Carriers Should Report COVID-19 Claims Accurately
On March 13, 2020, in a memo to system stakeholders, the Commissioner of Workers’ Compensation requested that when reporting a claim, carriers should clearly specify if a claim involves COVID19. The Commissioner said that this reporting could be done in the incident description field on the first report of injury. This was requested to help the Division monitor the impact of the pandemic event.
On March 27, 2020, in a memo to system stakeholders, the Commissioner of Workers’ Compensation encouraged workers’ compensation carriers to begin using the new International Association of Industrial Accident Boards and Commissions codes for electronic data interchange (EDI) claims reports: “cause of injury” code 83 – Pandemic and “nature of injury” code 83 – COVID-19 on April 1, 2020.
The codes should be used for COVID-19 injuries occurring on or after December 1, 2019. DWC has updated its claims EDI collection systems to accept these new code values.
Insurance carriers have been encouraged to contact their trading partners to discuss reporting these new codes. For questions, contact Martha Luevano at 512-804-4858 or martha.luevano@tdi.texas.gov.
The Injury Description Code is a three-part data element comprising Part of Body, Nature of Injury, and Cause of Injury codes. The additions and changes to these coding values are coordinated through the Workers Compensation Insurance Organization (WCIO) to promote the uniformity of code values for all workers compensation data collection organizations.
Commercial carriers that insure risks that can be expected to result in the reporting of COVID-19 claims such as hospitals, health care professionals as well as retail and grocery outlets may be the subject of data calls to review COVID-19 claims frequency and handling protocols. Similarly, governmental self-insurers who employ front-line first responders are likely, in our opinion, to also be the subject of such scrutiny.
Similar reporting requirements are expected to be implemented nationwide. The National Council on Compensation Insurance recently filed a memorandum to implement such changes to NCCI’s Statistical Plan for Workers Compensation and Employers Liability Insurance.
We anticipate that there will be significant regulatory and legislative interest in the manner in which carriers have handled COVID-19 claims after normal system operations begin to return. Enforcement actions may ensue as the Division identifies carrier and self-insurer deficiencies in reporting, payment or denial of these claims.
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