Claim Information

This screen contains much of the data you may need for complex claims, especially if litigation is involved.

Label	Description
Injury ID	Check to ensure you are working on the appropriate injury for patients who may have more than one injury record.
Subrogated	Check this box if the employer or insurer is entitled to reimbursement for money paid in medical and lost-time benefits for the injured worker, based on receiving funds later from another source.
Certification Type	Does the employer accept the certification of the claim as a workers' compensation case? `N` - No, rejects validity of claim `U` - Partial rejection, with clarification provided in Certifier Description `Y` - Yes, accepts certification of claim
Date Claim Certified	Date the claim was certified by the employer as a workers' comp case.
Certifier	Full name and title of company representative.
Certifier Description	Memo where you can record the employer's rationale for allowing the claim for certain listed conditions or enter other remarks pertinent to the claim.
Date Reported to MCO	Date the clinic reported the injury to the appropriate agency. Providers are sometimes required to report the employee's injury to an MCO or a state agency within a specified time after the initial treatment or visit.
Active Code	Does an active claim exist? Enter `Y`, `N`, or leave blank. Claims with activity within a period defined by the insurer are considered active claims. Claims with no activity within a period of time defined by the insurer are considered inactive.
Act/Inact Date	Date the Active/Inactive status took effect.
Date of Application	Date the claim was filed with the insurer.
Claim Status Code	Status of the claim after the insurer has completed an initial investigation of the claim. Choose from 14 possible codes from the drop-down list (a description of each appears in the status bar in the upper right portion of your screen).
Claim Status Date	Date associated with the status code of the claim.
Employer Pay Bills	Enter `Y` if the employer pays medical bills associated with this injury, `N` if the employer does not pay the bills.
Claim Assignment	Upon receipt of the First Notice of Injury the claim is assigned to insurer representatives who determine compensation issues. Enter the name of the person assigned.
Date $ Limit Reached	If the employer is paying the medical bills for the injury and has reached the payment limit, enter the date here.
Original Claim Number	Original claim number issued when you first record an injury in the Injuries table. This field is not editable.
Plan Begin Date	Date the medical management of the claim began.
Date Claim Settled	Date of agreement among the insurer, employer, and injured worker to pay a sum of money to resolve all past, present, or future medical liabilities of the claim.
Approve	Check the box if the claim is approved as a workers' comp accident by the company, insurer, etc.
Decision	If the Dispute field has been checked, the result of the dispute should be entered here. From the drop-down list, choose `A` if the claim is accepted, `D` if the claim is denied, or leave blank if there is no decision yet.
Company Atty ID	Link to File Maintenance > Attorney - Collection Agencies to select the legal representative for the company for this injury.
Litigation	Check if any legal action has been filed in this case and enter the date in the adjacent field.
Dispute	Check if the denial of the claim has been disputed.
A/D Date	Date the claim was approved or denied.
Employee Atty ID	Link to File Maintenance > Attorney - Collection Agencies to select the legal representative for the patient for this injury.
Company Correspondence	For the company responsible for this claim, enter the contact person, address, and FEIN.