- Reporting Responsibilities
- Acquired Reports of Injury
- First Reports of Injury
- 3 Ways to Report Injuries Electronically
- EDI Claims Release 3.1 Announcement
After an injury has occurred, the injured worker should notify the employer in writing of the injury; the written notice should include the date, time and place of injury, the nature of the injury and the name and address of the person injured. An employer or its insurer must report the injury, other than an injury that requires immediate first aid and no further medical treatment or lost time from work, to the Division of Workers’ Compensation within 30 days after knowledge of the injury. The First Report of Injury (FROI) is electronically filed with the Division. Employers have to report all injuries to their workers’ compensation insurance carrier or Third Party Administrator within 5 days of the date of injury or within 5 days of the date on which the injury was reported to the employer by the employee, whichever is later.
Acquired Reports of Injury
The Missouri Division of Workers’ Compensation (Division) does not have the ability currently to accept acquired reports of injury by Electronic Data Interchange. Therefore, when a company acquires claims from another Third-Party Administrator (TPA) or insurance company, the acquiring company must provide the Division with the information indicated below. The First Report of Injury (FROI) may be electronically submitted using the IAIABC “change” option on the FROI. The Division will use the following criteria to match what the acquiring company would submit to the Division on the FROI for acquired claims against what is currently in the Division’s system that was previously reported by the former TPA or insurance company:
- Insurer and TPA name, address and FEIN that is acquiring the claims;
- Employer name, address and FEIN;
- Division’s Injury Number that was assigned to the case;
- Employee’s name, address and SSN;
- Date of injury; and
- Body part injured (this field is optional)
Please note that if the employer has been granted self-insurance authority by the Division pursuant to §287.280 RSMo and rules applicable thereto, the TPA or service company would need to be approved by the Division in order to be regarded as the new approved service company that is handling the claims. Contact the Division’s Insurance Unit at 573-526-6004 for approval and for other possible compliance issues under the regulation.
The Division must also receive the following information from the acquiring company:
- Effective date of when the claims were acquired by the acquiring company.
- If it’s a TPA acquiring claims of another TPA, a list of all employers and cases that the acquiring TPA will be handling must be provided on a spreadsheet.
- The acquiring company would be responsible for reporting medical and lost time information to the Division on the acquired claims.
- The Division needs to mail notices on cases scheduled on any docket settings, including an evidentiary hearing, to the correct insurance company and/or TPA. Therefore, it is important to provide the Division with accurate information on the company that is acquiring the claims and who the attorney for the employer/insurer is.
- The Division will need to know how the acquiring company will be handling cases that are currently on appeal before the Labor and Industrial Relations Commission (LIRC). Therefore, please file the appropriate documentation with the LIRC through your attorney.
- For cases that are closed in the TPA or insurance companies books but are open per the Division’s records such as cases where the statute of limitation has not expired or a medical fee dispute (MFD) application is pending before the Division, please let the Division know if the acquiring company will take responsibility to defend and/or pay on cases where statute of limitation has not run if a Claim for Compensation is filed and if the acquiring company will hire defense counsel to defend and pay the MFD disputes.
- On cases that are pending before the Division, the acquiring company should file an Amended Answer to Claim for Compensation reflecting the correct insurance company and/or TPA that has acquired the claims.
- On permanent total and death cases, the acquiring company needs to indicate in writing if it will continue the payment of benefits to the claimant or dependent, etc. pursuant to the Award.
Other forms to be filed in the process include:
- The Answer to Claim For Compensation is filed by the lawyer for the insurer or third party administrator. Pursuant to 8 CSR 50-20010 (8) (A) the Answer must be filed within 30 days from the date the Division acknowledges receipt of the claim.
- The Medical Treatment Form is filed by a Missouri admitted or licensed insurance company or a Missouri licensed third party administrator. This is required for both medical only and lost time cases and must be filed:
- At the time of the initial treatment
- At the completion of the treatment and
- Any time the division requests a report
- The Notice of Commencement/Termination of Compensation is filed by the Missouri admitted or licensed insurance company or the Missouri licensed third party administrator. This form is required if the employee received compensation benefits after the three day waiting period and must be filed:
- Within 30 days of the date of the original notification of the injury
- Each time compensation is stopped or re-started
- Within 10 days after the termination of compensation
First Report of Injury
When a worker is injured, employers/insurers must file a First Report of Injury with the Division within 30 days from knowledge of the injury.
There are three cost effective ways listed below to electronically file First Reports of Injury. In January 2009 the Division mandated the use of EDI Claims Release 1.0 for electronic filing of the First Report of Injury. A large volume filer may want to use the first two options, and a low volume filer may find that the Web-based option is more cost effective for their needs.
The Division uses the International Association of Industrial Accident Boards and Commissions (IAIABC) EDI Claims Release 1.0 format for the First Report of Injury which is a standard format used by other states, insurance companies, third party administrators and self-insured employers who are authorized by the Division to file electronically. A signed Trading Partner Agreement needs to be on file with the Division prior to utilizing any of the three options. These options provide flexibility and allow the reporting entity to choose the option that is cost effective, efficient, and streamlines the reporting process. The Division sends an acknowledgment to the reporting entity informing them that the reports were accepted and an injury number was assigned to the case. The Division also notifies the reporting entity if the report submitted requires additional data fields to be completed or needs data corrected before the report is considered properly filed with the Division.
3 Ways to Report Injuries Electronically
- Electronic Data Interchange or EDI - A Division authorized vendor must be used to file the report with the Division. The vendor puts the data in the correct format and electronically transmits it to the Division.
The following documents are required to be filed by EDI vendors:
- Secure File Transfer Protocol SFTP - EDI/SFTP allows the filer to report directly with the Division of Worker's Compensation, which eliminates the cost of using a vendor. The reporting entity must program its computer to the IAIABC standards before transmitting reports to the Division.
The following documents are required to be filed by FTP vendors:
- Web Enabled Filing of First Reports of Injury - A low volume reporting entity may find the Web based option to be the most affordable option as it eliminates the need to hire a vendor or program their computer in the IAIABC standards. The data is entered and submitted through the Web.
The following documents are required to file using the web-enabled format:
- EDI Missouri Specific Requirements
- EDI Missouri Data Dictionary
- EDI Cause of Injury, Nature of Injury and Body Parts Codes
PURPOSE: The Division of Workers’ Compensation has designed the web enabled option for electronic filing of first report of injuries by the employer and/or insurer or third-party administrator. Service companies for self-insured employers must be approved by the Division. The third-party administrator must hold a valid certificate of authority from the Missouri Department of Commerce and Insurance or otherwise meets the requirements of Section 376.1075 to Section 376.1095, RSMo. This is in lieu of filing first report of injuries through FTP or an EDI vendor. Those trading partners that are currently using FTP or an EDI vendor and have entered into a trading partner agreement with the Division are not required to electronically submit first report of injuries through the web enabled option.
OBJECTIVE: The objective is to test, initiate, implement, and maintain the reports through electronic filing. The Division offers the web enabled option to the smaller reporting entities to encourage them to electronically file the First Report of Injury and reap the benefits and cost savings realized by larger employers and insurance companies.
WEB ENABLED GUIDELINES: The following explains the guidelines that are to be followed in order to submit the FROI through the web enabled option.
- The Online Report of Injury has been TESTED with internet Explorer 5.0, Firefox 1.0, Netscape 7.1, and newer versions. Earlier versions of these and some other browsers have not been tested and may or may not work with this application.
- The computer you are using should be connected to a printer so you can print information shown.
- This online application uses Secure Socket Layers (SSL). Data submitted using this application is encrypted in 128 bit key.
- You should have an active email address for each user.
- The Division will issue an access code to the Trading Partner or its duly authorized or lawfully empowered representative after signing the electronic partnering agreement and submitting it via facsimile transmission to the Division, ATTN: EDI Technician at 573-522-5043. To obtain an access code you need to provide the Federal Identification Number, email address of where the acknowledgements will be sent, contact person name and telephone number.
- Please contact the Division at 573-526-4943 if you have any questions.
Electronic Partnering/Confidentiality Agreement
In order for the Division to assign an Access Code, please submit, via facsimile transmission, a completed and signed Electronic Partnering/Confidentiality Agreement:Electronic Partnering/Confidentiality Agreement
Attn: EDI Technician at 573-522-5043