The PPD Rate is always set at the maximum rate if the employee is under 27 years of age at the time of injury.
If wage is set at 100%, not at 66.67%:
The PPD rate is based on expanded wages for normal fulltime employees, not to exceed the maximum PPD rate for the year of injury.
If employee is part of class:
If the normal hours scheduled for this class of workers are less than 24, raise the hours to 24 hours and pay at 2/3rds, not to exceed the maximum PPD rate for the year of injury.
If employee is not part of a class:
Raise to normal fulltime hours (usually 40 hours) and pay at 2/3rds, not to exceed the maximum PPD rate for the year of injury.
The following is a clarification of the IP, S1 and FN transmissions mentioned above. Reference will be made to the IAIABC EDI Implementation Guide, Release 1, dated February 15, 2002.
The Dictionary, page 6-26 defines IP as follows: Initial Payment. We interpret this to stand for the first payment date and amount made on a claim. There is only one "first" payment on any given claim, therefore only one IP transmission per claim. The first payment date is equal to the Maintenance_Type_Code_Date (see the Dictionary, page 6-28). The first payment amount is equal to Payment/Adjustment Paid To Date (see the Dictionary, page 6-37).
The Dictionary, page 6-25 defines S1 as follows: Suspension, returned to work, or medically determined/qualified to return to work. We interpret this to mean that all lost time benefits have ceased due to one of the three reasons stated in the definition. The claim remains open for a final medical and possible Permanent Disability. See Section 5, pages 5-50 and 5-51 for an example. Note that the narrative does not state that claim has been closed by the claim administrator.
The Dictionary, page 6-25 defines FN as follows: Final. We interpret this to mean that all benefits due the injured employee have been paid and the insurance carrier is closing their claim. In Section 5, see pages 5-31 and 5-32 for an example.
An employee is injured on 02/09/2004, misses work until 03/05/2004 and returns to work full time on that date. A final medical report is received and Permanent Disability Benefits are paid.
How can this be submitted?
Employee is injured on 02/09/2004, misses work until 03/05/2004 and returns to work full time on that date.
File a 148 00, via EDI, in order to submit the first report of injury.
- File an A49
IP, via EDI, in order to report the first payment date and amount. Payment type TTD (050)
and MTC Date (Maintenance_Type_Code_Date) = First payment date. Payment/Adjustment Paid
To Date = First payment amount.
File an A49 S1, via EDI, in order to report the accumulated amount paid for TTD. (The claim administrator is still waiting for the final medical report so he or she is unable to close the claim).
Final medical received and Permanent Disability Benefits paid.
- File a paper final medical
report showing the amount of Permanent Disability.
- File an A49
FN, via EDI, showing the accumulated total of PPDsch (030) or PPDnon (040)
payments made. (The claim administrator has paid all of the benefits due and
he or she is closing
NOTE: Either TTD or TPD can be reported via EDI, but not both for the same claim. PPD can be reported via EDI, but not in the same transmission as another payment type. These situations, however, can be reported using our Internet WKC-13, on our pending reports website.