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ClaimsClaim Reporting

Claims

Claim Reporting

Initial and Interim Claim reports must be submitted electronically via the WCRA Portal.  If you do not have a Portal account, go to the WCRA website landing page and click on the ‘Request Portal Access.’  If your application is accepted, you will receive an email with a link on how to set up your Portal account.

For more detailed information about WCRA Claims Reporting, the Claims Reference Guide is available on the Portal under Claims>Resources or upon request.

All serious claims of WCRA members involving a loss that occurred on or after October 1, 1979, or subsequent to membership in the Association, may be appropriate for reporting to the WCRA. The information requested on the initial Claim report is designed to provide the WCRA with sufficient data and information to determine if the Claim may involve liability to the WCRA. Initially, the WCRA needs the basic claimant information, a complete description of the injury, payment and reserve information, and the current status of the Claim, including recovery potential.  The WCRA also requests the First Report of Injury (FROI) be submitted with the initial Claim report to provide any additional clarifying information.  If the WCRA determines the claim will not present exposure to the WCRA, a Claim will not be opened or reserved.

Members should report claims involving serious injury or significant anticipated costs as described below.

CATASTROPHIC INJURY

Claims involving the following injuries should be promptly reported to the WCRA within 10 business days of notification of the injury to the member:

  • Spinal cord injury resulting in paraplegia or quadriplegia.
  • Moderate to severe brain injuries.
  • Major burns, defined as second- or third-degree burns involving covering 30 percent or more of the body, electrocution injuries, or if significant medical costs can be anticipated.
  • Amputations of a significant portion of one extremity or multiple limb amputations.
  • Complete vision loss.
SERIOUS INJURIES

Claims involving the following injuries should be promptly reported to the WCRA after taking into consideration the applicable Retention Limit that was in effect at the time of the Loss Occurrence:

  • Impairment of total vision by 50 percent or more.
  • Partial paralysis in an upper or lower extremity.
  • Crushing or massive internal injuries.
  • Multiple fractures or significant degloving injuries.
  • Occupational disease allegedly caused by working conditions or other job-related factors, including asbestosis, chronic pulmonary disease, or other occupational disease which results in a disability expected to last two years or more. In cases of occupational disease, each person who has been exposed is considered a separate Loss Occurrence.
  • A Loss Occurrence that is likely to produce multiple post-traumatic stress disorder Claims under Minn. Stat. § 176.011, subd. 15(d) and is considered likely to affect the interests of the Association.
INCURRED CLAIM COST THRESHOLD

A Claim should be reported promptly to the WCRA when the total incurred cost of a Claim exceeds the lesser of 50 percent of the applicable Retention Limit that was in effect at the time of the Loss Occurrence or $1,000,000.

 

For more detailed step-by-step instructions on how to submit an Initial Claim report, click here for the Portal Overview and Training.

  • If the WCRA has opened a reported Claim, Interim update reporting is required. The frequency of Interim reporting, as determined by the WCRA claims staff, will depend on the severity and stability of the Claim but typically is every 6 to 12 months (the anniversary and ½ anniversary of the date of injury).  The WCRA claims services staff will send electronic notifications to the designated Member contacts advising when a Claim update report is due.
  • Claim update reports not submitted by the due date will be considered past due. Claim payments that occur on a past-due claim that could negatively impact the WCRA’s exposure or do not protect the WCRA’s interests may be ineligible for reimbursement once retention is reached.
  • If the total medical and indemnity Member Payments made on a Claim are over the applicable Retention Limit, a reimbursement request may be submitted in lieu of a Claim update report (see Reimbursements tab). As part of their membership, Members and authorized TPAs agree to receive information requests, updates, and other Claims-related material electronically.

For more detailed step-by-step instructions on how to submit an Interim Claim update, click here for the Portal Overview and Training.