the paid cost of the claim must be reduced by the amount of paid or anticipated reimbursement from the fund and the net incurred and net paid costs of the claim must be reported on the unit. The gross incurred cost of the claim is defined as the gross evaluation of the claim prior to any actual or expected recovery on which the reimbursement was based, whether or not the claim is still open. The net incurred cost of the claim is the gross incurred cost less net reimbursement.
   
   Anticipated reimbursement for the above purpose is defined as the amount of reimbursement expected based on:
    

   • The rules governing the North Carolina Second Injury Fund

   • A written agreement between the carrier and the North Carolina Second Injury Fund

   • Percentage of the incurred cost to be reimbursed to the carrier on a particular claim

   When the allocation of the recovery to indemnity and medical is not known, the net incurred loss must be divided between indemnity and medical losses in the same proportion as the gross incurred indemnity and medical amounts.
   
   When the reimbursement becomes known by the carrier or the reimbursement is paid to the carrier after the first reporting of the claim but within one year after the 5th report due date, a correction report must be filed reducing the incurred cost of the claim by the amount of the paid or anticipated reimbursement. Correction reports are only required for prior reports that reflect an amount higher than the net incurred cost.
   
   If reimbursement becomes known by the carrier or the reimbursement is paid to the carrier as of the 6th report due date or subsequent report due date, a correction report is not required. In these situations, all adjustments are reported at the next valuation date as long as the claim remains open.
   
   The submission of correction reports may impact experience modifications pursuant to the rules of the Experience Rating Plan Manual.
   
   Example:
   
   A claim was reported as $20,000 (1st report), $50,000(2nd report) and $70,000 (3rd report). A notification of an anticipated Second Injury Fund reimbursement in the amount of $35,000 was received between the 3rd and 4th report levels. The net incurred cost of the claim is the latest value minus the anticipated reimbursement: ($70,000-$35,000=$35,000). The net incurred cost of claim ($35,000) is less than the total incurred loss amounts reported on the 2nd and 3rd reports. Correction reports must be submitted for the 2nd and 3rd reports. A correction report is not needed for the 1st report because the net incurred cost of $35,000is higher than the $20,000reported on the 1st report.
   
   Refer to Part 5-Subsequent and Correction Reports for further information regarding correction reports.

B.  Incurred Medical Losses

Incurred Medical Losses include all payments to doctors and hospitals, as well as physical rehabilitation costs and reserves for future payments but shall not include any claim expense. These losses consist of all paid and outstanding benefits.

C.  Expenses Included in Losses

Expenses must be included in reported losses except as noted in Section D below.

1. Medical or Legal Expenses Incurred for the Benefit of the Claimant

Medical or legal expenses incurred for the benefit of the claimant or that the carrier is required to produce for the benefit of the claimant must be reported as either an indemnity or medical loss depending upon the nature of the expense.

 

2. Employers Liability Loss Adjustment Expenses

Employer’s liability losses must include allocated loss adjustment expenses. The entire amount of losses and allocated loss adjustment expenses must be reported as incurred indemnity losses on the unit statistical report.

 

3. Awards

When an award to a claimant includes the cost of witness fees, attorney fees, other court costs or expert medical witness fees, the amount so awarded will be considered as part of the cost of benefit and shall be included with the incurred indemnity reported. With respect to claims brought by persons against whom an employee has brought a third party common law action, such special costs must be reported as incurred indemnity losses whether or not a recovery is made against the third party by the employee.

 

4. Vocational Rehabilitation Evaluation/Testing Expense

Evaluation expenses (which are defined as costs incurred in testing and evaluating the claimant’s ability, aptitude or attitude in determining suitability for vocational rehabilitation or placement) must be reported as incurred indemnity loss if such evaluation services are purchased from outside vendors.

 

Evaluation expenses incurred by carrier personnel may be reported as incurred loss if such expenses are related to the activities of individuals (other than claims supervisors or claims adjusters engaged in efforts to return an injured worker to gainful employment)that, at a minimum, satisfy the qualifications established by the state having jurisdiction over the particular claim.

 

5. Physical Rehabilitation

Physical rehabilitation costs incurred due to the purchase of physical rehabilitation services from outside vendors must be reported as part of incurred medical loss. For the purposes of this rule, physical rehabilitation concerns all medical activities performed and/or services rendered, in the treatment of an industrial injury or disease to achieve maximum recovery, relief and/or cure. The following physical rehabilitation activities by medically trained persons, including registered nurses, performed by outside vendors must be reported as incurred medical losses:

• Various necessary evaluations and therapies including physical, occupational, speech and hearing

• Coordination of services such as necessary medical equipment or special nursing care in a facility or the home

• Necessary consultation(s) with physician(s)

• Monitoring the treatment and progress of a claimant’s medical condition

• Coordination of family, agency and community services to provide optimal recovery

Additionally, expenses associated with the above activities performed by carrier personnel (other than claims supervisors or claims adjusters efforts to return an injured worker to gainful employment) may also be reported as part of medical losses if the carrier personnel are medically trained as one of the following:

 

• Physicians

• Licensed registered nurses

• Licensed speech therapists

• Registered physical therapists

• Dentists and dental technicians

• Occupational therapists

• Chiropractors

• Podiatrists

• Licensed physician assistants

• Licensed cardio-pulmonary technicians

D.  Expenses Excluded from Losses

Medical or legal expenses incurred for the benefit of the carrier must be treated as loss adjustment expense and excluded from the paid and incurred loss amounts.

 

1. Allocated Loss Adjustment Expenses(ALAE)

 

ALAE encompass the following costs to a carrier which can be directly allocated to a particular claim:

1. Fees of attorneys or other authorized representatives where permitted for legal services.

2. Court, Alternate Dispute Resolution and other specific items of expense such as:

   • Medical examinations of a claimant to determine the extent of the carrier’s liability, degree of permanency or length of disability

   • Expert medical or other testimony

   • Autopsy

   • Witnesses and summonses

   • Copies of documents such as birth certificates, death certificates or medical treatment records

   • Arbitration fees

   • Surveillance

   • Cost of appeals such as bond costs or filing fees

3. Medical cost containment expenses incurred with respect to a particular claim, to ensure that only reasonable and necessary costs of services are paid. These expenses include:

   • Bill auditing expenses for medical services rendered, including hospital bills (inpatient or outpatient), nursing home bills, physician bills, chiropractic bills, medical equipment charges, pharmacy charges, physical therapy bills and medical vendor bills

   • Hospital and other treatment utilization reviews, including pre-certification/pre-admission, concurrent or retrospective reviews

   • Preferred provider network/organization expenses

   • Medical fee review panel expenses

4. Expenses which are not defined as losses and are directly related to and directly allocated to the handling of a particular claim for services which are required to be performed by statute or regulation.

 

2. Unallocated Loss Adjustment Expense(ULAE)

 

ULAE includes loss adjustment expenses that are not defined as part of allocated loss adjustment expenses. ULAE is excluded from paid losses, incurred losses and ALAE. ULAE includes but is not limited to:

1. Carrier employees’ salaries, overhead and travel expenses which are considered loss adjustment expenses and are not included while performing activities previously listed as allocated loss adjustment expenses.

2. Fees paid to independent claims professionals or attorneys (hired to perform the function of claim investigation normally performed by claim adjusters) for developing and investigating a claim so that a determination can be made of the cause, extent of responsibility for the injury or disease, including evaluation and settlement of covered claims.

3. Penalties for which the carrier is liable for reasons beyond its control that accrue as benefits to the injured worker or the injured worker's dependents, such as for interest on awards or for penalties imposed upon the employer for improper conversion of awards must be reported as indemnity losses. Whenever the reason for a penalty is within the carrier’s control, it should be reported as unallocated loss adjustment expense and not as loss.

E. Fraudulent Claims

1. Definition

A fraudulent claim for policies effective before April 1, 2013 is a claim that meets either of the following requirements:

• The claim has been ruled or declared fully fraudulent by a court decision

• The claim or a portion of the claim has been deemed to be partially fraudulent by a court decision

2. Reporting

 

1. Reporting Fraudulent Claims for Policies Effective On or After April 1, 2013

   • If a claim is ruled or declared to be fraudulent and does not include any paid losses, incurred losses and/or ALAE as of the 1st report valuation, the claim must not be reported.

   • If a claim is ruled or declared to be fraudulent and includes any paid losses, incurred losses and/or ALAE, the claim must be reported with the appropriate loss values and Claim Code 02-Fully Fraudulent.

   • If a claim is ruled or declared to be fraudulent after the 1st report valuation and prior to the 6th report, correction reports are required for all previously submitted unit reports. The paid losses, incurred losses and/or ALAE must reflect the loss values as of the specific report level and the claim must be reported with Claim Code 02-Fully Fraudulent.

   • If the claim is ruled or declared to be fraudulent after the 6th report valuation or subsequent report valuations, report the claim with Claim Code 02-Fully Fraudulent. The paid losses, incurred losses and/or ALAE must reflect the losses valued at the specific report level. Correction report(s) must not be reported for all previously submitted report levels.

The submission of correction reports may impact experience modifications pursuant to the rules of the Experience Rating Plan Manual.

 

NOTE: The Claim Code 02-Fully Fraudulent will be used when reporting all fraudulent claims for new and renewal policies effective on or after April 1, 2013.

 

2. Reporting Fully Fraudulent Claims for Policies Effective Prior to April 1, 2013

 

When the claim has been ruled or declared fully fraudulent, the whole cost of the claim must be netted to zero for unit statistical reporting.

 

• If the claim is deemed to be fully fraudulent prior to the 1st report level, the claim is considered non-compensable and is not to be reported.

• If the claim is deemed fully fraudulent subsequent to the 1st report level, but within one year after the 5th report due date of the unit report on which the claim appears, a correction report must be filed. Reduce the incurred claim cost to zero.

• If the claim is deemed to be fully fraudulent as of the 6th report due date or subsequent, reduce the incurred claim cost to zero at the next valuation date.

The submission of correction reports may impact experience modifications pursuant to the rules of the Experience Rating Plan Manual.

 

3. Reporting Partially Fraudulent Claims for Policies Effective Prior to April 1, 2013
    

   • When a claim or portion of the claim is deemed to be partially fraudulent, the cost of the claim must be netted down to reduce the net incurred loss by the declared fraudulent amount.

   • If the claim or portion of the claim is deemed to be partially fraudulent prior to the 1st report level, the net incurred cost of the claim must reflect the reduction of the claim by the partially fraudulent amount.

   • If the claim or portion of the claim is deemed to be partially fraudulent subsequent to the 1st report level but within one year after the 5th report due date of the unit report on which the claim appears, a correction must be filed. The cost of the claim must be netted down to reduce the net incurred loss by the declared fraudulent amount. This must be corrected on all report levels impacting the current and two prior modifications.

   • If the claim or a portion of the claim is deemed to be partially fraudulent as of the 6th report due date or subsequent, a correction report is not required. If the claim remains open, reduce the net incurred loss by the declared fraudulent amount at the next valuation date.

   • When a partially fraudulent amount has not been allocated into indemnity and medical components by the adjudicator, the net incurred loss must be divided between indemnity and medical losses in the same proportion as the original gross incurred indemnity and medical.

 

Example:

A claim has been reported as $10,000 (1st report), $50,000(2nd report) and $70,000 (3rd report). After the 3rd report, the claim was determined to be partially fraudulent with the partially fraudulent amount established at $35,000. The net incurred cost of the claim is the latest value of the claim minus the partially fraudulent claim amount ($70,000-$35,000=$35,000). The net incurred cost of $35,000is less than the claim value amount reported on the 2nd and 3rd reports. Correction reports must be submitted for the 2^nd and 3rd reports. No correction report is needed for the first report because the net incurred cost of $35,000 is higher than the $10,000 reported on the 1st report.

 

3. Fraudulent Claim Code

This code identifies claims that are fraudulent. Report each claim with the appropriate fraudulent claim code.

F. Non-compensable Claims

1. Definition
   
   A claim is considered to be non-compensable if it meets one or more of the following requirements:

   • There is an official ruling denying benefits

   • The claimant has failed to file for benefits

   • The claimant has failed to prosecute the claim following the insurer’s denial of the claim

2. Reporting
   
   Reporting Non-compensable Claims for Policies Effective on or After April 1, 2013

   • If a claim is determined to be non-compensable based on Part 4.F.1-Non-compensable Claim Definition and does not include any paid losses, incurred losses and/or ALAE, the claim must not be reported.

   • If a claim is determined to be non-compensable based on Part 4.F.1-Non-compensable Claim Definition and does include paid losses, incurred losses and/or ALAE, the claim must be reported with the appropriate loss values. Report the claim with Type of Settlement (Loss Condition) Code 05.

   • If a claim is determined to be non-compensable after the 1st report valuation and prior to the 6th report valuation based on Part 4.F.1-Non-compensable Claim Definition, correction reports are required for all previously submitted unit reports. The paid losses, incurred losses and/or ALAE must continue to reflect the loss values as of each specific report level and the claim must be reported with Type of Settlement (Loss Condition) Code 05.

   •  If the claim is determined to be non-compensable after the 6th report valuation or subsequent report valuations based on Part 4.F.1-Non-compensable Claim Definition, report the claim with Type of Settlement (Loss Condition) Code 05.  The paid losses, incurred losses and/or ALAE must reflect the losses valued at the specific report level. Correction report(s) must not be reported for all previously submitted report levels.

3. Loss Condition Code - Type of Settlement
   
   Non-compensable claims are to be reported with Type of Settlement Code 05.

G.  Subrogation and Third Party Cases

In all cases where there has been a recovery of loss due to subrogation, or where the injured worker or his dependents have recovered from a third party, the amount of loss reported must be the net incurred loss.

 

For subrogation cases, the net incurred loss is defined as the gross incurred loss (i.e., the gross evaluation of the claim prior to any actual or expected recovery on which the award was based, whether the claim is still open or not) minus the amount recovered less recovery expenses. When the recovery expenses exceed the amount recovered, report the gross incurred loss amount instead of the net incurred loss amount.

 

For cases involving recovery by the injured employee or his dependents, the net incurred loss shall be:

 

1. the deficiency, if any, between the outstanding compensation provided by the North Carolina Workers' Compensation law and the net amount of recovery actually collected by the claimant, and

2. any other incurred indemnity and medical losses not recovered by the carrier's lien on the proceeds of the claimant’s third party recovery or by a third party action pursued by the insurance carrier.
    

When recovery by the injured worker or his dependents relieves the carrier of the liability for further compensation benefits as, for example, in cases involving recovery without the consent of the carrier, or where the recovery exceeds all future compensation benefits due, the net incurred loss shall be the sum of all amounts paid and any amounts payable into Special Funds, less the net recovery, if any, received from the claimant or third party.

 

When the allocation of the recovery to indemnity and medical is not known, the net incurred loss must be divided between indemnity and medical losses in the same proportion as the original gross incurred indemnity and medical losses.

 

When the carrier is (1) relieved of liability for death benefits to dependents who have made a compromise settlement with a third party without the consent of the carrier, but (2) liable for to the dependents not involved in such settlement, the sum of the net liabilities for dependency groups (1) and (2), each calculated separately in accordance with the foregoing rules, shall be added to any other indemnity and medical losses to determine the net liability for the case.

 

When a subrogation recovery or reimbursement by a third party is received by the carrier after the 1st reporting of the claim but within one year after the fifth report due date, a correction report must be submitted when the net incurred loss amount is less than the previously reported total incurred loss amount. Correction reports are only required for prior reports that reflect an amount higher than the net incurred cost.

 

If a subrogation recovery becomes known by the carrier or when the subrogation recovery is paid to the carrier as of the 6th or subsequent report due date, a correction report is not required. All adjustments are reported at the next valuation date as long as the claim remains open.

 

The submission of correction reports may impact experience modifications pursuant to the rules of the Experience Rating Plan Manual

 

Example:

A claim has been reported as $10,000 (1st report), $50,000(2nd report) and $70,000 (3rd report). Subrogation recovery is received in the amount of $35,000between the 3rd and 4th reports and recovery expenses are $6,000. The net incurred cost of the claim is the latest value minus the recovery reduced for the recovery expenses ($70,000-[$35,000-$6,000]=$41,000). The net incurred cost ($41,000) of the claim is less than the claim amount reported on the 3rd and 2nd reports and correction reports must be submitted for the 3rd and 2nd reports.

 

Refer to Part 5-Subsequent and Correction Reports for further information regarding correction reports.

 

EXCEPTION: If the sum of the total recovery amount is less than 10% of the gross incurred cost of the claim, do not submit a correction report.

H.  Claim Components

1. Loss Amounts
   
   The required loss amount fields for each claim are as follows:

   1. Incurred Indemnity Amount

   2. Paid Indemnity Amount

   3. Incurred Medical Amount

   4. Paid Medical Amount

   5. Paid Allocated Loss Adjustment Expense (ALAE) Amount

2. Claim Number
   
   Submit the alphanumeric code that uniquely identifies a specific claim. If the claim number changes, correction reports are required for all previously reported levels.

3. Claim Count
   
   Cases to be counted as claims must be only those in connection with which a loss payment has been made or a loss reserve established. A case closed without loss payment shall not be counted as a claim. A claim on which more than one payment is made shall be counted only once. An accident resulting in two or more reported claims shall have each claim counted separately.

4. Accident Date
   
   The month, day and year in which the accident occurred. The accident date must be within the policy period.
   
   NOTE: The policy period does not include the policy expiration date. An accident that occurs on the last day of the policy must be included on the unit for the next policy period.

5. Classification Code

Submit the classification code corresponding to the injured employee's payroll determined in accordance with the rules of the
Basic Manual for Workers Compensation and Employers Liability Insurance.

No claim may be assigned to any classification unless exposure has also been reported for that classification. Report the classification code under which the injured employee's payroll is assigned, even if, at the time of injury, the employee may have been involved in an activity that would be classified differently.

Note:
Paid Furloughed Employees

Statistical Code 0012 - Paid Furloughed Employees and its associated rules are not applicable for new and renewal policies with effective dates on and after 12:01 a.m. on July 1, 2023.

Statistical Code 0012 - Paid Furloughed Employees and its associated rules are applicable for new, renewal, and in-force policies effective March 1, 2020 through June 30, 2023.

For any claims attributable to an employee occurring prior to or after a temporary layoff or an involuntary leave, report losses to the classification for work normally performed by the employee that corresponds to the employee's payroll. No claim can be reported to Code 0012 - Paid Furloughed Employees.

6. Injury Code (Injury Type)
   
   Report the two-digit code that corresponds to the carrier's estimate, as of the valuation date, of the ultimate injury type of the claim; it does not have to correspond to the type of benefit being paid as of the valuation date.
   
   

   1. Death
      Submit each death claim unless the carrier has not incurred any liability. If payment is made prior to the death of a claimant and the carrier has not incurred liability on the death, report the loss on the basis of the injury prior to death. The amount reported as incurred indemnity must include all paid and outstanding benefits, including compensation prior to death, at the time of death (such as burial expenses) and following the death (such as to survivors and/or the North Carolina Second Injury Fund). The outstanding costs will be the carrier’s estimates of future payments.

   2. Permanent Total Disability
      
      Submit as permanent total disability each claim which meets the requirements identified in the North Carolina Workers Compensation Act.

   3. Permanent Partial Disability
      
      Submit as permanent partial disability each claim which meets the requirements identified in the North Carolina Workers Compensation Act.

      1. For Claims with Accident Dates Effective on or After April 1, 2013
         
         Permanent partial losses are defined as any permanent injury that does not involve permanent total disability.

      2. For Claims with Accident Dates Effective Prior to April 1, 2013
         
         A permanent partial loss is defined as:

         1. Any permanent injury that does not involve permanent total disability.

         2. Any temporary injury that satisfies any one of the following criteria:

            1. The duration of disability benefits exceeds or is expected to exceed one full year. No loss is to be reported as temporary total if the duration of total disability exceeds or is expected to exceed 52 weeks.

            2. A lump sum settlement is made or, in the judgment of the carrier, will be required to settle future benefits.

            3. The extent of the liability for future payments cannot be determined.

      3. Permanent Partial Amount
         
         The amount entered as incurred indemnity shall include specific benefits and compensation for temporary disability as well as loss of earning capacity.

   4. Temporary or Temporary Partial Disability
      
      Submit as temporary every claim that involves or is expected to involve, indemnity benefits but does not constitute a case of death, permanent total disability or permanent partial disability as defined in the North Carolina Workers Compensation Act.

   5. Medical Only Claims
      
      Submit as medical only every claim that involves medical costs with no indemnity costs incurred or expected to be incurred. Do not report any data in the incurred indemnity field when reporting claims involving medical only losses.

   6. Contract Medical
      
      Contract medical costs that cannot be allocated to individual claims must be reported in the aggregate as incurred medical and must be assigned to the governing classification of the employer. Contract medical costs allocated to individual claims must be reported in connection with these claims and will not be included in the amount reported as contract medical. The amount reported as contract medical must be the actual incurred costs to the carrier for such medical contracts, including payment to physicians and hospitals under contract.

7. Claim Status Code
   
   Report the one digit code that indicates the status of the claim.

8. Loss Condition Code
   
   Report the loss condition codes as described in Part 6 - Coding Values - Loss Conditions:

   1. Act

   2. Type of Loss

   3. Type of Recovery

   4. Type of Claim

   5. Type of Settlement

9. Jurisdiction State Code
   
   Report the state code of the governing jurisdiction that will administer the claim and whose statutes will apply to the claim adjustment process when that state is not North Carolina. Refer to Part 6-Coding Values-Exposure State/Jurisdiction State for a list of state codes.

10. Lump Sum Claims

    1. Lump Sum Amount
       
       When the claim involves a lump sum representing the commuted value of a specific award or benefit, report the actual lump sum amount.

    2. Lump Sum Indicator
       
       Report the one-digit alpha code that is used to indicate whether the claim has been settled with a lump sum amount as described in Part 6-Coding Values-Lump Sum Indicator.

 

11. Injury Description Code (Part, Nature, Cause)
    
    Report the injury description code as described in Part 6 - Coding Values–Injury Description Code (Part, Nature, Cause):
     

    1. Part of Body
       
       The part of the body that is injured and expected to be the most significant contributor to the cost of the claim.
        

    2. Nature of Injury
       
       The nature of the claim.
        

    3. Cause of Injury
       
       The cause of the injury.
        

12. Update Type
    
    Report the alpha code that identifies the loss activity. Refer to Part 6 - Coding Values for the appropriate Update Type codes.
     

13. Catastrophe Number
    
    Any accident resulting in two or more reported claims must be reported as a catastrophe. All claims resulting from the accident are assigned a number beginning with 01. If there is more than one catastrophe under the policy, each succeeding catastrophe should be increased by one with the highest number available being 10. In the event the number of catastrophes under the policy exceeds 10, report another set of catastrophes beginning with 01. A separate set of catastrophe numbers beginning with 01 must be used for each policy. Numbers11 through 99 are reserved for Extraordinary Loss Event Catastrophe Numbers.
    
    ELE Catastrophe Number 12—COVID-19 (Coronavirus) Pandemic
    
    ELE Catastrophe Number 12 must be reported for claims attributable to the COVID-19 (coronavirus) pandemic with Accident Dates of 12/1/2019 through 6/30/2023. For claims reported with Catastrophe Number 12, the Nature of Injury Code 83–COVID-19 and Cause of Injury Code 83–Pandemic must also be reported.
    
    For claims attributable to COVID-19 (coronavirus) with Accident Dates on and after 7/1/2023, ELE Catastrophe Number 12 must not be reported. These claims must only be reported with Nature of Injury Code 83-COVID 19, and if applicable, these claims are also reported with Cause of Injury Code 83-Pandemic when the description of Pandemic applies to these claims, as described in Part 6 of the Statistical Plan. 
     

14. Managed Care Organization (MCO) Type
    
    Report the two digit code that corresponds to the type of organization which will administer the applicable medical losses. If the claimant is receiving treatment from more than one physician, report the MCO of the primary care physician. Refer to Part 6 - Coding Values for the appropriate Managed Care Organization (MCO) codes.
     

15. Occupation Description
    
    Include a narrative description of the regular occupation of the claimant.
     

16. Vocational Rehabilitation Indicator
    
    The alpha code that indicates the inclusion of vocational rehabilitation costs in the losses.
     

17. Fraudulent Claim Code
    
    This code identifies whether the claim is not fraudulent, partially fraudulent or fully fraudulent. Refer to Part 6 - Coding Values for the applicable Fraudulent Claim Code.
     

18. Paid Indemnity Amount
    
    Report the dollar amount of paid indemnity expenses for the claim as of the loss valuation date. These losses consist of all paid benefits due to an employee’s lost wages or inability to work, including compensation paid to a deceased prior to death, burial expense, claimant’s attorney fees, vocational rehabilitation benefits, payments to the state and employers liability losses and expenses.
     

19. Paid Medical Amount
    
    Report the whole dollar amount of medical losses paid for the claim as of the loss valuation date.
     

20. Allocated Loss Adjustment Expense (ALAE) Paid
    
    Report the dollar amount of allocated loss adjustment expense paid for this claim as of the loss valuation date.
     

21. Claim Count Total
    
    Submit the total number of claims reported for North Carolina. In the case of corrections and subsequent reports, this must be the revised total. Contract medical claims are not to be included in this total.
     

22. Incurred Indemnity Amount Total
    
    Submit the total of the Incurred Indemnity amounts reported for North Carolina within the USR. In the case of corrections and subsequent reports, this must be the revised total.
     

23. Incurred Medical Amount Total
    
    Submit the total of the Incurred Medical amounts reported for North Carolina within the USR. In the case of corrections and subsequent reports, this must be the revised total.
     

24. Paid Indemnity Amount Total
    
    Submit the total of the Paid Indemnity amounts reported for North Carolina within the USR. In the case of corrections and subsequent reports, this must be the revised total.
     

25. Paid Medical Amount Total
    
    Submit the total of the Paid Medical amounts reported for North Carolina within the USR. In the case of corrections and subsequent reports, this must be the revised total.
     

26. Paid Allocated Loss Adjustment Expense (ALAE) Amount Total
    
    Submit the total of the paid ALAE amounts reported for North Carolina within the USR. In the case of corrections and subsequent reports, this must be the revised total.