Claim

The Claim page, available for selection from the Details menu, allows you to view claim information on the Event, Loss, Injury, MMI, Contacts, OSHA, SHARPS, Voc Rehab, Related Claims, Status History, Attributes, and 3rd Party tabs for the selected claim.

Note: Please refer to the Claim Header Information help file for documentation regarding fields appearing in the header information of the Claim page.

The table below describes the information found on the Event tab of the Claim page:

Event Tab
Field	Description
Claim Summary	Click to open the Claim Summary page, which provides an AI-generated summary of the claim. Available for auto liability, general liability, property liability, and workers’ compensation claims only.
Event Section
Event Number	The event number for the displayed record
Event Desc	A detailed summary of the loss occurrence or event and damage
Loss Date	The date for the event
Loss Time	The time of the loss (if available)
Loss Desc	A brief description of the injuries or damages the claimant suffered because of the event; this field is limited to a maximum of 80 characters.
Event Closed	The date the event was closed
Site	The site code of injury
Source	The injury code that corresponds to the factor that led to the overall event (ex. motor vehicle accident)
Cause	A NCCI (National Council on Compensation Insurance) code describing the general cause of the loss, specific to each line of business.
Nature/Result	A NCCI (National Council on Compensation Insurance) code describing the type of loss resulting from the Cause, specific to each line of business.
Part/Target	A NCCI (National Council on Compensation Insurance) code describing the specific area or item of loss resulting from the Cause, specific to each line of business.
Location Section
Jurisdiction	Indicates what state has responsibility for the loss
Payroll State	Indicates in what state the employee receives wages
Structure Location Code	The structure code associated with the location; available to clients using the Corporate Structure model
Address	The address where the loss occurred
City/State/Zip	The city, state and zip for the loss address
County	The county where the loss occurred
Organization	The organization the employee is associated with
Client	The client name and contract number
Account	The account name and number
Unit	The unit name and number
Corporate Structure	Displays structure information at the claim level. Click the plus sign (+) to expand this section and view the following columns: Level: Number value of the level of the structure. Contract/Account/Unit: The specific contract, account, or unit numbers for the level of the structure, if applicable. Structure Code: The specific structure code assigned to the structure level, if applicable. Name: The name of the structure level.
Gross Incurred and Net Incurred Tabs	These tabs display a graphical representation of the total (gross) and total minus recoveries (net) incurred on a claim. Hovering over a column displays the amount for the category and clicking a column redirects you to the details of that payment type.

The following flags will display on the Event tab of the Claim page in viaOne if they have been activated in JURIS:

Event Tab - Flags

Flag

Description

Alert

Indicates he examiner placed alert text on a claim or payment.

Appealed

Appears for disability claims that have a Decision Due Date entered on the ERISA Appeals page. The flag is deactivated when all ERISA records are deleted from the claim.

Apportionment

Appears if the claim involves a liable third party (does not apply to disability)

Claimant Represented

Displayed when the plaintiff attorney Name field on the Legal page is populated, regardless of whether the claim is in litigation.

ICD Alert

Alerts the examiner that a claimant has been off-work close to or past a time that is deemed appropriate for the claimant's injury/illness. If one of these flags appear on a claim record, it indicates to the examiner that the claim requires special attention. These flags only appear on disability or workers' compensation claims. There are two ICD Alert flags that can appear as follows:

ICD Alert
Flag	Description
Mid Range Alert	Appears when the claimant reaches the middle date in the recommended return to work date range and has yet to return to work. If the ICD record on the claim is set at Mid Range alert status, the ICD yellow alert flag appears.
At-Risk Alert	Appears when the claimant has been off work for an extended period of time and indicates the claim needs to be reviewed. While the At Risk Date is not outside the recommended date range for the specific injury/illness, it is close enough to the end of the date range to cause concern. If the ICD record on the claim is set to At Risk or At Risk - 7 alert status, the red ICD alert flag appears. At Risk - 7

Litigation

Appears if the claim has been in litigation

Managed Care

Appears when a claim is assigned to Sedgwick Managed Care. This flag is deactivated when a Managed Care closed date is entered.

Medicare

Appears when a workers' compensation or general liability claimant is a Medicare beneficiary

Triage

Appears when nurse triage was performed and triage notes exist for the claim

Overpayment - Balance

Appears when a claim has reached overpayment status and an overpayment balance exists on the claim. If the overpayment record is deleted, the flag no longer displays.

Overpayment - Recovered

Appears when a claim has reached overpayment status but the overpayment balance is zero. If the overpayment record is deleted, the flag no longer displays.

Rehabilitation

Appears if indemnity vocational rehabilitation reserves exist on the file

Relapse

Appears if the claim is in relapse

SIF

Appears for all Workers' Comp claims that have special fund information entered.

The flag changes in appearance based on information entered on the Special Funds tab of the Recoveries/Offsets page:

SIF File: Displays when the Notice Filed date has been entered.
SIF Accepted: Displays when the Date Accepted by Fund is entered.

Sub Owner

Appears if one or more sub owner (i.e., other examiners or specialists) is assigned to the claim

Subrogation

Appears if there is subrogation on a claim

The table below describes the information found on the Loss tab of the Claim page:

Loss Tab

Field

Description

Loss Date

The date of loss for the occurrence

Loss Description

A detailed summary of the loss occurrence or event and damage as it relates to the claim

Type of Facility

Type of facility at the location of the loss.

Type of Business

Type of business at the location of the loss.

Rept To Client

The date the loss occurrence or event was reported to the client

Rept By Client

The date the call center completed intake. If a claim is manually set up in JURIS, this field displays the actual date the fax or mail was received, or the date we received verbal notification of the new claim.

Claim Type

See Type under the Header Information table above

Sub Type

Displays the sub type of the claim.

List of sub types

Rept To TPA

The date reported to TPA

Intake

Indicates Yes if claim was handled by claim intake; Indicates No if not

Created

The date the claim was created in JURIS

Other Code

Other classification code; Office/Client defined field

Opened

The date the claim was opened

Fraud Indicator

Indicates Yes or No if fraudulent activity is suspected

Closed

The date the claim was closed; Blank if claim is not been closed

Excess Status

Indicates if the claim has reached excess either through scheduled paid and incurred amounts on a claim or when an examiner manually places the claim in excess through JURIS. Statuses include the following:

Incurred exceeds reporting level. Not Reported.
Incurred exceeds reporting level. Reported on <report date>.
Incurred exceeds retention. Not Reported.
Incurred exceeds retention. Reported on <report date>.
Paid exceeds retention. Not Reported.
Paid exceeds retention. Reported on <report date>.

Last Action

The date of the last action on the claim. This includes any of the following:

Claim status change
Claim detail change
Claim catastrophe change
MBR bill approved or payment issued from MBR
Update made to the claim from JURIS

MPN Eligible

Indicates Yes or No for MPN Eligibility

Eligibility Date

Indicates the date of eligibility

Deductible Program

Indicates Yes or No for deductible program

Location Section

Jurisdiction

The state in which the claim is filed

Payroll State

For work comp - The state from which the employee's compensation is generated. For all other claims - The state from which coverage premiums are generated.

Address

The street address where the loss occurred, if the location is different than where the employee works

City/State/Zip

The city, state and zip code where the loss occurred

County

The county seat or parish where the loss occurred

Organization

The name of the entity that corresponds to the accident site

Client

The client name

Account

The account name

Unit

The unit name

Structure Location Code

The structure code associated with the location; available to clients using the Corporate Structure model

(Location) Phone Number

Contact phone number at the loss location

Catastrophe Section

Catastrophe Number

Number assigned to the catastrophe record. Click the number link to download and open the Catastrophe Bulletin attachment in .pdf format.

Catastrophe Type

Type of catastrophic event. Options include ISO or NCCI.

Catastrophe Name

Name of catastrophic event.

Begin Date

Date the catastrophic event began.

End Date

Date the catastrophic event ended.

Update

Enter a number in the Show Records Per Page field and click Update to view the amount of records specified.

The table below describes the information found on the Injury tab of the Claim page:

Note: The Injury tab only appears for workers’ compensation and liability claims.

Injury Tab
Field	Description
Cause	The injury code that corresponds to the overriding factor that prompted the injury (ex. broken glass)
Nature/Result	The injury code that corresponds to the general type of damage that occurred as a result of the event (ex. damaged eyeglasses)
Part/Target	The injury code that corresponds to the specific part of body or object that was damaged as a result of the event (ex. eye)
Point of Impact	Location of the vehicle where impact occurred (e.g., Drivers Side, Passenger Side). Only displayed for auto liability claims with coverage code Collision (CL), Comprehensive (CM), or Property Damage (PD).
Body Side	The specific side of the body or object that was injured or damaged (if applicable). Options include Anterior, Bilateral, Left, Posterior, and Right. Only displayed for certain types of claims: Workers' compensation claims Auto liability claims with coverage code Bodily Injury (BI) or Med Pay (MP) General liability claims with coverage code BI, MP, or Personal Injury (PI) Property liability claims with coverage code Other (OT)

The table below describes the information found on the MMI tab of the Claim page:

Note: The MMI tab only appears for workers' compensation claims.

MMI Tab
Field	Description
Impairment Percentage	The percentage of impairment the claimant has as a result of the injury/loss
Impairment Type	The type of impairment the claimant has as a result of the injury/loss. Options are: % of Man Scheduled Permanency Wage Loss
Determination Method	The method of determining the impairment percentage. Actual or Estimated will appear here. The impairment is estimated until an official finalization of the claim has been made or until additional litigation begins to increase the amount of permanency after finalization.
Date of MMI	The date of the employee's Maximum Medical Improvement
Settlement Method	The method of determining the employee's settlement amount. One of the following options will display: 0 - Claim Not Subject to Settlement 3 - Stipulated award (Carrier/Settlement) (N/A: MA & NY) 4 - Findings and Award (Judicial Award) (N/A: MA & NY) 5 - Dismissal or Take Nothing (Non-Compensable) 6 - Compromise Settlement (N/A: MA, NY, PA & DE) 7 - No Safety Devices (Applicable to New Mexico Only) 9 - All Other Settlements (N/A: NJ) 10 - Aggravation of Prior Work-Related Injuries (ME Only)
Settlement Date	The date the settlement took effect
Settlement Type	The description of the settlement
Apportionment Percentage	The percent, if any, of apportionment (division of settlement among two or more parties)
Date Apportionment Set	The date apportionment amounts above 0% were first established on the claim. If multiple apportionment records exist, the field displays the first date apportionment was set with Sedgwick as the payer.
Apportionment Data	Displays the part(s) of the claimant's body for which apportionment values were established. Click an apportionment record in the list to open a Details page displaying additional information about the apportionment. The Details page provides an Apportionment Record section displaying the part/target selected and the date apportionment was established and an Apportionment Details section listing the percentage of apportionment applied to each responsible payer. Click the + beside a detail record to expand it, displaying the payer’s address and contact information.

The table below describes the information found on the Sedgwick Contacts tab of the Claim page:

Sedgwick Contacts Tab
Field	Description
Examiner	The name of the examiner assigned to the claim
Address	The street name and number for the examiner's home office
City/State/Zip	The city, state and zip code for the examiner's home office
Phone	The phone number where examiner can be reached
Fax	The fax number where examiner can be reached
Supervisor	The name of the examiner's supervisor
Phone	The phone number where examiner's supervisor can be reached

The table below describes the information found on the OSHA tab of the Claim page:

Note: The OSHA tab is only available for those clients who subscribe to viaOne OSHA Auto Determination (Level 3) for the claim's account or unit, and the claim's date of loss is within the effective dates for this contracted service.

OSHA Tab
Field	Description
OSHA Recordable	Indicates Yes or No
Accident/Illness Code	The accident/illness code for the claim. Displays one of the following: 0 - Unknown 1 - Injury 2 - All Other Occupational Illnesses 3 - Disorders Associated with Repeated Trauma 4 - Disorders Due to Physical Agents 6 - Respiratory Conditions Due to Toxic Agent 7 - Dust Diseases of the Lung 8 - Occupational Skin Diseases or Disorder
Injury or Illness Work Related	Indicates Yes or No
Injury or Illness Resulted in Days Away from Work	Indicates Yes or No
Injury or Illness Resulted in Restricted Work Activity	Indicates Yes or No
Medical Treatment Beyond First Aid	Indicates Yes or No
Employee Loss of Consciousness	Indicates Yes or No
Significant Injury or Illness Diagnosed	Indicates Yes or No
Did the injury or illness involve an exposure to BBP from needle stick/cut/puncture	Indicates Yes or No
Removed from Job Due to OSHA Health Standards	Indicates Yes or No
Tested Positive for TB Exposure	Indicates Yes or No
Threshold Shift in Hearing > 10 db and Hearing Level > 25 db	Indicates Yes or No
Employee Death OSHA Recordable	Indicates Yes, No, or N/A (when no date of death is recorded for the employee)
Employee Hospitalized Overnight as an In-Patient	Indicates Yes or No
Time Employee Began Work	The time the employee began work on the day the injury or illness occurred, if available
Location of Case	The location code
Action Employee Performing When Injured	The action code
Privacy Case	Indicates Yes or No
OSHA Account	The account number
OSHA Unit	The unit number

The table below describes the information found on the SHARPS tab of the Claim page. The information displayed on this tab varies depending on the State listed for the claim’s Location on the Summary tab of the Claim page. If the state is California, additional information is required for reporting to the state and is displayed here accordingly. A smaller subset of information is required for all other states.

Note: The SHARPS tab is only available for those clients who subscribe to SHARPS Level B for the claim's account or unit, and the claim's date of loss is within the effective dates for this contracted service.

SHARPS Tab - All States Except California
Field	Description
SHARPS Injury Case	Indicates whether the claim meets the jurisdiction’s criteria for a SHARPS injury case
Identify SHARP involved (if known) -	Displays the Type of sharp object involved in the claim from the available list, and the Brand Name of Device (if known)
Work area where the injury occurred?	The specific information about where the injury occurred, if known
Brief description of how the incident occurred (i.e. procedure being done, action being performed (disposal, injection, etc.), body part injured.)	Additional details pertaining to the incident

SHARPS Tab - California Only
Field	Description
SHARPS Injury Case	Indicates whether the claim meets the jurisdiction’s criteria for a SHARPS injury case
Procedure being performed at time of injury	The medical procedure being performed at the time of the incident
Describe how the incident occurred	A brief description of the incident
Identify SHARP involved (if known)	The Type of sharp object involved in the claim, and its Brand and Model (if known)
Did the device being used have engineered SHARPS injury protection?	Indicates whether the device involved includes protective equipment or features; if the response is Yes, the following options are also displayed: Was engineered SHARPS injury protection on the SHARPS involved? Options are Yes or No Was the protection mechanism activated? Options are Yes or No Did the exposure incident occur: Options are Before Activation, During Activation, or After Activation
Does the exposed employee believe that controls could have prevented the injury	Indicates whether the claimant involved believes the injury could have been prevented with additional controls
Employee’s opinion and comments on the exposure incident	Additional comments from the claimant

The table below describes the information found on the Voc Rehab tab of the Claim page:

Note: This Voc Rehab tab only applies to Workers' Compensation or Disability claims.

Voc Rehab Tab
Field	Description
Vendor	The vendor's address. If none available, then No Address Record Available will display
Notes	Displays note text for the entry
Created	The date the note was created
By	The login of the person who created the note
For	The login of the person who the note was created for
Show [#] Records Per Page (Update)	To expand the list of notes, enter the number of records you wish to display in the Show [#] Records Per Page field and click the Update link

The table below describes the information found on the Related Claims/Cases tab of the Claim page:

Related Claims/Cases Tab
Field	Description
Claim/Case Number	Any related claim or case number(s) for the selected claim
Line	The line of coverage for the claim; See the Header Information table above for options
Coverage	The coverage for the claim; See the Header Information table above for options
Claim Status	The status of the claim
Claimant	The claimant's name
Show [#] Records Per Page (Update)	To expand the list of claims, enter the number of records you wish to display in the Show [#] Records Per Page field and click the Update link

The table below describes the information found on the Status History tab of the Claim page:

Status History Tab
Field	Description
Export Results	Click the Export Results button to export the data to a CSV (comma-separated values) file. The File Download page will appear, allowing you to open the file in Microsoft Excel (or other program) or save the file to another location. The name of the file will default to the name of the page you exported the data from, along with the date and time you exported the file.
Status Date	The date the claim status was changed
Changed By	The login of the person who changed the claim status
Status	The status change that was made to the claim
Sub Status	The sub status change that was made to the claim
Reopened	Displays Y for Yes or N for No to indicated whether or not the claim was reopened
Reason Code	Applies to Workers' Compensation claims for the state of Florida only. Click the Code hyperlink to display reason code detail in the status pain.
Show [#] Records Per Page (Update)	To expand the list of claims, enter the number of records you wish to display in the Show [#] Records Per Page field and click the Update link

The table below displays when there is Attribute information associated with a claim:

Attributes Tab
Element	Description
Category	Data attribute category
Sub-Category	Data attribute sub-category
Type	Data attribute type
Value	Data attribute value
Deleted?	Displays Yes if the record has been deleted; displays No if the record has not been deleted.

Tip: You can sort data by clicking on the desired column heading.

The table below describes the information found on the 3rd Party tab of the Claim page:

3rd Party Tab - Automobile Liability Claims
Element	Description
VIN	The Vehicle Identification Number of the automobile issued by the manufacturer
Make	The auto manufacturer who made the car (ex. Pontiac)
Model	The category or type of vehicle involved (ex. Bonneville)
Year	The year the vehicle was made
Plate	The automobile license plate number on the car
State	The state that issued the license plate
Damage Description	A summary of all destroyed vehicle parts or mechanisms as a result of the event
Show [#] Records Per Page (Update)	To expand the list of Location Code entries, enter the number of records you wish to display in the Show [#] Records Per Page field and click the Update link
Owner
Name	The individual or entity listed on the auto title
Address	The home address of the auto owner
Country	The country in which the owner resides/operates
Phone-Cell	The mobile telephone number of the owner
Owner Type	Relation of the vehicle owner to the claim (e.g., Client, Driver, Other)
Driver
Name	The name of the individual operating the vehicle at the time of the event
Address	The home address of the individual operating the vehicle at the time of the event
Country	The country in which the driver resides
Phone-Work	The work telephone number of the driver
Phone-Home	The home telephone number of the driver
Phone-Cell	The mobile telephone number of the driver
License No	Driver’s license number of the 3rd party
State	State that issued the 3rd party’s driver’s license
Claim Information
Reported to Carrier?	Indicates if the incident was reported to an outside insurance carrier
Passenger Ph	Contact phone number of the vehicle’s passenger
Claim Num	Number assigned to 3rd party insurance claim
Claim Office	Name of office handling 3rd party claim
Claim Office Phone	Contact phone number of office handling 3rd party claim