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S T A T
E O F
M A I N E
WORKERS'
COMPENSATION BOARD
27 State
House Station
FAX
(207) 287‑7198
TEL
(207) 287‑7086
MEMORANDUM
Date
Sent: Aug 28 2009
TO: Parties
Interested in Board Rulemaking
SUBJECT: Adopted
Rules
Rule Chapter
3(5) - Electronic Filing of Proof of Coverage
%20EDI-POC%20Adopted%20web%20notice_files/image001.gif){kind=small}
The Maine
Workers' Compensation Board has adopted the attached rules. The effective date of the rules is August 22, 2009.
AGENCY CONTACT PERSON: John C. Rohde, General
Counsel
AGENCY NAME: Workers'
Compensation Board
ADDRESS: 27 State House Station
TELEPHONE: 207-287-7086
EMAIL: John.Rohde@Maine.gov
Please Note: Most offices
will only receive one copy of this notification. Please ensure that copies are distributed to
your staff. Thank you.
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If
you no longer wish to receive these mailings, please contact: Lynne
McKenney, Secretary Associate Legal Workers'
Compensation Board 27
State House Station Tel: (207) 287-7086 / Fax: (207) 287-7198 Email: Lynne.McKenney@Maine.gov It
would be helpful if you would include the three digit code located on the upper
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MAPA-4
Notice of Agency Rule-making Adoption
AGENCY: WORKERS’
COMPENSATION BOARD
CHAPTER NUMBER AND TITLE:
Rule Chapter 3(5) - Electronic Filing of Proof of Coverage
ADOPT
(LEAVE BLANK -
ASSIGN
CONCISE SUMMARY
(UNDERSTANDABLE BY
AVERAGE CITIZEN):
This
rule requires electronic filing by insurance companies of notice of new,
renewal, or endorsement of any workers’ compensation policy.
EFFECTIVE DATE (TO
BE FILL
AGENCY CONTACT PERSON: John C. Rohde, General Counsel
AGENCY NAME: Workers’ Compensation Board
ADDRESS: 27 State House Station
TELEPHONE: 207-287-7086
EMAIL: John.Rohde@Maine.gov
%20EDI-POC%20Adopted%20web%20notice_files/image002.gif){kind=small}
Please
approve bottom portion of this form and
assign
appropriate MFASIS number.
APPROV
Authorized signature
FUND AGENCY ORG APP JOB OBJT AMOUNT
014 90C 2001 01
90-351 WORKERS' COMPENSATION BOARD
Chapter 1: PAYMENT OF BENEFITS
* * * * *
§ 10. Notice of Workers' Compensation Insurance
Insurance
companies shall file with the Board a Notice of Workers' Compensation Insurance
(WCB-1A) within 14 days after issuance, renewal, or endorsement of any workers'
compensation policy to an employer. A copy of the Notice of Workers'
Compensation Insurance (WCB-1A) must be mailed to the employer within 14 days
after issuance, renewal, or endorsement of the workers' compensation policy.
* * * * *
90-351 WORKERS' COMPENSATION BOARD
Chapter 3: FORM FILING
* * * * *
§ 5. Electronic filing of proof of coverage
1. General
A. (1) Unless a
waiver has been granted pursuant to subsection (1)(B) of this section, insurance
companies shall file with the Board notice of the issuancenew, renewal,
or endorsement of any workers’ compensation policy to an employer using
International Association of Industrial Accident Boards and Commissions
(“IAIABC”) Proof of Coverage Release 2.1.
(2) For
notices filed within the 52-week period immediately following the effective
date of this rule, the required notice must be filed with the Board no later
than 14 days from the transaction effective date for issuance, renewal or add
endorsement. However, if a transaction is submitted and rejected within
the initial 14 day period, the notice will not be considered late if it is
resubmitted and accepted by the Board within 30 days after the TR
acknowledgement code is sent by the Board. Transactions initially
submitted later than 14 days after issuance, renewal or endorsement shall be
considered late even if resubmitted and accepted by the Board within 30 days
after the TR acknowledgement code is sent by the Board.
(3) For
notices filed after the period specificied in subsection (1)(A)(2) of this
section, the required notice must be filed with the Board no later than 14 days
after issuance, renewal or endorsement.
B. (1) The
Board, at its discretion by majority vote of its membership, may grant an
insurer a waiver of the filing requirements of this section if the insurer
establishes to the satisfaction of the Board that compliance with these
requirements would cause undue hardship. For purposes of this section, undue
hardship means significant difficulty or expense. Requests for waivers must be submitted in
writing and addressed to the Chair of the Workers’ Compensation Board, 27 State
House Station,
(2) Individual
waiver. An individual notice of Proof of Coverage can be filed by paper or fax
if the Executive Director or the Executive Director's designee finds that the
insurer was prevented from complying with this section because of circumstances
beyond the control of the insurer. A
decision by the Executive Director or the Executive Director's designee may be
appealed to the Board of Directors. The
appeal must be in writing; must set forth the reasons why the appealing party
believes the decision should be reversed; and must be filed within 7 (seven)
days of the date of the decision appealed from.
2. Definitions
A. Application acknowledgement codes. A code
used to identify whether or not a transaction has been accepted by the Board. A
sender will receive one of the following codes after submitting a transaction:
(1) HD. The transmission was rejected and the Proof
of Coverage is not filed.
(2) TA
(Transaction accepted). The transaction was accepted and the Proof of Coverage
is filed.
(3) TE
(Transaction accepted with errors). The transaction was accepted with errors
and the Proof of Coverage is filed. The error or errors will be identified in
the acknowledgement transmission that is sent by the Board. All identified
errors must be corrected within 14 days after the date the acknowledgement
transmission was sent by the Board.
(4) TR
(Transaction rejected). The entire transaction has been rejected and the Proof
of Coverage is not filed.
(5) TW
and TN. These application
acknowledgement codes are not used.
B. Data element. A single piece of information
(for example, policy effective date). Each data element is assigned a name and
a number. Except as modified in this rule, data element names and numbers are
as defined in IAIABC Proof of Coverage Release 2.1, Data Dictionary June 1,
2007 Edition (Appendix XI).
C. Data element requirement code. A code used to
designate whether or not a data element has to be included in a transaction.
Each data element is assigned one of the following data element requirement
codes:
(1) M
(Mandatory). The data element must be present and must be in a valid format or
the transaction will be rejected.
(2) MC
(Mandatory/Conditional). The data element is mandatory if the conditions
defined in the
(3) E
(Expected). The data element is expected when a transaction is submitted. The
transaction will be accepted without the data element and the notice of Proof
of Coverage is filed but is incomplete. The entity submitting the transaction
will receive a message indicating the transaction was accepted with errors and
identifying the missing or incorrect data element or elements. The notice of
Proof of Coverage must be completed by submitting the missing or corrected data
element or elements within 14 days after the error message is sent by the Board
or prior to any subsequent submission for the same policy, whichever is sooner.
(4) EC
(Expected/Conditional). The data element is expected if the conditions defined
in the
(5) IA
(If Available). The data element should be sent if available. If the data
element is sent, the Workers’ Compensation Board may edit the data to ensure
valid value and format. A filing will not be rejected if the only error is a
missing data element designated IA.
(6) NA
(Not Applicable). The data element does not apply to the triplicate code and
does not have to be sent. The Board will not edit these data elements.
(7) R
(Restricted).
(8) F
or FT (Fatal Technical). Data elements that must be sent. If a data element
designated F is not present and in a valid format, the filing will be rejected.
(9) X
(Exclude). The data element does not apply to the triplicate code and does not
have to be sent. The Board will not edit these data elements.
D. Record. A defined group of data elements that is
identified by the transaction set identifier.
E. Report. A report is equivalent to a transaction.
F. Transaction. The communication of data that represents a
single business event. A transaction
consists of one or more records.
G. Triplicate
code. The triplicate code defines the
specific purpose for which the transaction is being sent. It is a combination of the Transaction Set
Purpose Code (DN0300), Transaction Set Type Code (DN0334) and Transaction
Reason Code (DN0303).
3. Requirements for filing using IAIABC
Proof of Coverage Release 2.1
A. Triplicate code. One of the triplicate codes contained in the MWCB Proof of Coverage Element Requirement
B. Data
element requirements. Data element
requirements are as set forth in the
90-351
Rule Chapter 3, Section 4 Electronic Filing
List of Appendices
I.
Claims
Release 3 (CR 3), First Report of Injury (FROI),
Element
Requirement Table, Revised
II. MWCB CR 3, Subsequent Report of Injury
(SROI),
III. MWCB CR 3, FROI, Conditional Requirement
Table
IV. MWCB CR 3, SROI, Conditional Requirement
Table
V. Proprietary EDI, FROI, File Layout Table
VI. Proprietary EDI, FROI, Element Requirement
Table
VII. Proprietary EDI, FROI, Error Message Table
VIII. IAIABC CR 3, Data Dictionary,
IX. MWCB Proof of Coverage Element Requirement
X. MWCB Proof of Coverage Conditional
Requirement
XI. IAIABC Proof of Coverage Release 2.1 Data
Dictionary, 06/01/07 Edition
Rule-Making
Fact Sheet
(5 MRSA
§ 8057-A)
AGENCY: WORKERS’ COMPENSATION BOARD
NAME, ADDRESS,
PHONE NUMBER OF AGENCY CONTACT PERSON:
John
C. Rohde, General Counsel, Workers’ Compensation Board, 27 State House Station,
Augusta ME 04333-0027 TEL:
208-287-7086;
Email:
John.Rohde@Maine.gov
CHAPTER NUMBER
AND RULE TITLE: Rule Chapter 3(5) -
Electronic Filing of Proof of Coverage
STATUTORY
AUTHORITY: 39-A M.R.S.A. § 152(2),
152(2-A) and 401(3)
DATE AND PLACE
OF PUBLIC HEARING: Monday, June 8, 2009,
9:00 a.m.,
COMMENT
DEADLINE: Thursday, June 18, 2009, 5:00 p.m.
PRINCIPAL
REASON OR PURPOSE FOR PROPOSING THIS RULE:
Requiring electronic filing
of proof of coverage will help ensure that the Board’s coverage records are
up-to-date and accurate. This will help
the Board ensure that all employers are complying with the requirement to
secure workers’ compensation coverage for their employees.
ANALYSIS
AND EXPECT
For the first 52 weeks after the rule is effective, notices must
be filed with 14 days of issuance, renewal or endorsement; but, if the original
notice is filed within 14 days and rejected, the notice will not be considered
late if it is refilled within 30 days after the Board rejected the original
filing.
After this one-year period, all filings must be made within 14
days after issuance, renewal or endorsement.
FISCAL
IMPACT OF THE RULE:
FOR RULES WITH FISCAL IMPACT OF $1 MILLION OR
MORE, ALSO INCLUDE:
ECONOMIC IMPACT, WHETHER OR NOT QUANTIFIABLE IN MONETARY
TERMS:
INDIVIDUALS OR GROUPS AFFECT
BENEFITS OF THE RULE:
Note: If necessary, additional pages may be used.
CHAPTER 3 § 5
Electronic Filing of Proof of
Coverage
BASIS STATEMENT
The amendment to Chapter 3 requires electronic filing by insurance companies of notice of the issuance, renewal or endorsement of any workers’ compensation policy.
SUMMARY OF COMMENTS
Commentators 1 and 2 support the draft rule except that they believe the employer Unemployment Insurance data element should be Expected instead of Mandatory. Commentator 1 states that insurers do not have access to UI numbers directly, that the numbers can change over time, and, that it is important to not block the filing of proof of coverage because without an accepted proof of coverage, First Reports of Injury and Notices of Controversy cannot be filed.
RESPONSE: The UIAN must be mandatory to ensure integrity of the database; FROIs are accepted without POC filings; this rule was drafted through consensus-based rulemaking.
Commentators 2 believes the grace period in section 5(1)(A)(2) should be made permanent.
RESPONSE: The grace period should give ample time to make sure everyone adapts to the process and can be revisited later if need be; this rule was drafted through consensus-based rulemaking.
Commentator 3 believes fines for failing to submit accurate UI numbers should be indefinitely suspended.
RESPONSE: The fines are in place to ensure compliance with the rule; and this rule was drafted through consensus-based rulemaking.
COMMENTATORS
1. Acadia Insurance Company; Dan Swift, AVP & Assistant General Counsel.
2. American Insurance Association; John P. Murphy, Vice President.
3. Workers’
Compensation Coordinating Council;