Data Tips
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Policy—What is Deductible Endorsement Record Reporting
In the WCIO WCPOLS Policy Data standard, the Deductible Endorsement Record—Record Type 43 is reported when an applicable deductible program exists with the policy contract.
The Deductible Endorsement Record is state specific, so it is required to be reported for every state on the policy when the deductible program applies.
If certain deductible statistical codes are reported on the corresponding Exposure Record(s) signifying that a deductible exists, then the Deductible Endorsement Record must be reported, or the exposure record will incur edits.
There are also three data elements found on the WCPOLS Deductible Endorsement Record—Record Type 43 that are reported through Proof of Coverage (POC) and required in some POC states:*
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Deductible Amount Per Claim/Accident
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Losses Subject to Deductible Code
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Basis of Deductible Calculation Code
POC states may use these elements to determine if large deductibles are in place or to compare with other state agencies’ information.
*Refer to the
Proof of Coverage State Guide on
ncci.com for POC state applicability to the deductible record data elements.
Unit Statistical Data—State Act and Federal USL&HW Benefits Claim Development
When a policy covers both a State Act and Federal USL&HW benefits, the resulting losses that include both coverages must be reported as one claim.
The associated Loss Coverage Act Code—Act Code reported for the loss is based on the incurred loss as of the unit report valuation date as follows:
The Loss Coverage Act Code may change from one report level to the next based on loss development.
Example:
An employee was injured on the job. The employer of that employee had a policy providing coverage for both State Act and Federal USL&HW benefits. As of the 1st report valuation, only State Act benefits applied to this claim; therefore, Loss Coverage Code—01 (State Act) was reported. However, as of the 2nd report valuation, both State Act and Federal USL&HW benefits applied to this claim. Therefore, Loss Coverage Code—02 (USL&HW Act) was reported as follows:
