1 |
CURRENCY |
|
ICL_CURRENCY |
WAERS |
CUKY |
5 |
0 |
Currency |
TCURC |
2 |
CLAIM |
|
ICL_CLAIM |
ICL_CLAIM |
CHAR |
17 |
0 |
Number of Claim |
* |
3 |
EXCLAIMNO |
|
ICL_JURIS_CLAIMNO |
ICL_CLAIMNO |
CHAR |
20 |
0 |
Jurisdiction Claim Number |
|
4 |
JURISREGION |
|
ICL_JURISREGION |
REGIO |
CHAR |
3 |
0 |
Jurisdiction Region |
T005S |
5 |
JURISCOUNTRY |
|
ICL_JURICOUNTRY |
LAND1 |
CHAR |
3 |
0 |
Jurisdiction Country |
T005 |
6 |
PREP |
|
ICL_PREPARER |
BU_PARTNER |
CHAR |
10 |
0 |
Preparer |
* |
7 |
PREP_DESCR |
|
ICL_PREP_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Preparer Description |
|
8 |
PREP_SCR |
|
ICL_PREPARER |
BU_PARTNER |
CHAR |
10 |
0 |
Preparer |
* |
9 |
PREPAREDDATE |
|
ICL_EMP_PREPAREDDATE |
ICL_PREPARED_DATE |
DATS |
8 |
0 |
Date Prepared |
|
10 |
EMPL |
|
ICL_EMPLOYER |
BU_PARTNER |
CHAR |
10 |
0 |
Employer |
* |
11 |
EMPL_DESCR |
|
ICL_EMPL_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Employer Description |
|
12 |
EMPL_SCR |
|
ICL_EMPLOYER |
BU_PARTNER |
CHAR |
10 |
0 |
Employer |
* |
13 |
EMP_PAYROLL |
|
ICL_EMP_PAYROLL |
ICL_PAYROLL |
CHAR |
2 |
0 |
Employer Payroll |
TICL380 |
14 |
EMP_INDUSTRYCODE |
|
ICL_EMP_INDUSTRYCODE |
ICL_INDUSTRYCODE |
NUMC |
6 |
0 |
Industry Code |
TICL381 |
15 |
EMP_INDSTRCODEN |
|
ICL_EMP_INDUSTRYCODEN |
ICL_TEXT60 |
CHAR |
60 |
0 |
Industry Code Name |
|
16 |
EMP_UINUMBER |
|
ICL_EMP_UINUM |
ICL_EMP_UINUM |
NUMC |
9 |
0 |
Employer Unemployment Insurance Number |
|
17 |
EMP_NATOFBUS |
|
ICL_EMP_NATOFBUS |
ICL_NATURE_OF_BUSINESS |
CHAR |
6 |
0 |
Nature of Business |
TICL387 |
18 |
EMP_NATOFBUSN |
|
ICL_EMP_NATOFBUSN |
ICL_NATOFBUS_TEXT |
CHAR |
40 |
0 |
Nature of Business |
|
19 |
EMP_FEIN |
|
ICL_FEIN |
ICL_FEIN |
NUMC |
9 |
0 |
FEIN |
|
20 |
EMP_LOCNUM |
|
ICL_EMP_LOCNUM |
ICL_LOCNUM |
CHAR |
15 |
0 |
Insured Location Number of Employer |
|
21 |
EMP_DATEREPTO |
|
ICL_EMP_DATEREPTOEMPL |
ICL_DATEREPTOEMPL |
DATS |
8 |
0 |
Date on Which Injury Reported to Employer |
|
22 |
EMP_LOSSCOND_ACT |
|
ICL_EMP_LOSS_COND_ACT |
ICL_LOSS_COND_ACT |
CHAR |
2 |
0 |
Loss Conditions: Type of Transaction (NCCI) |
TICL389 |
23 |
EMP_LOSS_ACTN |
|
ICL_EMP_LOSS_COND_ACTN |
ICL_TEXT40 |
CHAR |
40 |
0 |
Loss Condition: Transaction Type Description |
|
24 |
EMP_LOSS_TYPE |
|
ICL_EMP_LOSS_COND_LOSS_TYPE |
ICL_LOSS_COND_LOSS_TYPE |
CHAR |
2 |
0 |
Loss Conditions: Type of Loss (NCCI) |
TICL390 |
25 |
EMP_LOSS_TYPEN |
|
ICL_EMP_LOSS_COND_LOSS_TYPEN |
ICL_TEXT40 |
CHAR |
40 |
0 |
Loss Condition: Loss Type Description |
|
26 |
EMP_RECOVER_TYPE |
|
ICL_EMP_LOSS_COND_RECOVER_TYPE |
ICL_LOSS_COND_RECOVERY_TYPE |
CHAR |
2 |
0 |
Loss Conditions: Type of Recovery |
TICL391 |
27 |
EMP_RECVR_TYPEN |
|
ICL_EMP_LOSS_COND_RECOVR_TYPEN |
ICL_TEXT40 |
CHAR |
40 |
0 |
Loss Condition: Recovery Type Description |
|
28 |
EMP_COVERAG_TYPE |
|
ICL_EMP_LOSS_COND_COVERAG_TYPE |
ICL_LOSS_COND_COVERAGAE_TYPE |
CHAR |
2 |
0 |
Loss Condition: Type of Coverage |
TICL392 |
29 |
EMP_COVERG_TYPEN |
|
ICL_EMP_LOSS_COND_COVRG_TYPEN |
ICL_TEXT40 |
CHAR |
40 |
0 |
Loss Condition: Coverage Type Description |
|
30 |
EMP_SETTLE_TYPE |
|
ICL_EMP_LOSS_COND_SETTLE_TYPE |
ICL_LOSS_COND_SETTLEMENT_TYPE |
CHAR |
2 |
0 |
Loss Conditions: Settlement Type |
TICL393 |
31 |
EMP_SETTLE_TYPEN |
|
ICL_EMP_LOSS_COND_SETTLE_TYPEN |
ICL_TEXT40 |
CHAR |
40 |
0 |
Loss Conditions: Settlement Type Description |
|
32 |
EMPE |
|
ICL_EMPLOYEE |
BU_PARTNER |
CHAR |
10 |
0 |
Employee |
* |
33 |
EMPE_DESCR |
|
ICL_EMPE_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Employee Description |
|
34 |
EMPE_SCR |
|
ICL_EMPLOYEE |
BU_PARTNER |
CHAR |
10 |
0 |
Employee |
* |
35 |
EMPE_EMP_STATUS |
|
ICL_EMP_STATUS |
ICL_EMP_STATUS |
CHAR |
2 |
0 |
Employment Status |
TICL382 |
36 |
EMPE_EMP_STATUSN |
|
ICL_EMP_STATUSN |
ICL_TEXT30_LOWERCASE |
CHAR |
30 |
0 |
Employment Status Description |
|
37 |
EMPE_HIREDATE |
|
ICL_EMP_HIREDATE |
ICL_HIREDATE |
DATS |
8 |
0 |
Employee Date of Hire |
|
38 |
EMPE_AWW |
|
ICL_EMP_PREINJURY_AWW |
ICL_RESAMOUNT |
CURR |
15 |
2 |
Pre-Injury Average Weekly Wage |
|
39 |
EMPE_OTHR_PAY |
|
ICL_EMP_OTHER_WEEKLY_PAY |
ICL_RESAMOUNT |
CURR |
15 |
2 |
Other Weekly Payments |
|
40 |
EMPE_WAGEBASIS |
|
ICL_EMP_WAGEBASIS |
ICL_WAGEBASIS |
CHAR |
2 |
0 |
Employee Wage Basis |
TICL384 |
41 |
EMPE_WORKDAYS |
|
ICL_EMP_WORKDAYS |
ICL_WORKDAYS |
CHAR |
1 |
0 |
Number of Days Regularly Worked per Week |
|
42 |
EMPE_DISCFB |
|
ICL_EMP_WDFB |
ICL_RESAMOUNT |
CURR |
15 |
2 |
Discontinued Fringe Benefits |
|
43 |
EMPE_NOOFDEP |
|
ICL_EMP_NUMOFDEPENDENTS |
NUM2 |
NUMC |
2 |
0 |
Employee Number of Dependents |
|
44 |
EMPE_NOOFENTEXEM |
|
ICL_EMP_NUMOFENTEXEMPTIONS |
NUM2 |
NUMC |
2 |
0 |
Employee Number of Entitled Exemptions |
|
45 |
EMPE_NOOFWHEXEM |
|
ICL_EMP_NUMOFWHDEXEMPTIONS |
NUM2 |
NUMC |
2 |
0 |
Employee Number of Withholding Exemptions |
|
46 |
EMPE_LDW |
|
ICL_EMP_INTDATELDW |
ICL_INTDATELDW |
DATS |
8 |
0 |
Initial Date Last Day Worked |
|
47 |
EMPE_RTW |
|
ICL_EMP_INITIALRTW |
ICL_INITIALRTW |
DATS |
8 |
0 |
Initial Return to Work Date |
|
48 |
EMPE_MMI_DATE |
|
ICL_EMP_MMI_DATE |
ICL_MMI_DATE |
DATS |
8 |
0 |
Date of Maximum Medical Improvement |
|
49 |
EMPE_WORKTIME |
|
ICL_EMP_WORKBEGINTIME |
TIME |
TIMS |
6 |
0 |
Time Employee Began Work Before Accident |
|
50 |
EMPE_OCC_CODE |
|
ICL_EMP_OCC_CODE |
ICL_OCC_CODE |
CHAR |
2 |
0 |
Employee Occupation Code |
TICL394 |
51 |
EMPE_OCC_CODEN |
|
ICL_EMP_OCC_CODEN |
ICL_TEXT50 |
CHAR |
50 |
0 |
Employee Occupation Code |
|
52 |
EMPE_MC_CODE |
|
ICL_EMP_MC_CODE |
ICL_MANUAL_CLASS_CODE |
CHAR |
4 |
0 |
Manual Classification Code |
TICL395 |
53 |
EMPE_MC_CODEN |
|
ICL_EMP_MC_CODEN |
ICL_TEXT20 |
CHAR |
20 |
0 |
Manual Classification Code |
|
54 |
EMPE_OBJINJ |
|
ICL_EMP_OBJINJ |
ICL_EMP_OBJINJ |
CHAR |
6 |
0 |
Object or Substance That Directly Injured the Employee |
TICL396 |
55 |
EMPE_OBJINJN |
|
ICL_EMP_OBJINJN |
ICL_TEXT40 |
CHAR |
40 |
0 |
Object or Substance That Directly Injured the Employee |
|
56 |
EMPE_INITTRMNTCO |
|
ICL_EMP_INITTRMNTCODE |
ICL_INITTRMNTCODE |
CHAR |
1 |
0 |
Initial Treatment Code |
TICL388 |
57 |
EMPE_INITRMNTCON |
|
ICL_EMP_INITTRMNTCODEN |
ICL_TEXT40 |
CHAR |
40 |
0 |
Initial Treatment Type Description |
|
58 |
EMPE_NOI |
|
ICL_EMP_NOI |
ICL_NATURE_OF_INJURY |
CHAR |
2 |
0 |
Nature of Injury |
TICL385 |
59 |
EMPE_NOIN |
|
ICL_EMP_NOIN |
ICL_TEXT30_LOWERCASE |
CHAR |
30 |
0 |
Name of Nature of Injury |
|
60 |
EMPE_COI |
|
ICL_EMP_COI |
ICL_CAUSE_OF_INJUEY |
CHAR |
2 |
0 |
Cause of Injury |
TICL386 |
61 |
EMPE_COIN |
|
ICL_EMP_COIN |
ICL_TEXT30_LOWERCASE |
CHAR |
30 |
0 |
Name of Cause of Injury |
|
62 |
EMP_CONPER |
|
ICL_CONTACT_PERSON |
BU_PARTNER |
CHAR |
10 |
0 |
Employer Contact Name |
* |
63 |
EMP_CONPER_DESCR |
|
ICL_CONPER_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Employer Contact Description |
|
64 |
EMP_CONPER_SCR |
|
ICL_CONTACT_PERSON |
BU_PARTNER |
CHAR |
10 |
0 |
Employer Contact Name |
* |
65 |
CLAIM_ADMIN |
|
ICL_CLAIM_ADMIN |
BU_PARTNER |
CHAR |
10 |
0 |
BP Number for Claim Administrator (Claim Handling Company) |
* |
66 |
CLAIM_ADMIN_DESC |
|
ICL_CLAIM_ADMIN_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Claim Administrator Description |
|
67 |
CLAIM_ADMIN_SCR |
|
ICL_CLAIM_ADMIN |
BU_PARTNER |
CHAR |
10 |
0 |
BP Number for Claim Administrator (Claim Handling Company) |
* |
68 |
CLAIM_ADMIN_FEIN |
|
ICL_FEIN |
ICL_FEIN |
NUMC |
9 |
0 |
FEIN |
|
69 |
CLADMN_DATEREPTO |
|
ICL_EMP_DATEREPTOCLADM |
ICL_DATEREPTOCLADM |
DATS |
8 |
0 |
Date of Report of Injury to Claim Administrator |
|
70 |
INSURER |
|
ICL_INSURER |
BU_PARTNER |
CHAR |
10 |
0 |
Insurer |
* |
71 |
INSURER_DESC |
|
ICL_INSURER_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Insurer Description |
|
72 |
INSURER_SCR |
|
ICL_INSURER |
BU_PARTNER |
CHAR |
10 |
0 |
Insurer |
* |
73 |
INSURER_FEIN |
|
ICL_FEIN |
ICL_FEIN |
NUMC |
9 |
0 |
FEIN |
|
74 |
INSURED |
|
ICL_POLH |
BU_PARTNER |
CHAR |
10 |
0 |
Insured |
* |
75 |
INSURED_DESC |
|
ICL_INSURED_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Insured |
|
76 |
INSURED_SCR |
|
ICL_POLH |
BU_PARTNER |
CHAR |
10 |
0 |
Insured |
* |
77 |
INSURED_FEIN |
|
ICL_FEIN |
ICL_FEIN |
NUMC |
9 |
0 |
FEIN |
|
78 |
ACC_SITE_ORG |
|
ICL_ACC_SITE_ORG |
BU_PARTNER |
CHAR |
10 |
0 |
Accident Site Organization Name |
* |
79 |
ACC_SITE_ORG_DES |
|
ICL_ACC_SITE_ORG_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Accident Site Organization Name Description |
|
80 |
ACC_SITE_ORG_SCR |
|
ICL_ACC_SITE_ORG |
BU_PARTNER |
CHAR |
10 |
0 |
Accident Site Organization Name |
* |
81 |
MCO |
|
ICL_MCO |
BU_PARTNER |
CHAR |
10 |
0 |
Managed Care Organization (MCO) |
* |
82 |
MCO_DESCR |
|
ICL_MCO_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Managed Care Organization (MCO) |
|
83 |
MCO_SCR |
|
ICL_MCO |
BU_PARTNER |
CHAR |
10 |
0 |
Managed Care Organization (MCO) |
* |
84 |
MCO_IDNUM |
|
ICL_EMP_MCO_IDNUM |
ICL_MCO_IDNUM |
CHAR |
9 |
0 |
Managed Care Organization (MCO) ID Number |
|
85 |
MED_PROV |
|
ICL_MEDPROV |
BU_PARTNER |
CHAR |
10 |
0 |
WComp: Initial Medical Service Provider |
* |
86 |
MED_PROV_DESCR |
|
ICL_MEDPROV_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Initial Medical Provider Description |
|
87 |
MED_PROV_SCR |
|
ICL_MEDPROV |
BU_PARTNER |
CHAR |
10 |
0 |
WComp: Initial Medical Service Provider |
* |
88 |
XINITIALPROVIDER |
|
ICL_PARTOCC02 |
XFELD |
CHAR |
1 |
0 |
WComp: Initial Medical Service Provider |
|
89 |
LAWYER |
|
ICL_LAWY |
BU_PARTNER |
CHAR |
10 |
0 |
Lawyer |
* |
90 |
LAWYER_DESCR |
|
ICL_LAWY_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Lawyer/Attorney |
|
91 |
LAWYER_SCR |
|
ICL_LAWY |
BU_PARTNER |
CHAR |
10 |
0 |
Lawyer |
* |
92 |
LAWY_STARTDATE |
|
ICL_EMP_ATTORNEYSTARTDATE |
ICL_ATTORNEYSTART_DATE |
DATS |
8 |
0 |
Date Attorney Started Working for Claimant |
|
93 |
LAWY_DISCLOSURE |
|
ICL_EMP_DISCLOSUREDATE |
ICL_DISCLOSURE_DATE |
DATS |
8 |
0 |
Disclosure Date |
|
94 |
PREP_EMPL |
|
ICL_PREP_EMPLOYER |
BU_PARTNER |
CHAR |
10 |
0 |
Preparer's Employer |
* |
95 |
PREP_EMPL_DESCR |
|
ICL_PREP_EMPL_DESCR |
CHAR50 |
CHAR |
50 |
0 |
Preparer's Employer Description |
|
96 |
PREP_EMPL_SCR |
|
ICL_PREP_EMPLOYER |
BU_PARTNER |
CHAR |
10 |
0 |
Preparer's Employer |
* |
97 |
OSHA_CASE_NUM |
|
ICL_OSHA_CASE_NUM |
ICL_OSHA_CASE_NUM |
CHAR |
15 |
0 |
Occupational Safety & Health Administration (OSHA) Case No. |
|
98 |
BODY_PART_CODE |
|
ICL_BODY_PART_CODE |
ICL_BODY_PART_CODE |
CHAR |
2 |
0 |
Code for Injured Body Part |
|
99 |
BODY_PART_CODEN |
|
ICL_BODY_PART_CODEN |
ICL_TEXT30_LOWERCASE |
CHAR |
30 |
0 |
Description of Injured Body Part Code |
|
100 |
DATELOSS |
|
ICL_LOSSDATE |
DATE |
DATS |
8 |
0 |
Date of Loss/Claim |
|
101 |
TIMELOSS |
|
ICL_LOSSTIME |
TIME |
TIMS |
6 |
0 |
Time of Claim/Loss |
|
102 |
LTIMEZONE |
|
ICL_LTIMEZONE |
TZNZONE |
CHAR |
6 |
0 |
Time Zone of Claim/Loss Event |
* |
103 |
EMPE_DEATHDATE |
|
EMPE_DATE_OF_DEATH |
ICL_EMPE_DATE_OF_DEATH |
DATS |
8 |
0 |
Date of Death of Employee |
|