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Injury and Loss Codes

Brief description of Injury Type code and Loss Condition code for unit statistical reporting.;

The Statistical Plan - 2008 Edition, Part 6, provides all the coding specifications for reporting premium and losses. We are frequently asked for injury or loss codes. The Injury Type code is a two digit number. Here are the national codes used by Indiana. Note that some states have different codes which the USP Manual would further explain. Also, remember for claims coded as 06, medical only, are discounted by 70% in the experience rating formula.

Code
Description
01
Death

02

Permanent total disability

03

State specials (FL & LA)

04

State special (FL)

05

Temporary injury

06

Medical only

07

Contract medical*

08

not used

09

Permanent partial disability


*Contract medical refers to medical costs that have a predetermined total price and are not directly related to services rendered for medical services performed. This may occur when a medical care provider (MCP) and a carrier agree that the MCP will directly treat their injured workers for a predetermined fee and amount of time. The contract price is the same regardless of the number of claims that actually occur.

Loss Condition code is a ten digit number consisting of five components: act, type of loss, type of recovery, type of coverage, and type of settlement. Refer to the USP Manual for the details.

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The material in this document has been prepared and shared for informational purposes only and should not be relied upon as legal advice on any particular situation.