Administering a Workers' Comp claim

The Workers' Comp claim form comprises multiple tabs: Home, Comp Claim Claimant, Comp Claim Injury, and Comp Claim Legal.

You can:

To administer Workers' Comp claims:

  1. In the modules bar, select WC Claims.
    A list of WC Claims displays. From here you can Add, Edit, Delete, and Move Claim.
  2. To edit an existing claim, locate the entry and click (Jump).
    See the following table to complete the form fields.
  3. To add a claim, click Add.
    The Workspace Selector page opens.
  4. In Choose a Workspace, select an entry from the list, and click GO.
    The Comp Claim form opens.
  5. Complete the form:

Claim Details

This section is dedicated to details about the worker's comp claim.

Employee

Select the Employee who is making the claim.

Date of Injury

Select the date of injury.

Jurisdiction State

Select the state that has jurisdiction of the claim.

Claim Status

Select a status.

Policy

Select your WC Policy.

Claim Type

Select the claim type: Indemnity, Medical Only, Report Only.

Carrier Claim Number

See OSHA Case Number.

ClientSpace Claim ID

Auto-filled.

Carrier Claim Type

A way to categorize the claim. By default ClientSpace includes Report Only, Medical Only, and Indemnity.

OSHA Case Number

The OSHA Case Number is read-only and is set using auto-numbering business logic on insert of the claim form. This numbering begins at 1 at the beginning of each calendar year based on the Date of Injury (DOI) year of the claim within the Workspace. The rule is configured to run on the Default and Imports pipelines. If the Injury Date of a claim changes, a warning is triggered to notify the user that the OSHA Case Number will be re-generated. The case is then auto-numbered based on the new Injury Date. The Case Number is set based on the next available case number for that year.

The OSHA 300 report and OSHA 301 Merge (run from Comp Claim) show the Case Number and is sorted by lowest to highest. The Case Number is shown if present, otherwise, it will show the Carrier Claim Number.

Time of Injury

Enter the time the injury actually occurred.

Start of work (DOI)

Date of injury.

Employee Report Date

Employee Report Time

Enter the date and time of the report.

Client Report Date

Carrier Report Date

Client Report Date defaults to the current date.

Claim Specialist

Select from the list.

Carrier Claim Adjuster

Is available when you select Policy.

TPA

Select a third-party administrator.

Transmission Status

Select a status: Hold, Ready for Transmit, Transmitted.

Claim Deductible

ClientSpace retrieves the deductible from the Pricing Batch first (if it exists) and uses it to set the Claim Deductible. Note that the Current Record checkbox must be checked on the Pricing Batch, denoting it as the current Pricing Batch. Also note that if the deductible is set to $0.00 on the current Pricing Batch, it is treated as a valid value and may be used in deductible bill amount calculations. If there is no current Pricing Batch record, ClientSpace sets the Claim Deductible using the WC Deductible field from the Client Master record.

Similar Employee

Allows the user to connect the claim to another employee in the workspace.

Communications Log

Used for any notes or correspondence associated with the Claim

Show Details

Select this option to display the Additional Claim Information section.

Employee Vouchers Retrieved

On the header action for retrieving vouchers, once the vouchers are retrieved this check box will be set to true.

Additional Claim Information

This section is dedicated to additional claim information about the worker's comp claim.

Close Date

Date the claim is closed. This field clears if claim states does not equal Closed.

Resulted in Death

Indicate whether the claim resulted in death.

Date of Death

If the Resulted in Death field contains Yes, indicate the date of death.

Claim Reported By

Shock Loss

TBD

Suppress on OSHA Log

Indicates if the claim is included or excluded from the OSHA 300A report.

  • Selected: Exclude the claim.
  • Cleared: Include the claim.

Privacy Consideration

TBD

FMLA Event

Indicate whether the claim is FMLA-related.

3 Lost Work Days?

Indicate whether the claim resulted in more than three lost work days.

Drug Screen Completed

Indicate whether a drug screening was completed.

Results

Indicate whether the result of the drug screening was positive or negative.

Details

Indicate any details regarding the drug screening results.

Employee's Normal Job

Indicate whether , at the time of the incident for the claim, was the employee performing their normal job duties.

Employee Safety Violation

Indicate whether the individual violated safety standards when the injury occurred.

Light Duty Available

Indicate whether the individual can perform other alternative light-duty work that would not affect the injury.

Employee Driving

Indicate whether incident occurred while employee was driving.

Vehicle Type

If the Employee Driving field contains Yes, indicate the type of vehicle that the employee operated during the incident.

Ticket Issued

Indicate whether the police or other agency issued a ticket as the result of the incident.

Fraud Suspected

Select this check box to indicate that fraud is suspected for this incident.

Litigated

Select one of the following options to indicate the litigation status:

  • Not in Litigation

  • Pending Litigation

  • In Litigation

Eligible for Subrogation

TBD

LDF

ClientSpace uses business rules to set the Loss Development Factor in the LDF field using the LDF data set up in the Admin Workspace. See Adding and Maintaining Loss Development Factors.

Best Hazard Index

TBD

Best Hazard Class

Enter the Best Hazard Class associated with this company

Financial Notes

Any information regarding the financial aspects of the claimant or the company.

Additional Details

Any additional information regarding the claim.

Audit

An ongoing record of changes to the claim and who made the changes.

The following fields are audited:

  • Claim Status

  • Transmission Status

  • Claim Type

  • Date of Injury

  • Time of Injury

  • Employee Report Date

  • Time Workday Start

  • Date Reported

  • Date Carrier Report

  • Date Close

  • Date Death

  • Date Last Worked

  • Date Last Paid

  • Date First Payment Mailed

Is the claim COVID-19 related?

Select this option to indicate whether this claim is to an employee who became ill with COVID-19 while performing work-related activities.
  1. Click Apply.

To provide details of the injury:

  1. Click the Comp Claim Injury tab.
  2. Complete the fields.

Privacy Consideration

When selected, the Claimant's Name on the OSHA 300 report is replaced with the word Private.
  1. Click Save.

To send an FROI:

On new claims, if there is an FROI email template set up, you can send a First Report of Injury (FROI) notification email to an insurance carrier, a client, or an internal team member notifying them of a new Worker's Compensation claim.

  1. Click Send FROI under Workflow in the Action Center of the Comp Claim.

To delete Workers' Comp claims:

  1. In the modules bar, select WC Claims.
    A list of WC Claims displays. From here you can Delete a claim.
  2. Use the Quick Search bar to find a claim to delete.
    See Quick Search.
  3. Select the row that contains the claim to delete and click Delete.
    The system displays a message about deleting the claim.
Use the following table to determine how to continue.

If the system displays the following message:

Then complete the following:

Are you certain you want to delete this Claim and related forms?

Click OK to confirm the deletion of the claim.

This Claim has active Notes and or Attachments, and cannot be deleted

You cannot delete a claim that has active notes or attachments. You must administer the claim and remove any active notes or attachments before you can delete the claim.

Click OK and correct the issue before trying again.

After correcting the issue, repeat this procedure to delete the claim.