|
Compensation Payments |
|
01 |
Permanent Partial Disability (PDR less than 100%) |
|
02 |
Permanent Total Disability |
|
06 |
Temporary Disability |
|
15 |
Claimant Attorney Permanent Partial |
|
16 |
Claimant Attorney Permanent Total |
|
1B |
Claimant Attorney Death Benefits |
|
1C |
Claimant Incurred Legal Expense |
|
11 |
Claimant Attorney Temporary Disability |
|
12 |
Claimant Attorney VR |
|
13 |
Subsequent Injury - All Costs Except Doctors |
|
14 |
Subsequent Injury - Doctors |
|
1A |
Death Benefits |
|
17 |
Burial Expenses |
|
18 |
State Salvage - Compensation Recovery |
|
|
|
DOIs Prior To 1-1-94 |
|
V1 (07) |
VR1 Maintenance |
|
V2 (08) |
VR2 Testing and Evaluation |
|
V3 (09) |
VR3 Training |
|
|
|
|
DOIs and Voc/Rehab Cases Commencing On Or After 1-1-94 |
|
1D |
VR1 Inside Cap |
|
1E |
VR1 Outside Cap |
|
1Q |
VR3 Inside Cap |
|
1R |
VR3 Outside Cap |
|
1H |
Evaluation |
|
1K |
Plan Development |
|
1F |
Job Placement |
|
1G |
Job Placement Outside Cap |
|
1J |
Evaluation Outside Cap |
|
1M |
Plan Development Outside Cap |
|
1N |
Miscellaneous Inside Cap |
|
1P |
Miscellaneous Outside Cap |
|
|
20 |
Treating Physicians - all physicians, dentists, chiropractors, radiologists, Christian Science practitioners and acupuncturists |
|
21 |
Hospitals - including nursing homes, convalescent homes, and sanitariums |
|
22 |
MMC/External Vendor Fees |
|
23 |
Payments to Injured - for transportation, living expense, medical reimbursement |
|
24 |
Pharmacies |
|
25 |
Medical Services - all ambulance, nurses, medical exams, x-rays, interpreters, blood banks, and gymnasiums |
|
26 |
Appliances - all sellers, renters, manufacturers of artificial eyes, limbs, orthopedic appliances, beds, hearing aids, and glasses |
|
27 |
All Reimbursement to Attorneys, Insurance Companies and Agencies - this is not reportable to IRS |
|
28 |
Physical Therapy |
|
29 |
Cost Containment - payments to cost containment vendors for bill review charges, etc. |
|
30 |
Medical Evaluations and All Related Costs Procured by Applicant or Applicant's Attorney |
|
31 |
Medical Evaluations and All Related Costs Procured by State Fund on Represented Claims |
|
32 |
Medical Evaluations and All Related Costs Performed by AMEs/IMEs |
|
33 |
Medical Evaluations and All Related Costs on Non-Represented Claims |
|
34 |
Early Intervention - Used for State Cases Only |
|
|
|
|
Loss Expense Payments (Pen/Arb - Penalty/Arbitration) |
|
71 |
Temporary Disability Late Payment Penalty Caused by Employer |
|
|
|
|
Miscellaneous Services |
| |
|
Payment Code |
Reimbursable Expense |
Description |
|
5A |
Reports |
- Copy Work
- Request for hospital records
- Employment records or Military records
- Police or Highway Patrol records
- Dependency Records (birth, death, divorce, marriage certificates
- Social Security records
- Autopsy reports or Death Certificates
|
|
5B |
Investigations |
- Outside Investigator Services
- Retail credit check
- Technical survey
- Outside defense attorney services
|
|
5C |
Court Fees |
- Voluntary Arbitration
- Testimony of witness
- Interpreter fees
- Witness fees, including travel
- Subpoena services
- Transcript of testimony
- Depositions
- Notary fees
- Filing fees
- Mandatory arbitration
|
|
5D |
Ergonomics/Safety |
- Ergonomic Assessments
- Safety Consultants, Environmental Quality Analysis
- Non- VR Job Analysis
|
| |
|
Other |
|
CC |
Canceled Check |
|
SP |
Stop Payment |
|
SV |
Salvage (Subrogation Recovery) |
|
RC |
Returned Compensation Money |
|
RM |
Returned Medical Money |
