Claim Administrators

Scope: This policy applies to all Commission departments except the Criminal Injuries Compensation Fund (CICF) and CICF files.

This document was designed to show our Claim Administrators several scenarios that may occur throughout the life of a claim and what EDI transactions would be required for each scenario. This document covers the following:

1. Claim Event Flow (as defined by the IAIABC)
2. Establish or Acquire Claim
3. Initial Payment or Equivalent
4. Partial Suspension
5. Suspension of all Indemnity Benefits
6. Resumption of Benefits
7. Suspension of Resumed Benefits
8. File Any Time After First Report

This document outlines several business scenarios to assist a Claim Administrator with their EDI Transaction on Older Claims (Pre 10/1/2008). Please reference EDI Catchup Process for Older Claims and EDI UR Requirements Table for additional information on this process.

This process applies to all Virginia Workers’ Compensation Commission EDI trading partners who are handling active pre October 1, 2008 claims. All EDI Carriers and Self‐Insured Employers are required to submit claims data for active claims, regardless of their date of injury, via EDI beginning July 2012. This process provides trading partners an alternative to having to create the full set of transactions, as well as monitor their acceptance, in the appropriate EDI formats prior to their EDI Implementation date.

All Commission facsimile (fax) equipment and services are available to receive documents 24 hours a day, 7 days a week.

Any document submitted by fax shall be deemed filed with the Commission as of the date and time it is received by the Commission’s fax equipment or service agent to which it has been sent.

Vocational Rehabilitation Guidelines- Español

Guidelines issued by the Commission to provide understanding between the parties about the vocational rehabilitation process, to facilitate appropriate vocational rehabilitation benefits and services, and eliminate needless conflict and litigation over such benefits and services.

The Commission has implemented guidelines to its employees to help ensure that information for determining eligibility for employment is not provided without the written consent of the employee. The procedures outlined in the Telephone Disclosure Guidelines are used by the Commission personnel in determining what information will be disclosed upon telephone inquiry. To view the complete Telephone Disclosure Guidelines, please see the link above.

 A table for determining compensable percentage of hearing loss has been promulgated by the Commission.

The average decibel loss is to be translated into percentage of compensable hearing loss of each ear according to the attached table.

The Snellen's Chart is a chart developed in 1862 by the Dutch ophthalmologist Herman Snellen, the son of the renowned physician, Dr. F. A. Snellen. The younger Snellen studied medicine in The Netherlands under Gerard Johann Mulder, Jacobus Ludovicus Conradus Schroeder van der Kolk, and Franz Cornelis Donders. He received his medical doctorate at Utrecht in 1858.

Dr. Snellen's chart is used to measure the percentage of loss of visual acuity.