1 |
PARTNER |
|
ICL_PART |
BU_PARTNER |
CHAR |
10 |
0 |
Claim Participant |
* |
2 |
ROLE |
|
ICL_ROLE |
ICL_ROLE |
CHAR |
4 |
0 |
Participant Role Key |
* |
3 |
EMP_PAYROLL |
|
ICL_EMP_PAYROLL |
ICL_PAYROLL |
CHAR |
2 |
0 |
Employer Payroll |
TICL380 |
4 |
EMP_INDUSTRYCODE |
|
ICL_EMP_INDUSTRYCODE_DI |
ICL_INDUSTRYCODE_DI |
CHAR |
6 |
0 |
Industry Code |
|
5 |
EMP_UINUMBER |
|
ICL_EMP_UINUM_DI |
ICL_EMP_UINUM_DI |
CHAR |
9 |
0 |
Employer UI Number |
|
6 |
EMP_NATOFBUS |
|
ICL_EMP_NATOFBUS |
ICL_NATURE_OF_BUSINESS |
CHAR |
6 |
0 |
Nature of Business |
TICL387 |
7 |
EMP_LOCNUM |
|
ICL_EMP_LOCNUM |
ICL_LOCNUM |
CHAR |
15 |
0 |
Insured Location Number of Employer |
|
8 |
EMP_DATEREPTO |
|
ICL_EMP_DATEREPTOEMPL_DI |
ICL_DATEREPTOEMPL_DI |
CHAR |
8 |
0 |
Date Employer Had Knowledge of the Injury |
|
9 |
EMP_LOSSCOND_ACT |
|
ICL_EMP_LOSS_COND_ACT |
ICL_LOSS_COND_ACT |
CHAR |
2 |
0 |
Loss Conditions: Type of Transaction (NCCI) |
TICL389 |
10 |
EMP_LOSS_TYPE |
|
ICL_EMP_LOSS_COND_LOSS_TYPE |
ICL_LOSS_COND_LOSS_TYPE |
CHAR |
2 |
0 |
Loss Conditions: Type of Loss (NCCI) |
TICL390 |
11 |
EMP_RECOVER_TYPE |
|
ICL_EMP_LOSS_COND_RECOVER_TYPE |
ICL_LOSS_COND_RECOVERY_TYPE |
CHAR |
2 |
0 |
Loss Conditions: Type of Recovery |
TICL391 |
12 |
EMP_COVERAG_TYPE |
|
ICL_EMP_LOSS_COND_COVERAG_TYPE |
ICL_LOSS_COND_COVERAGAE_TYPE |
CHAR |
2 |
0 |
Loss Condition: Type of Coverage |
TICL392 |
13 |
EMP_SETTLE_TYPE |
|
ICL_EMP_LOSS_COND_SETTLE_TYPE |
ICL_LOSS_COND_SETTLEMENT_TYPE |
CHAR |
2 |
0 |
Loss Conditions: Settlement Type |
TICL393 |
14 |
EMPE_EMP_STATUS |
|
ICL_EMP_STATUS |
ICL_EMP_STATUS |
CHAR |
2 |
0 |
Employment Status |
TICL382 |
15 |
EMPE_WAGEBASIS |
|
ICL_EMP_WAGEBASIS |
ICL_WAGEBASIS |
CHAR |
2 |
0 |
Employee Wage Basis |
TICL384 |
16 |
EMPE_WORKDAYS |
|
ICL_EMP_WORKDAYS |
ICL_WORKDAYS |
CHAR |
1 |
0 |
Number of Days Regularly Worked per Week |
|
17 |
EMPE_NOOFDEP |
|
ICL_EMP_NUMOFDEPENDENTS_DI |
NUM2_DI |
CHAR |
2 |
0 |
Employee Number of Dependents |
|
18 |
EMPE_NOOFENTEXEM |
|
ICL_EMP_NUMOFENTEXEMPTIONS_DI |
NUM2_DI |
CHAR |
2 |
0 |
Employee Number of Entitled Exemptions |
|
19 |
EMPE_NOOFWHEXEM |
|
ICL_EMP_NUMOFWHDEXEMPTIONS_DI |
NUM2_DI |
CHAR |
2 |
0 |
Employee Number of Withholding Exemptions |
|
20 |
EMPE_LDW |
|
ICL_EMP_INTDATELDW_DI |
ICL_INTDATELDW_DI |
CHAR |
8 |
0 |
Initial Date Last Day Worked |
|
21 |
EMPE_RTW |
|
ICL_EMP_INITIALRTW_DI |
ICL_INITIALRTW_DI |
CHAR |
8 |
0 |
Initial Return to Work Date |
|
22 |
EMPE_MMI_DATE |
|
ICL_EMP_MMI_DATE_DI |
ICL_MMI_DATE_DI |
CHAR |
8 |
0 |
Date of Maximum Medical Improvement |
|
23 |
EMPE_WORKTIME |
|
ICL_EMP_WORKBEGINTIME_DI |
TIME_DI |
CHAR |
6 |
0 |
Time Employee Began Work Before Accident |
|
24 |
EMPE_OCC_CODE |
|
ICL_EMP_OCC_CODE |
ICL_OCC_CODE |
CHAR |
2 |
0 |
Employee Occupation Code |
* |
25 |
EMPE_MC_CODE |
|
ICL_EMP_MC_CODE |
ICL_MANUAL_CLASS_CODE |
CHAR |
4 |
0 |
Manual Classification Code |
* |
26 |
EMPE_OBJINJ |
|
ICL_EMP_OBJINJ |
ICL_EMP_OBJINJ |
CHAR |
6 |
0 |
Object or Substance That Directly Injured the Employee |
TICL396 |
27 |
EMPE_INITTRMNTCO |
|
ICL_EMP_INITTRMNTCODE |
ICL_INITTRMNTCODE |
CHAR |
1 |
0 |
Initial Treatment Code |
TICL388 |
28 |
EMPE_NOI |
|
ICL_EMP_NOI |
ICL_NATURE_OF_INJURY |
CHAR |
2 |
0 |
Nature of Injury |
TICL385 |
29 |
EMPE_COI |
|
ICL_EMP_COI |
ICL_CAUSE_OF_INJUEY |
CHAR |
2 |
0 |
Cause of Injury |
TICL386 |
30 |
EMP_PREPAREDDATE |
|
ICL_EMP_PREPAREDDATE_DI |
ICL_EMP_PREPAREDDATE_DI |
CHAR |
8 |
0 |
Date Prepared |
|
31 |
CLADMN_DATEREPTO |
|
ICL_EMP_DATEREPTOCLADM_DI |
ICL_DATEREPTOCLADM_DI |
CHAR |
8 |
0 |
Date Claim Administrator Had Knowledge of the Injury |
|
32 |
XINITIALPROVIDER |
|
ICL_PARTOCC02 |
XFELD |
CHAR |
1 |
0 |
WComp: Initial Medical Service Provider |
|
33 |
LAWY_STARTDATE |
|
ICL_EMP_ATTORNEYSTARTDATE_DI |
ICL_ATTORNEYSTART_DATE_DI |
CHAR |
8 |
0 |
Date Attorney Started Working for Claimant |
|
34 |
LAWY_DISCLOSURE |
|
ICL_EMP_DISCLOSUREDATE_DI |
ICL_DISCLOSURE_DATE_DI |
CHAR |
8 |
0 |
Disclosure Date |
|
35 |
OSHA_CASE_NUM |
|
ICL_OSHA_CASE_NUM |
ICL_OSHA_CASE_NUM |
CHAR |
15 |
0 |
Occupational Safety & Health Administration (OSHA) Case No. |
|
36 |
BODY_PART_CODE |
|
ICL_BODY_PART_CODE |
ICL_BODY_PART_CODE |
CHAR |
2 |
0 |
Code for Injured Body Part |
|
37 |
EMPE_DEATHDATE |
|
ICL_EMPE_DATE_OF_DEATH_DI |
|
CHAR |
8 |
0 |
Date of Death of Employee |
|
38 |
CURRENCY |
|
ICL_CURRENCY_DI |
ICL_CURRENCY_DI |
CHAR |
5 |
0 |
Currency |
|
39 |
CLAIM |
|
ICL_CLAIM |
ICL_CLAIM |
CHAR |
17 |
0 |
Number of Claim |
* |
40 |
EXCLAIMNO |
|
ICL_JURIS_CLAIMNO |
ICL_CLAIMNO |
CHAR |
20 |
0 |
Jurisdiction Claim Number |
|
41 |
JURISREGION |
|
ICL_JURISREGION |
REGIO |
CHAR |
3 |
0 |
Jurisdiction Region |
* |
42 |
JURISCOUNTRY |
|
ICL_JURICOUNTRY |
LAND1 |
CHAR |
3 |
0 |
Jurisdiction Country |
* |
43 |
PREPAREDDATE |
|
ICL_EMP_PREPAREDDATE_DI |
ICL_EMP_PREPAREDDATE_DI |
CHAR |
8 |
0 |
Date Prepared |
|
44 |
EMP_FEIN |
|
ICL_FEIN_DI |
ICL_FEIN_DI |
CHAR |
9 |
0 |
FEIN |
|
45 |
EMPE_HIREDATE |
|
ICL_EMP_HIREDATE_DI |
ICL_HIREDATE_DI |
CHAR |
8 |
0 |
Employee Date of Hire |
|
46 |
EMPE_AWW |
|
ICL_EMP_PREINJURY_AWW_DI |
ICL_RESAMOUNT_DI |
CHAR |
15 |
0 |
Pre-Injury Average Weekly Wage |
|
47 |
EMPE_OTHR_PAY |
|
ICL_EMP_OTHER_WEEKLY_PAY_DI |
ICL_RESAMOUNT_DI |
CHAR |
15 |
0 |
Other Weekly Payments |
|
48 |
EMPE_DISCFB |
|
ICL_EMP_WDFB_DI |
ICL_RESAMOUNT_DI |
CHAR |
15 |
0 |
Discontinued Fringe Benefits |
|
49 |
EMPE_NOIN |
|
ICL_EMP_NOIN |
ICL_TEXT30_LOWERCASE |
CHAR |
30 |
0 |
Name of Nature of Injury |
|
50 |
EMPE_COIN |
|
ICL_EMP_COIN |
ICL_TEXT30_LOWERCASE |
CHAR |
30 |
0 |
Name of Cause of Injury |
|
51 |
CLAIM_ADMIN_FEIN |
|
ICL_FEIN_DI |
ICL_FEIN_DI |
CHAR |
9 |
0 |
FEIN |
|
52 |
INSURER_FEIN |
|
ICL_FEIN_DI |
ICL_FEIN_DI |
CHAR |
9 |
0 |
FEIN |
|
53 |
INSURED_FEIN |
|
ICL_FEIN_DI |
ICL_FEIN_DI |
CHAR |
9 |
0 |
FEIN |
|
54 |
MCO_IDNUM |
|
ICL_EMP_MCO_IDNUM |
ICL_MCO_IDNUM |
CHAR |
9 |
0 |
Managed Care Organization (MCO) ID Number |
|
55 |
DATELOSS |
|
ICL_LOSSDATE_WC_DI |
ICL_DATE_DI |
CHAR |
8 |
0 |
Date of Loss |
|
56 |
TIMELOSS |
|
ICL_LOSSTIME_DI |
ICL_TIME_DI |
CHAR |
6 |
0 |
Time of Claim/Loss |
|
57 |
LTIMEZONE |
|
ICL_LTIMEZONE |
TZNZONE |
CHAR |
6 |
0 |
Time Zone of Claim/Loss Event |
* |