Birth Injury Attorney Florida

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					                                                      Sample Workers Compensation Record Layout (July 2003)


                                                          starting    field
field no                    field_name                    position   length   decimals   type                 Description From Specifications
                                                                                                A = Active Claim, D = Deleted Claim, E = Claim Paid in Error,
   1       Record Type                                           1        1      0        A     I = Incident Report only
   2       Accounting Date                                       2        8      0        D     CCYYMMDD
   3       Claim Number                                         10       25      0        A
   4       Prior TPA Claim Number                               35       25      0        A
   5       Name of Insured                                      60       30      0        A
   6       Policy Number                                        90       12      0        A
   7       Policy Effective Date                               102        8      0        D     CCYYMMDD
   8       Policy Expiration Date                              110        8      0        D     CCYYMMDD
   9       Payroll Classification Code                         118        5      0        A
  10       Line of Business                                    123        2      0        A     always WC
  11       Jurisdiction State                                  125        2      0        A
  12       Payroll (Premium/Risk) State                        127        2      0        A
  13       Catastrophe Number                                  129        5      0        N
  14       Claimant Social Security Number                     134       11      0        A
  15       Injury Description Code-Part of Body                145        3      0        A
  16       Injury Description Code-Nature of Injury            148        3      0        A
  17       Injury Description Code-Cause of Injury             151        3      0        A
  18       Loss Conditions-Type of Act                         154        2      0        A
  19       Loss Conditions-Type of Coverage                    156        2      0        A
  20       Loss Conditions-Type of Loss                        158        2      0        A
  21       Loss Conditions-Type of Recovery                    160        2      0        A
  22       Loss Conditions-Type of Settlement                  162        2      0        A
  23       Voc. Rehab. Indicator                               164        1      0        A
  24       Lump Sum Indicator                                  165        1      0        A
  25       Fraudulent Claim Indicator                          166        2      0        A
  26       Managed Care Organization Indicator                 168        2      0        A
  27       Loss Coverage Code                                  170        2      0        A
  28       Occupation Description                              172       30      0        A
  29       Gender of Claimant                                  202        1      0        A
  30       Marital Status of Claimant                          203        1      0        A
  31       Employment Status of Claimant                       204        2      0        A
  32       Surgery Indicator                                   206        1      0        A
  33       Attorney/Authorized Rep. Indicator                  207        1      0        A
  34       Controverted Case Indicator                         208        1      0        A
                                                                                                                                             A = alpha-numeric
                                                                                                                                                      D = Date
                                                                                                                                                   N = numeric
       -Fixed Length Text                                                                                                                          Z = financial
       --Currency in 11 characters with assumed decimal                          1
                                                   Sample Workers Compensation Record Layout (July 2003)


                                                         starting  field
field no                     field_name                  position length decimals   type              Description From Specifications
   35      Social Security Ben. Offset Indicator               209       1   0        A
   36      Unemployment Ben. Offset Indicator                  210       1   0        A
   37      Pension Plan Ben. Offset Indicator                  211       1   0        A
   38      Other Benefit Offset Indicator                      212       1   0        A
   39      Special Fund Ben. Offset Indicator                  213       1   0        A
   40      Employer FEIN                                       214       9   0        A
   41      Employer SIC Code                                   223       5   0        A
   42      Zip Code of Injury Site                             228       5   0        N
   43      Claimant Last Name                                  233      20   0        A
   44      Claimant First Name                                 253      15   0        A
   45      Number of Dependents                                268       2   0        N
   46      Pre-Injury Weekly Wage of Claimant                  270      11   2        Z    currency
   47      Post Injury Weekly Wage                             281      11   2        Z    currency
   48      Percentage of Impairment                            292       3   2        N
   49      Accident State                                      295       2   0        A
   50      Mtd of Determining Pre-Inj. Wage                    297       2   0        A
   51      Benefit Type 1                                      299       2   0        A
   52      Weekly Benefit for Benefit Type 1                   301      11   2        Z    currency
   53      Benefit Paid To Date for Ben. Type 1                312      11   2        Z    currency
   54      Benefit Type 2                                      323       2   0        A
   55      Weekly Benefit for Benefit Type 2                   325      11   2        Z    currency
   56      Benefit Paid To Date for Ben. Type 2                336      11   2        Z    currency
   57      Benefit Type 3                                      347       2   0        A
   58      Weekly Benefit for Benefit Type 3                   349      11   2        Z    currency
   59      Benefit Paid To Date for Ben. Type 3                360      11   2        Z    currency
   60      Benefit Type 4                                      371       2   0        A
   61      Weekly Benefit for Benefit Type 4                   373      11   2        Z    currency
   62      Benefit Paid To Date for Ben. Type 4                384      11   2        Z    currency
   63      Benefit Type 5                                      395       2   0        A
   64      Weekly Benefit for Benefit Type 5                   397      11   2        Z    currency
   65      Benefit Paid To Date for Ben. Type 5                408      11   2        Z    currency
   66      Reserve Type Code                                   419       2   0        A
   67      Beneficiary 1 Relationship Code                     421       2   0        A
   68      Beneficiary 2 Relationship Code                     423       2   0        A
   69      Beneficiary 3 Relationship Code                     425       2   0        A
                                                                                                                                  A = alpha-numeric
                                                                                                                                           D = Date
                                                                                                                                        N = numeric
      -Fixed Length Text                                                                                                                Z = financial
      --Currency in 11 characters with assumed decimal                      2
                                                   Sample Workers Compensation Record Layout (July 2003)


                                                         starting  field
field no                     field_name                  position length decimals   type              Description From Specifications
    70     Beneficiary 4 Relationship Code                     427       2   0        A
    71     Beneficiary 5 Relationship Code                     429       2   0        A
    72     Beneficiary 1 Dependency Code                       431       1   0        A
    73     Beneficiary 2 Dependency Code                       432       1   0        A
    74     Beneficiary 3 Dependency Code                       433       1   0        A
    75     Beneficiary 4 Dependency Code                       434       1   0        A
    76     Beneficiary 5 Dependency Code                       435       1   0        A
    77     Sched. Indemnity Body Member Code                   436       3   0        A
    78     Scheduled Indemnity % Disability                    439       3   2        N
    79     # Weeks of Sched. Indemnity Benefits                442       3   0        N
    80     Non-Sched. Indemnity % Disability                   445       3   2        N
    81     # Weeks of Temp. Indemnity Benefits                 448       3   0        N
    82     Other Weekly Payments                               451      11   2        Z    currency
    83     Soc. Sec./Other Benefit Offset Amount               462      11   2        Z    currency
    84     Loss Description                                    473      40   0        A
    85     Accident Date                                       513       8   0        D    CCYYMMDD
    86     Date Reported to TPA/Insurer                        521       8   0        D    CCYYMMDD
    87     Claimant Date of Birth                              529       8   0        D    CCYYMMDD
    88     Claimant Date of Hire                               537       8   0        D    CCYYMMDD
    89     Claimant Date of Death                              545       8   0        D    CCYYMMDD
    90     Date Reported to Employer                           553       8   0        D    CCYYMMDD
   100     Date Disability Begain                              561       8   0        D    CCYYMMDD
   101     Date of Return to Work                              569       8   0        D    CCYYMMDD
   102     Date of Max. Med. Improvement                       577       8   0        D    CCYYMMDD
   103     Date Claim Closed                                   585       8   0        D    CCYYMMDD
   104     Beneficiary 1 Date of Birth                         593       8   0        D    CCYYMMDD
   105     Beneficiary 2 Date of Birth                         601       8   0        D    CCYYMMDD
   106     Beneficiary 3 Date of Birth                         609       8   0        D    CCYYMMDD
   107     Beneficiary 4 Date of Birth                         617       8   0        D    CCYYMMDD
   108     Beneficiary 5 Date of Birth                         625       8   0        D    CCYYMMDD
   109     Date of First Indemnity Payment                     633       8   0        D    CCYYMMDD
   110     Year Last Exposed                                   641       4   0        D    CCYY
   111     Date Lump Sum Settlement Paid                       645       8   0        D    CCYYMMDD
   112     Claim Status                                        653       2   0        A
   113     Injury Type (Severity Code)                         655       2   0        A
                                                                                                                                  A = alpha-numeric
                                                                                                                                           D = Date
                                                                                                                                        N = numeric
      -Fixed Length Text                                                                                                                Z = financial
      --Currency in 11 characters with assumed decimal                      3
                                                        Sample Workers Compensation Record Layout (July 2003)


                                                            starting  field
field no                     field_name                     position length decimals     type              Description From Specifications
   114     Incurred Indemnity (including Voc. Rehab.)             657      11   2          Z    currency
   115     Incurred Medical                                       668      11   2          Z    currency
   116     Incurred Expense (ALAE)                                679      11   2          Z    currency
   117     Claimants Atty Fees Incurred                           690      11   2          Z    currency
   118     Employers Atty Fees Incurred                           701      11   2          Z    currency
   119     Deductible Reimbursement                               712      11   2          Z    currency
   120     Paid Indemnity (including Voc. Rehab.)                 723      11   2          Z    currency
   121     Paid Medical                                           734      11   2          Z    currency
   122     Paid Expense (ALAE)                                    745      11   2          Z    currency
   123     Employer Attorney Fees Paid                            756      11   2          Z    currency
   124     Claimant Attorney Fees Paid                            767      11   2          Z    currency
   125     Voc. Rehab. Education/Training Cost Paid               778      11   2          Z    currency
   126     Voc. Rehab. Evaluation Incurred                        789      11   2          Z    currency
   127     Voc. Rehab. Maintenance Paid                           800      11   2          Z    currency
   128     Voc. Rehab. Education/Training Incurred                811      11   2          Z    currency
   129     Voc. Rehab. Evaluation Cost Incurred                   822      11   2          Z    currency
   130     Voc. Rehab. Maintenance Incurred                       833      11   2          Z    currency
   131     Other Voc. Rehab. Paid                                 844      11   2          Z    currency
   132     Total Paid Voc. Rehab                                  855      11   2          Z    currency
   133     Total Incurred Voc. Rehab                              866      11   2          Z    currency
   134     Hospital Cost Paid                                     877      11   2          Z    currency
   135     Physician Cost Paid                                    888      11   2          Z    currency
   136     Applicants Medical Eval. Cost Paid                     899      11   2          Z    currency
   137     Indep. Med. Eval. Cost Paid                            910      11   2          Z    currency
   138     Other Medical Paid                                     921      11   2          Z    currency
   139     Funeral Cost Paid                                      932      11   2          Z    currency
   140     Funeral Allowance Incured                              943      11   2          Z    currency
   141     Lump Sum Settlement Amount                             954      11   2          Z    currency
   142     Annuity Purchase Price Amount                          965      11   2          Z    currency
   143     Temporary Disability Paid                              976      11   2          Z    currency
   144     Temporary Disability Incurred                          987      11   2          Z    currency
   145     Permanent Partial Disability Paid                      998      11   2          Z    currency
   146     Permanent Total Disability Paid                      1009       11   2          Z    currency
   147     Death Benefit Paid                                   1020       11   2          Z    currency
   148     Lump Sum Remarriage Payment                          1031       11   2          Z    currency
                                                                                                                                       A = alpha-numeric
                                                                                                                                                D = Date
                                                                                                                                             N = numeric
      -Fixed Length Text                                                                                                                     Z = financial
      --Currency in 11 characters with assumed decimal                           4
                                                     Sample Workers Compensation Record Layout (July 2003)


                                                           starting  field
field no                      field_name                   position length decimals   type              Description From Specifications
   149     Employers Liability Paid to Date                    1042       11   2        Z    currency
   150     Employers Liability Incurred                        1053       11   2        Z    currency
   151     Product Liability Subrogation Recovery Amt          1064       11   2        Z    currency
   152     Auto Liability Subrogation Recovery Amount          1075       11   2        Z    currency

  153      Other Liability Subrogation Recovery Amount        1086      11     2       Z     currency
  154      Penalties Paid from Indemnity                      1097      11     2       Z     currency
  155      Expert Witness Fees Paid                           1108      11     2       Z     currency
  156      Pension Indemnity Paid                             1119      11     2       Z     currency
  157      Scheduled Indemnity Incurred Amount                1130      11     2       Z     currency
  158      Non-Scheduled Indemnity Incurred                   1141      11     2       Z     currency
           Pension Indemnity Benefits Previously
  159      Reserved but not Paid                              1152      11     2       Z     currency

  160      Present Value of Future Indemnity Payments         1163      11     2       Z     currency
  161      Defense Medical Eval. Cost Paid                    1174      11     2       Z     currency
  162      Indemnity Subrogation Recovery Amount              1185      11     2       Z     currency
  163      Medical Subrogation Recovery Amount                1196      11     2       Z     currency
  164      Expense Subrogation Recovery Amount                1207      11     2       Z     currency
  165      Gross Incurred                                     1218      11     2       Z     currency
           Date Claimant Enrolled in Oregon Voc. Rehab.
  166      Program                                            1229       8     0       D     CCYYMMDD
           Date Claimant Completed Oregon Voc. Rehab.
  167      Program                                            1237       8     0       D     CCYYMMDD
           Date Claimant Enrolled in Florida Voluntary
  168      Voc. Rehab. Program                                1245       8     0       D     CCYYMMDD
           Date Claimant Completed Florida Voluntary
  169      Voc. Rehab. Program                                1253       8     0       D     CCYYMMDD
           Indemnity Incurred while Claimant Not in
  170      Florida Voluntary Voc. Rehab. Program              1261      11     2       N     currency
           Indemnity Incurred while Claimant Enrolled in
  171      Florida Voluntary Voc. Rehab. Program              1272      11     2       Z     currency
           Temporary Total Benefits Incurred while
           Claimant Enrolled in Oregon Voc. Rehab.
  172      Program                                            1283      11     2       Z     currency
                                                                                                                                    A = alpha-numeric
                                                                                                                                             D = Date
                                                                                                                                          N = numeric
        -Fixed Length Text                                                                                                                Z = financial
        --Currency in 11 characters with assumed decimal                      5
                                                       Sample Workers Compensation Record Layout (July 2003)


                                                           starting    field
field no                     field_name                    position   length   decimals   type              Description From Specifications

           Incurred Indemnity other than Temporary Total
           and Voc. Rehab Befefits while Claimant
  173      Enrolled Oregon Voc. Rehab. Program                 1294       11      2        Z     currency
           Voc Rehab Education Cost Incurred while
           Claimant Enrolled in Florida Voluntary Voc
  174      Rehab Program                                       1305       11      2        Z     currency
           Voc Rehab Evaluation Cost Incurred while
           Claimant Enrolled in Florida Voluntary Voc
  175      Rehab Program                                       1316       11      2        Z     currency

  176      Certificate Number (for Master Policies only)       1327       10      0        A
  176      Filler                                              1337      163




                                                                                                                                        A = alpha-numeric
                                                                                                                                                 D = Date
                                                                                                                                              N = numeric
        -Fixed Length Text                                                                                                                    Z = financial
        --Currency in 11 characters with assumed decimal                          6

				
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Description: Birth Injury Attorney Florida document sample