Claim status and reason for status

This data management bulletin assists insurers with the coding relationship of the claim status and reason for status fields.

The requirement to report the claim status and reason for status is specified within the Workers’ compensation insurers’ interface data specifications for the monthly insurer interface as per 4.5.7 – Claim status and 4.5.11 – Reason for status.

Coding relationship

The reason for status must be supplied for claims where the claim status is either ‘rejected’, ‘ceased’ or ‘suspended’:

• Rejected (REJ) - the application for compensation is rejected
• Ceased (CSD) - the insurer has terminated entitlements to compensation
• Suspended (SPD) - entitlements to compensation are suspended.

The claims management processing to a claim status of rejected, ceased or suspended is attributed to a particular section of the Act. To measure and monitor the purpose of this claim status, a reason for status is required. The reason for status provides a separate code for each type of reason for rejecting, ceasing or suspending a claim under the Act. Insurers reject claims where, for some reason, the event or the person is not covered under the Act. Below is the list of applicable reason for status codes where the claim status is ‘rejected’.

Code

Rejection reason (REJ)
Not a worker s.11	01
Not an injury s.32(1-4)	02
Not an injury - psychiatric - excluded by s32(5)	03
Subjecting to abnormal risk during absence s34(1)(c)	04
Not a journey s.35	05
Journey - traffic offence or breach of Criminal Code s36(2)(a)	06
Journey - substantial delay, interruption or deviation s.36(20(b)	07
Insurer not liable s.87	08
Outside Queensland s.113	09
Industrial deafness - excluded under s.125 - initial application	10
Industrial deafness - excluded under s.126 - further application	11
Out of time - excluded under s.131	12
Invalid application s.132	13
Fraud - excluded under s.537	14
Persons other than workers - not covered under Div 3 Part 4 Ch 1	15
Compensated under corresponding law s.116	16
Self-inflicted injury - excluded under s.129	17
Wilful misconduct - excluded under s.130	18
Seafarer - excluded under s.121	19
Miner - excluded under s.123	20

Insurers cease claims where, for some reason, the event or the person is no longer entitled to compensation under the Act. Below is the list of applicable reason for status codes where the claim status is ‘ceased’.

Code

Cessation reason (CSD)
Entitlement to compensation stops if compensation nder corresponding laws - s.116	41
Entitlement to compensation ends if damages claim is finalised (setlement or judgement) - s.119	42
Maximum statutory entitlement reached - s.140	42
5 year limit reached	44
Injury not likely to improve with further treatment - s.144B	45
Insurer review of entitlement to compensation	46
Worker receives notice of assessment - s.190	47
Redemptions - s.171, s.172, s.173, s.176	48

Insurers suspend claims where, for some reason, the worker or person does not comply with sections of the Act. Below is the list of applicable reason for status codes where the claim status is ‘suspended’.

Code

Suspension reason
Worker refused to be examined by a registered person - s.135	61
Worker serving term of imprisonment - s.137	62
Compensation not payable during suspension under Chapters 3, 4, 11 or 13 - s.138	63
Insurer review of entitlement to compensation	64
Worker refuuses to participate in rehabilitaiton - s.232	65

Reporting requirement

The reason for status must be supplied if the claim status is rejected, ceased or suspended. If the claim status is:

• rejected, the reason for status must be a valid code between 01 and 20
• ceased, the reason for status must be a valid code between 41 and 48
• suspended, the reason for status must be a valid code between 61 and 65.

Reason for status in reporting

The reason for status is used in insurer reporting as well as the Q-COMP Statistics report. Below is an excerpt from the Q-COMP Statistics report.

More information

Telephone the Data Management Team on (07) 3020 6366 or email statistics@qcomp.com.au.