A. CODES COMMON TO PREMIUM AND LOSSES

  1. Reporting Number and Valuation Date

    CodeDescription
    1Valued as of the 18th month after the month in which the policy became effective
    2Valued 30 months after the month in which the policy became effective
    3Valued 42 months after the month in which the policy became effective
    4Valued 54 months after the month in which the policy became effective
    5Valued 66 months after the month in which the policy became effective
    6Valued 78 months after the month in which the policy became effective
    7Valued 90 months after the month in which the policy became effective
    8Valued 102 months after the month in which the policy became effective
    9Valued 104 months after the month in which the policy became effective
    AValued 126 months after the month in which the policy became effective

     

  2. Correction Type

    Indicates the type of correction report being submitted.  Applicable only to correction reports.

    CodeDescription
    HHeader Record Correction
    EExposure Record Correction (First Reports Only)
    LLoss Record Correction
    TTotal Record Correction Only
    MMultiple Record Corrections

     

  3. Exposure State

    The following state code number must be used:  New York – 31.

     

  4. Policy Conditions

    Report the 1-position code for each policy condition.

    1. Three Year Fixed Rate Indicator

      “Y” = Policy is a three-year fixed rate policy
      “N” = Policy is not a three-year fixed rate policy

       

    2. Multi-state Policy Indicator

      “Y” = Policy is a multi-state policy
      “N” = Policy is not a multi-state policy

       

    3. Interstate Policy Indicator

      “Y” = Policy is interstate rated
      “N” = Policy is not interstate rated

       

    4. Estimated Audit Code

      “Y” = Exposures expressed on unit report are estimated
      “N” = Exposures expressed on unit report are not estimated
      “U” = Exposures expressed on unit report are estimated – uncooperative insured

       

    5. Retrospective Rated Policy Indicator

      “Y” = Policy is retrospectively rated
      “N” = Policy is not retrospectively rated

       

    6. Canceled Mid-Term Indicator

      “Y” = Policy has been canceled mid-term 
      “N” = Policy has not been canceled mid-term

       

    7. Managed Care Organization Indicator

      “Y” = Policy has provisions for the administration of losses under an approved managed care organization or preferred provider organization
      “N” = Policy does not have provisions for the administration of losses by an approved managed care organization or preferred provider organization
  5. Policy Type ID

    Identifies the type of coverage, plan indicator and non-standard provisions of the policy.

    1. Type of Coverage

      CodeDescription
      01Standard Workers’ Compensation Policy
      09Non-Standard Policy

       

    2. Plan Type

      CodeDescription
      01Voluntary Policy

       

    3. Non-Standard Type

      CodeDescription
      01Non-Standard
      02Excluding Medical
      06Excess Medical
  6. Deductible Type

    Identifies the type of deductible being reported.

    1. Type of Deductible – First Two Positions

      CodeDescription
      00No Deductible
      01Medical Losses Only
      02Indemnity Losses Only
      03Medical & Indemnity Losses

       

    2. Type of Plan – Second Two Positions

      CodeDescription
      00No Deductible
      01Per Claim
      02Per Accident
      03Per Policy (Aggregate)
      04Percent of Claim Cost
      05Percent of Premium
      06Coinsurance Only
      07Benefit Coinsurance
      08Per Accident Coinsurance
      09Per Policy and Accident (Aggregate)
      10Per Claim and Policy (Aggregate)
      11Coinsurance Percent With Claim and Policy Aggregate Limits
      12Variable

B. EXPOSURE CODES

  1. Update Type

    Identifies the activity of an exposure record.

    CodeDescription
    PPreviously Reported
    R Revised

     

  2. Exposure Coverage

    Indicates the Act (Law) under which the exposure for the record’s classification code is associated.

    CodeDescription
    00For use with Statistical Codes
    01State or Federal Act, Excluding USL & HW
    02USL & HW Coverage on “F” or non “F” Classifications

     

  3. Premium Codes

    1. Premium Subject to Experience Modification (Reported Above Line “A”)

      1. Premium for Increased Limits

        DescriptionCode
        Employers’ Liability Increased Limits (in 000’s) 
        With Workers’ Compensation 
        $100/100/1,0009803
        $100/100/2,5009804
        $100/100/5,0009805
        $100/100/10,0009806
        $500/500/5009807
        $500/500/1,0009808
        $500/500/2,500 9809
        $500/500/5,000 9810
        $500/500/10,0009811
        $1,000/1,000/1,0009812
        $1,000/1,000/2,5009813
        $1,000/1,000/5,0009814
        $1,000/1,000/,10,0009815
        Over $1,000/1,000/10,0009816

         

        DescriptionCode
        Employers’ Liability Increased Limits (in 000’s) 
        Without Workers’ Compensation 
        $100/100/1,0009823
        $100/100/2,5009824
        $100/100/5,0009825
        $100/100/10,0009826
        $500/500/5009827
        $500/500/1,0009828
        $500/500/2,5009829
        $500/500/5,0009830
        $500/500/10,0009831
        $1,000/1,000/1,0009832
        $1,000/1,000/2,5009833
        $1,000/1,000/5,0009834
        $1,000/1,000/,10,0009835
        Over $1,000/1,000/10,0009836
         
        All Other Increased Limits9837
        For unpublished limits within the table, use the next highest limit code.

         

        Employers’ Liability Increased Limits – Admiralty or FELACode
        $50,0009817
        $100,0009818
        $200,0009819
        $300,0009820
        $400,0009821
        $500,0009822
        Over $500,0009840
         
        Employers’ Liability Increased Limits – Additional Premium to Balance to Minimum9848

        Note: The increased limits premium applicable to non-ratable classification exposures should be reported as not subject to the experience modification.

      2. Construction Employment Territory Differential Premium

        DescriptionCode
        Territory 19126
        Territory 29127
        Territory 39128

       

      DescriptionCode
      1. Premium Credit From Carrier Filed Drug-Free Workplace Program Before Experience Modification
      9841
      1. Additional Premium From Flat Increase on Outstanding Policies
      0998
      1. Premium Credit Resulting From Flat Decrease on Outstanding Policies
      0994
      1. Deductible Applied to Manual Premium Before Experience Modification
      9664
      1. No Exposure (“If Any”)
      1111
      1. EL Extension under VFBL
      9850
      1. EL Extension under VAWBL
      9851
      1. Repatriation Expense
      9606
      1. Waiver of Subrogation Premium
      0930

       

    2. Premium Not Subject to Experience Modification (Lines “D”, “E” or “F”)

      DescriptionCode
      1. Radiation Exposure
      9985
      1. CPAP Premium Credit
      9046
      1. Premium Credit From Carrier Filed Drug-Free Workplace Program After Experience Rating
      9846
      1. Deductible Applied to Manual Premium From Carrier Filed Deductible Programs After Experience Modification
      9663
      1. Premium Credit From Managed Care or Preferred Provider Organization Programs
      9874
      1. New York Merit Rating Program

        Factor = .92
        Factor = 1.00
        Factor = 1.04
        Factor = 1.08

      9885
      9884
      9896
      9886

      1. Premium to Balance To Minimum Premium

        Other Than Maritime or FELA
        Maritime or FELA

       
      9884
      9849

      1. Non-Ratable Elements

        For Class 4771
        For Class 7405
        For Class 7431

       
      0771
      7445
      7453

      1. Compulsory Workplace Safety Program Surcharge
      9747

       

    3. Premium Not Subject to Experience Modification (Lines “D”, “E” or “F”)

      DescriptionCode
      1. Radiation Exposure
      9985
      1. CPAP Premium Credit
      9046
      1. Premium Credit From Carrier Filed Drug-Free Workplace Program After Experience Rating
      9846
      1. Deductible Applied to Manual Premium From Carrier Filed Deductible Programs After Experience Modification
      9663
      1. Premium Credit From Managed Care or Preferred Provider Organization Programs
      9874
      1. New York Merit Rating Program

        Factor = .92
        Factor = 1.00
        Factor = 1.04
        Factor = 1.08

      9885
      9884
      9896
      9886

      1. Premium to Balance To Minimum Premium

        Other Than Maritime or FELA
        Maritime or FELA

       
      9884
      9849

      1. Non-Ratable Elements

        For Class 4771
        For Class 7405
        For Class 7431

       
      0771
      7445
      7453

      1. Compulsory Workplace Safety Program Surcharge
      9747
      1. Workplace Safety & Loss Prevention Program (WSLPIP) Credits

        Drug & Alcohol Prevention
        Return-To-Work
        Safety Incentive

      9753
      9743
      9748

      1. Short Rate Penalty Premium
      0931
      1. Safe Patient Handling Program Premium Credit
      9651
      1. Schedule Rating Adjustment

        Credit
        Debit

      9887
      9889

       

    4. Premium Not Subject to Experience Modification and Not to be Included in Standard Premium (Lines “H”, “I” or “J”).

      DescriptionCode
      1. Premium Discount Amount-Stock Company or Type A
      0063
      1. Premium Discount Amount-Non-Stock Company or Type B
      0064
      1. Expense Constant Amount
      0900
      1. Terrorism Premium Amount
      9740
      1. Natural Disaster & Catastrophic Industrial Accidents Premium
      9741
      1. New York WC Security Fund Surcharge
      9749

C. LOSS INFORMATION CODES

  1. Injury Type

    CodeDescription
    1Death
    2Permanent Total Disability
    5Temporary Total Disability
    6Medical Only Claims
    7Contract Medical
    10Permanent Partial Disability – Scheduled – Loss – Of – Use
    11Permanent Partial Disability – Non-Scheduled

     

  2. Claim Status

    CodeDescription
    0Open
    1Closed
    2Reopened

     

  3. Loss Conditions

    1. Act

       

      CodeDescription
      01State or Federal Act, excluding USL & HW
      02USL & HW “F” Classes or USL & HW Coverage on Non “F” Classifications

       

    2. Type of Loss

       

      CodeDescription
      01Trauma
      02Occupational Disease (OD)
      03Cumulative Injury Other Than Disease

       

    3. Type of Recovery

       

      CodeDescription
      01No Recovery
      03Subrogation (Third Party)

       

    4. Type of Claim

       

      CodeDescription
      01Workers’ Compensation Only
      02Employers’ Liability Only
      03Workers’ Compensation & Employers’ Liability
      04Liability-Over

       

  4. Managed Care Organization Type

     

    CodeDescription
    00The claim is not administrated by an approved managed care or preferred provider organization
    01The claim’s medical losses are administrated by an approved managed care organization
    03The claim’s medical losses are administrated by a licensed preferred provider organization

     

  5. Fraudulent Claim Codes

     

    CodeDescription
    00Not Fraudulent
    01Partially Fraudulent
    02Fully Fraudulent

     

  6. Injury Description Codes

    1. Part – identify the part of body injured
    2. Nature – identify the nature of the injury
    3. Cause – identify the specific cause of injury

    Refer to the following Injury Description Codes:

INJURY DESCRIPTION CODES – PART OF BODY

INJURY DESCRIPTION CODES – PART OF BODY
CODEPART OF BODYNARRATIVE DESCRIPTION
I. Head
10Multiple Head InjuryAny combination of below parts
11Skull*
12Brain*
13Ear(s)Includes:  hearing, inside eardrum
14Eye(s)Includes:  optic nerves, vision, eye lids
15NoseIncludes:  nasal passage, sinus, sense of smell
16Teeth*
17MouthIncludes:  lips, tongue, throat, taste
18Soft Tissue*
19Facial BonesIncludes: jaw
II. Neck
20Multiple Neck InjuryAny combination of below parts
21VertebraeIncludes:  spinal column bone, “cervical segment”
22DiscIncludes:  spinal column cartilage, “cervical segment”
23Spinal CordIncludes:  nerve tissue, “cervical segment”
24LarynxIncludes:  cartilage and vocal cords
25Soft TissueOther than larynx or trachea
26Trachea*
V. Lower Extremities
50Multiple Lower ExtremitiesAny combination of below parts
51Hip*
52Upper LegFemur and corresponding muscles
53KneePatella
54Lower LegTibia, fibula and corresponding muscles
55AnkleTarsals
56FootMetatarsals, heel, Achilles tendon and corresponding muscles – excluding ankle or toes
57Toes*
58Great Toe*
VI. Multiple Body Parts
64Artificial ApplianceBraces, etc.
65Insufficient Info to Properly Identify – UnclassifiedInsufficient information to identify part affected
66No physical InjuryMental disorder
90Multiple Body Parts (including Body Systems & Body Parts)Applies when more than one major body part has been affected, such as an arm and a leg and multiple internal organs.
91Body Systems and Multiple Body SystemsApplies to the functioning of an entire body system has been affected without specific injury to any other part, as in the case of poisoning, corrosive action, inflammation, affecting internal organs, damage to nerve centers, etc., does not apply when the systemic damage results from an external injury affecting an external part such as a back injury which includes damage to the nerves of the spinal cord.

INJURY DESCRIPTION CODES – NATURE OF INJURY

INJURY DESCRIPTION CODES – NATURE OF INJURY
CODENATURE OF INJURYNARRATIVE DESCRIPTION
I. Specific Injury
01No Physical Injuryi.e., Glasses, contact lenses, artificial appliance, replacement of artificial appliance
02AmputationCut off extremity, digit, protruding part of body, usually by surgery, i.e. leg, arm
03Angina PectorisChest pain
04Burn

(Heat) Burns or scald. The effect of contact with hot substances.
(Chemical) burns, tissue damage resulting from the corrosive action chemicals, fume, etc., (acids, alkalies)

07ConcussionBrain, cerebral
10ContusionBruise - intact skin surface hematoma
13CrushingTo grind, pound or break into small bits
16DislocationPinched nerve, slipped/ruptured disc, herniated disc, sciatica, complete tear, HNP subluxtion, MD dislocation
19Electric ShockElectrocution
22EnucleationRemoval of organ or tumor
25Foreign Body*
28FractureBreaking of a bone or cartilage
30FreezingFrostbite and other effects of exposure to low temperature
31Hearing Loss or ImpairmentTraumatic only.  A separate injury, not the sequelae of another injury.
32Heat ProstrationHeat stroke, sun stroke, heat exhaustion, heat cramps and other effects of environmental heat.  Does not include sunburn.
34HerniaThe abnormal protrusion of an organ or part through the containing wall of its cavity.
36InfectionThe invasion of a host by organisms such as bacteria, fungi, viruses, mold, protozoa or insects, with or without manifest disease.
37InflammationThe reaction of tissue to injury characterized clinically by heat, swelling, redness and pain.
40LacerationCut, scratches, abrasions, superficial wounds, calluses, wound by tearing
41Myocardial InfarctionHeart attack, heart conditions, hypertension. The inadequate blood flow to the muscular tissue of the heart.
42Poisoning – General (Not OD or Cumulative Injury)A systemic morbid condition resulting from the inhalation, ingestion, or skin absorption of a toxic substance affecting the metabolic system, the nervous system, the circulatory system, the digestive system, the respiratory system, the excretory system, the musculoskeletal system, etc. includes chemical or drug poisoning, metal poisoning, organic diseases, and venomous reptile and insect bites. Does NOT include effects of radiation, pneumoconiosis, corrosive effects of chemicals; skin surface irritations, septicemia or infected wounds.
43PunctureA hole made by the piercing of a pointed instrument.
46Rupture*
47SeveranceTo separate, divide or take off.
49SprainInternal derangement, a trauma or wrenching of a joint, producing pain and disability depending upon degree of injury to ligaments.
52StrainInternal derangement, the trauma to the muscle or the musculotendinous unit from violent contraction or excessive forcible stretch.
54AsphyxiationStrangulation, drowning
55VascularCerebrovascular and other conditions of circulatory systems, NOC, excludes heart and hemorrhoids.
Includes: strokes, varicose veins - non toxic.
58Vision Loss*
59All Other Specific Injuries, NOC*
II. Occupational Disease or Cumulative Injury
60Dust Disease, NOCAll other pneumoconiosis
61AsbestosisLung disease, a form of pneumoconiosis, resulting from protracted inhalation of asbestos particles.
62Black LungThe chronic lung disease or pneumoconiosis found in coal miners.
63ByssinosisPneumoconiosis of cotton, flax and hemp workers
64SilicosisPneumoconiosis resulting from inhalation of silica (quartz) dust.
65Respiratory DisordersGases, fumes, chemicals, etc.
66Poisoning – Chemical (Other Than Metals)Man-made or organic
67Poisoning – MetalMan-made
68DermatitisRash, skin or tissue inflammation including boils, etc., generally resulting from direct contact with irritants or sensitizing chemicals such as drugs, oils, biologic agents, plants, woods or metals which may be in the form of solids, pastes, liquids or vapors and which may be contacted in the pure state or in compounds or in combination with other materials.  Does NOT include skin tissue damage resulting from corrosive action of chemicals, burns from contact with hot substances, effects of exposure to radiation, effects of exposure to low temperatures or inflammation or irritation resulting from friction or impact.
69Mental DisorderA clinically significant behavioral or psychological syndrome or pattern typically associated with either a distressing symptom or impairment of function. i.e., acute anxiety, neurosis, stress, non-toxic depression.
70RadiationAll forms of damage to tissue, bones or body fluids produced by exposure to radiation.
71All Other Occupational Disease Injury, NOC*
72Loss of Hearing*
73Contagious Disease*
74Cancer*
75AIDS*
76VDT – Related DiseasesVideo display terminal diseases other than carpal tunnel syndrome
77Mental Stress*
78Carpal Tunnel SyndromeSoreness, tenderness and weakness of the muscles of the thumb caused by pressure on the median nerve at the point at which it goes through the carpal tunnel of the wrist
79Hepatitis C*
80All Other Cumulative Injury, NOC*
83COVID-19Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a coronavirus.
III. Multiple Injury
90Multiple Physical Injuries Only*
91Multiple Injuries Including Both Physical and Physiological*

INJURY DESCRIPTION CODES – CAUSE OF INJURY

INJURY DESCRIPTION CODES – CAUSE OF INJURY
CODECAUSE OF INJURYNARRATIVE DESCRIPTION
I. Burn or Scald – Heat or Cold Exposures – Contact With
01ChemicalsIncludes hydrochloric acid, sulfuric acid, battery acid, methanol, antifreeze.
02Hot Objects or Substances*
03Temperature ExtremesNon-impact injuries resulting in a burn due to hot or cold temperature extremes. Includes freezing or frostbite.
04Fire or Flame*
05Steam or Hot Fluids*
06Dust, Gases, Fumes or VaporsIncludes inhalation of carbon dioxide, carbon monoxide, propane, methane, silica (quartz), asbestos dust and smoke.
07Welding OperationsIncludes welder's flash (burns to skin or eyes as a result of exposure to intense light from welding.)
08RadiationIncludes effects of ionizing radiation found in X- rays, microwaves, nuclear reactor waste, and radiating substances and equipment. Includes non-ionizing radiation such as sunburn.
11Cold Objects or Substances*
14Abnormal Air Pressure*
84Electrical CurrentIncludes electric shock, electrocution and lightning.
09Contact With, NOCNot otherwise classified in any other code. Includes cleaning agents and fertilizers.
II. Caught In, Under or Between
10Machine or MachineryRunning or meshing objects, a moving and a stationary object, two or more moving objects
12Object HandledIncludes medical hospital bed & parts, wheelchair, clothespin vise.
20Collapsing Materials (Slides of Earth)Either man-made or natural.
13Caught In, Under or Between, NOCNot otherwise classified in any other code.
III. Cut, Puncture, Scrape – Injured By
15Broken Glass*
16Hand Tool, Utensil; Not PoweredIncludes needle, pencil, knife, hammer, saw, axe, screwdriver.
17Object Being Lifted or HandledIncludes being cut, punctured or scraped by a person or object being lifted or handled.
18Powered Hand Tool, ApplianceIncludes drill, grinder, sander, iron, blender, welding tools, nail gun.
19Caught, Puncture, Scrape, NOCNot otherwise classified in any other code. Includes power actuated tools.
IV. Fall, Slip or Trip
25From Different Level (Elevation)Includes collapsing chairs, falling from piled materials, off wall, catwalk, bridge.
26From Ladder or Scaffolding*
27From Liquid or Grease Spills*
28Into OpeningsIncludes mining shafts, excavations, floor openings, elevator shafts.
29On Same Level*
30Slipped, Did Not FallSlip or trip and did not come in contact with the floor or ground.
32On Ice or Snow*
33On Stairs*
31Fall, Slip or Trip, NOCNot otherwise classified in any other code. Includes tripping over object, slipping on organic material, slip but fall not specified.
V. Motor Vehicle
40Crash of Water Vehicle*
41Crash of Rail Vehicle*
45Collision or Sideswipe with Another VehicleVehicle collision, both vehicles in motion.
46Collision with a Fixed ObjectCollision occurring with standing vehicle or stationary object.
47Crash of Airplane*
48Vehicle UpsetIncludes overturned or jackknifed.
50Motor Vehicle, NOCNot otherwise classified in any other code. Includes injuries due to sudden stop or start, being thrown against interior parts of the vehicle and vehicle contents being thrown against occupants.
VI. Strain or Injury By
52Continual NoiseInjury to ears or hearing due to the cumulative effects of constant or repetitive noise.
53TwistingFree bodily motion that imposes stress or strain on some part of body. Includes assumption of unnatural position, involuntary motions induced by sudden noise, fright or loss of balance.
54Jumping*
55Holding or CarryingApplies to objects or people. Includes restraining a person.
56LiftingIncludes objects or people.
57Pushing or PullingIncludes objects or people.
58Reaching*
59Using Tool or Machinery*
61Wielding or ThrowingPhysical effort or overexertion from attempts to resist a force applied by an object being handled.
97Repetitive MotionCumulative injury or condition caused by continual, repeated motions; strain by excessive use.  Includes Carpal Tunnel Syndrome.
60Strain or Injury By, NOCNot otherwise classified in any other code.
VII. Striking Against or Stepping On
65Moving Part of Machine*
66Object Being Lifted or Handled*
67Sanding, Scraping, Cleaning OperationInclude scratches or abrasions caused by sanding, scraping, cleaning operations.
68Stationary Object*
69Stepping on Sharp Object*
70Striking Against or Stepping On, NOCNot otherwise classified in any other code.
74Fellow Worker; PatientStruck by co-worker, either on purpose or accidentally. Includes being struck by a patient while lifting or moving them not in act of a crime.
75Falling or Flying Object*
76Hand Tool or Machine in Use*
77Motor VehicleApplies when a person is struck by a motor vehicle, including rail vehicles, water vehicles, airplanes.
78Moving Parts of Machine*
79Objects Being Lifted or HandledIncludes dropping object on body part.
80Object Handled By OthersIncludes another person dropping object on injured person's body part.
85Animal or InsectIncludes bite, sting or allergic reaction.
86Explosion or Flare BackRapid expansion, outbreak, bursting, or upheaval. Includes explosion of cars, bottles, aerosol cans, or buildings. "Flare back" involves superheated air and combustible gases at temperatures just below the ignition temperature.
81Struck or Injured, NOCNot otherwise classified in any other code. Includes kicked, stabbed, bitten.
IX. Rubbed or Abraded By
94Repetitive MotionCaused by repeated rubbing or abrading; applies to non-impact cases in which the injury was produced by pressure, vibration or friction between the person and the source of injury. Includes callous, blister.
95Rubbed or Abraded, NOCNot otherwise classified in any other code. Includes foreign body in ears.
X. Miscellaneous Causes
82Absorption, Ingestion or Inhalation, NOCNot otherwise classified in any other code. Applies only to non-impact cases in which the injury resulted from inhalation, absorption (skin contact), or ingestion of harmful substances.
83PandemicIncludes disease epidemic that has spread across a large region.
87Foreign Matter (Body) in (Eyes)Injury to eyes resulting from foreign matter that is not otherwise classified in any other code.
88Natural DisasterInjury resulting from natural disaster. Includes hurricane, earthquake, tornado, flood, forest fire.
89Person in Act of a Crime (Other Than Gunshot)Specific injury, other than gunshot, caused as a result of contact between injured person and another person in the act of committing a crime. Includes robbery or criminal assault.
90Other Than Physical Cause of InjuryStress, shock, or psychological trauma that develops in relation to a specific incident or cumulative exposure to conditions.
93GunshotInjury is caused by the discharge of a firearm. Includes instances where injury arises from being struck by the fired projectile, burned by muzzle blast or deafened by report of gunshot.
91MoldIncludes mildew.
96TerrorismAn act that causes injury to human life, committed by one or more individuals as part of an effort to coerce a population group(s) or to influence the policy or affect the conduct of any government(s) by coercion.
98Cumulative, NOCCumulative, not otherwise classified in any other code. Involves cases in which the cause of injury occurred over a period of time, any condition increasing in severity over time.
99Other – Miscellaneous, NOCNot otherwise classified in any other code.

JURISDICTION STATE CODE

Jurisdiction State Code identifies the governing jurisdiction that administers the claim.

STATECODESTATECODESTATECODE
Alabama01Louisiana17Oklahoma35
Alaska54Maine18Oregon36
Arizona02Maryland19Pennsylvania37
Arkansas03Massachusetts20Puerto Rico58
California04Michigan21Rhode Island38
Colorado05Minnesota22South Carolina39
Connecticut06Mississippi23South Dakota40
Delaware07Missouri24Tennessee41
District of Columbia08Montana25Texas42
Florida09Nebraska26Utah43
Georgia10Nevada27Vermont44
Hawaii52New Hampshire28Virginia45
Idaho11New Jersey29Washington46
Illinois12New Mexico30West Virginia47
Indiana13New York31Wisconsin48
Iowa14North Carolina32Wyoming49
Kansas15North Dakota33  
Kentucky16Ohio34