- 1. REPORTING OF STATISTICS
- 2. PREPARATION AND COMPLETION OF UNIT STATISTICAL REPORTS
- 3. MANAGE DATA
- 4. SUBMISSION CONTROL RECORD
- 5. VALIDATION OF STATISTICS PRIOR TO SUBMISSION
- 6. CORRECTION OF ERRORS
- 7. FILING REQUIREMENTS
- 8. MULTI-STATE POLICIES
- 9. UNCOLLECTIBLE PREMIUMS
- 10. REINSURANCE
- 11. NATIONAL DEFENSE PROJECTS
- 12. RADIATION EXPOSURE – NUCLEAR REGULATORY COMMISSION PROJECTS
- 13. RADIATION EXPOSURE – OTHER THAN NUCLEAR REGULATORY COMMISSION PROJECTS
- 14. COVERAGE FOR OTHER THAN PAYROLL BASED EXPOSURES
- 15. EXCLUDING MEDICAL AND EXCESS COVERAGE FOR MEDICAL PAYMENTS (PER CLAIM OR PER ACCIDENT BASIS) – EXCLUDING MEDICAL POLICIES
- 16. DATE OF VALUATION, FILING AND FINE MONTH
- 17. TIMELINESS AND DATA QUALITY FINE PROGRAM
- 18. CLASSIFICATION CODES
- 19. MULTIPLE YEAR POLICIES OTHER THAN THREE-YEAR FIXED RATE
- 20. THREE-YEAR FIXED RATE POLICIES
- 21. WHOLE DOLLAR AMOUNTS REQUIRED
- 1. REPORT NUMBER
- 2. CORRECTION SEQUENCE NUMBER
- 3. CORRECTION TYPE
- 4. REPLACEMENT REPORT CODE
- 5. CARRIER CODE
- 6. POLICY NUMBER
- 7. POLICY EFFECTIVE DATE
- 8. POLICY EXPIRATION DATE
- 9. EXPOSURE STATE
- 10. STATE EFFECTIVE DATE
- 11. RISK ID NUMBER (OPTIONAL)
- 12. EMPLOYER NAME
- 13. EMPLOYER ADDRESS
- 14. FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
- 15. POLICY CONDITIONS
- 16. POLICY TYPE ID
- 17. DEDUCTIBLE TYPE
- 18. DEDUCTIBLE PERCENT
- 19. DEDUCTIBLE AMOUNT PER CLAIM/ACCIDENT
- 20. DEDUCTIBLE AMOUNT – AGGREGATE
- 1. EXPERIENCE MODIFICATION EFFECTIVE DATE
- 2. RATE EFFECTIVE DATE
- 3. UPDATE TYPE
- 4. EXPOSURE COVERAGE CODE
- 5. CLASSIFICATION CODE
- 6. EXPOSURE AMOUNT
- 7. MANUAL RATE
- 8. SPLIT PERIOD CODE
- 9. PREMIUM AMOUNT
- 10. PREMIUM AMOUNT SUBJECT TO EXPERIENCE MODIFICATION FACTOR
- 11. TOTAL SUBJECT PREMIUM AMOUNT
- 12. EXPERIENCE MODIFICATION FACTOR
- 13. PREMIUM NOT SUBJECT TO EXPERIENCE MODIFICATION FACTOR
- 14. TOTAL PAYROLL EXPOSURE
- 15. TOTAL STANDARD PREMIUM AMOUNT
- 16. PREMIUM DISCOUNT AMOUNT
- 17. EXPENSE CONSTANT AMOUNT
- 18. CATASTROPHE PROVISION FOR TERRORISM
- 19. CATASTROPHE PROVISION FOR NATURAL DISASTERS AND CATASTROPHIC INDUSTRIAL ACCIDENTS
- 20. NEW YORK WORKERS’ COMPENSATION SECURITY FUND SURCHARGE
- 1. REPORTING OF LOSSES
- 2. UPDATE TYPE
- 3. CLAIM NUMBER
- 4. ACCIDENT DATE
- 5. INCURRED LOSSES
- 6. EXPENSES EXCLUDED FROM LOSSES
- 7. EXPENSES INCLUDED IN LOSSES
- 8. FRAUDULENT CLAIMS
- 9. NON-COMPENSABLE REPORTING
- 10. RECOVERIES – SUBROGATION, THIRD-PARTY CASES
- 11. LUMP-SUM CLAIMS
- 12. PAID LOSSES
- 13. ALLOCATED LOSS ADJUSTMENT EXPENSE ("ALAE") PAID AMOUNT
- 14. CLASSIFICATION CODE
- 15. INJURY TYPE
- 16. CLAIM STATUS
- 17. LOSS CONDITION CODE
- 18. JURISDICTION STATE
- 19. CATASTROPHE NUMBER
- 20. MANAGED CARE ORGANIZATION TYPE
- 21. INJURY DESCRIPTION CODE
- 22. OCCUPATION DESCRIPTION
- 23. NEW YORK STATE WORKERS’ COMPENSATION BOARD CASE NUMBER
- 24. CLAIMANT’S WEEKLY WAGE
- 25. CLAIMANT ATTORNEY FEES INCURRED (OPTIONAL)
- 26. EMPLOYER ATTORNEY FEES INCURRED (OPTIONAL)
- 27. TOTALS
- 1. SUBSEQUENT REPORTS
- 2. CORRECTION REPORTS
- 3. METHOD OF REPORTING
- 4. LINK DATA
- 5. REPLACEMENT REPORTS
- 6. PROCEDURE FOR CORRECTION OF CLAIMS AFTER SUBSEQUENT REPORTS HAVE BEEN FILED