Claim status & 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 under
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 |
43 |
| 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 6447or email statistics@qcomp.com.au.