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ClaimsClaims Reporting

Claims

Claims Reporting

For more detailed information about WCRA Claims Reporting, please see the Claims Reference Guide.

Claim reports must be submitted electronically via the WCRA Portal. To be able to report using the WCRA Portal, an individual account with a username and password needs to be set up.

For the first report, use the Initial Claim Report and include basic claim caption information, a complete description of the occurrence and injury, payment information, and the current status of the claim including recovery potential. For subsequent reports, prior to submitting a reimbursement, use the Interim Claim Report to provide a status update. If a Reimbursement Request is submitted, you do not need to submit a separate Interim Claim Report.

All serious claims of WCRA members involving a loss which occurred on or after October 1, 1979, or subsequent to membership in the Association, may be appropriate for reporting to the WCRA. Members should report claims involving serious injury or significant anticipated costs as described below.

CATASTROPHIC INJURY

Claims involving the following injuries should be promptly reported to the WCRA within 10 business days of notification of the injury to the member:

  1. Spinal cord injury resulting in paraplegia or quadriplegia.
  2. Moderate to severe brain injuries.
  3. Major burns, defined as second- or third-degree burns involving covering 30 percent or more of the body, electrocution injuries, or if significant medical costs can be anticipated.
  4. Amputations of a significant portion of one extremity or multiple limb amputations.
  5. Complete vision loss.
SERIOUS INJURIES

Claims involving the following injuries should be promptly reported to the WCRA after taking into consideration the applicable Retention Limit that was in effect at the time of the Loss Occurrence:

  1. Impairment of total vision by 50 percent or more.
  2. Partial paralysis in an upper or lower extremity.
  3. Crushing or massive internal injuries.
  4. Multiple fractures or significant degloving injuries.
  5. Occupational disease allegedly caused by working conditions or other job-related factors, including asbestosis, chronic pulmonary disease, or other occupational disease which results in a disability expected to last two years or more. In cases of occupational disease, each person who has been exposed is considered a separate Loss Occurrence.
  6. A Loss Occurrence that is likely to produce multiple post-traumatic stress disorder Claims under Minn. Stat. § 176.011, subd. 15(d) and is considered likely to affect the interests of the Association.
INCURRED CLAIM COST THRESHOLD

A Claim should be reported promptly to the Association when the total incurred cost of a Claim exceeds the lesser of 50 percent of the applicable Retention Limit that was in effect at the time of the Loss Occurrence or $1,000,000.

Over time, some injuries that do not meet the reporting criteria for catastrophic or serious injuries develop into Claims that may reach a Member’s selected Retention Limit. In determining whether the total incurred cost of a Claim exceeds the reporting requirement, Members should include all medical and indemnity Member Payments made to the claimant(s) involved in the loss plus the undiscounted medical and indemnity reserves, including the aggregate reserve in a multi-claimant loss, established by the member for future claim costs. Setting accurate and adequate lifetime reserves is as important for Members as it is for the WCRA. Each Member has its own reserving philosophy. The WCRA claims staff, when performing its Claims reviews, examines case reserves and reserving methodologies for reasonableness.

Please note that there are some exceptions to these criteria. A Claim need not be reported to the WCRA if it has been settled on a full, final, and complete basis with limited medical exposure, and the total Member Payments are not expected to exceed the applicable Retention Limit. Nor is it necessary to report a second injury fund Claim that’s responsible for 100 percent of the Ultimate Loss, or a Claim where a recovery is being made such that, total Member Payments will not exceed the applicable Retention Limit.

Initial Claim reports must be submitted electronically via the WCRA Portal.  The information requested on the initial Claim report is designed to provide the WCRA with sufficient data to determine if the Claim may involve liability to the WCRA. Initially, the WCRA needs the basic claimant information, a complete description of the Loss Occurrence and injury, payment information, and the current status of the Claim, including recovery potential. The WCRA also requests the First Report of Injury (FROI) be submitted with the initial Claim report to provide any additional clarifying information.

If the information submitted by the Member on the initial Claim report is inadequate for the Association to evaluate and determine its liability, if any, additional or explanatory information may be requested from the Member. If the
Association determines the claim will not involve exposure to the WCRA, a Claim will not be opened or reserved. Any Claims that are anticipated to present exposure to the WCRA based on WCRA’s independent reserving calculations will be opened and placed on a diary schedule for interim Claim update reporting.

A member should submit an initial reimbursement request to the WCRA after payments to the claimant or claimants involved in the same loss exceed the retention limit that was in effect at the time of injury.

Reimbursement requests may be submitted in the anniversary and half-year anniversary months of the date of loss (exceptions apply).

Reimbursement Requests must be submitted electronically via the WCRA Portal. To be able to report using the WCRA Portal, an individual personal account with a username and password needs to be set up. If you do not have a WCRA Portal account go to the WCRA website at www.wcra.biz to access the application form and additional information about this service.

The following information should be provided to the WCRA:

  • Reimbursement Request Form for each occurrence.
  • Indemnity Documentation.
  • Medical and Vocational Rehabilitation Reports.
  • Medical and Vocational Rehabilitation Payment Documentation.
  • Legal documents such as Stipulations, Findings, and Orders.
  • Apportionment.

The WCRA shall provide indemnification to a Member for 100 percent of the Member Payments of Ultimate Loss sustained in each Loss Occurrence in excess of the applicable Retention Limit selected by the Member. Ultimate Loss is defined more specifically in the Definitions section herein but generally includes the required benefits payable under Minnesota Statutes Chapter 176 and excludes Claim Expenses and penalties.