| Record Identifier |
1-2 |
2 |
A/N |
This field contains the character "ID". |
| Insurer Processing Date |
3-10 |
8 |
A/N |
This field contains the date the Insurer record was created or updated by the Insurer within its system. The date is in the CCYYMMDD format. |
| Insurer Provided SSN |
11-19 |
9 |
A/N |
This field contains the SSN for the claimant. This is a required field. |
| Obligor SSN |
20-28 |
9 |
A/N |
This field contains the Obligor SSN that was provided by OCSE to the Insurance Matching agency for its use in identifying a claimant. |
| Obligor Last Name |
29 - 48 |
20 |
A/N |
This field contains the person's last name for the SSN that was provided by OCSE to the Insurance Matching agency for its use in identifying a claimant. |
| Obligor First Name |
49-63 |
15 |
A/N |
This field contains the person's first name for the SSN that was provided by OCSE to the Insurance Matching agency for its use in identifying the Claimant. |
| Insurer Identifier |
64-72 |
9 |
A/N |
This field contains either: a valid nine-digit Taxpayer Identification Number assigned to the Insurer, a Federal
Employee Identification Number (FEIN), or another designated identification. |
| Insurer Name |
73-117 |
45 |
A/N |
This field contains the name of the Insurer where the insurance claim is maintained and to which the State
is directed to send the insurance intercept request for processing.
This is a required field. |
| Insurer Address Line 1 |
118-157 |
40 |
A/N |
This field contains Insurer address information within this first street field. This is a required field, unless
Insurer Address Line 2 is provided.
If not provided, this field contains all spaces. |
| Insurer Address Line 2 |
158-197 |
40 |
A/N |
This field contains Insurer address information within this second street field.
If not provided, this field contains all spaces. |
| Insurer Address City Name |
198-227 |
30 |
A/N |
This field contains the city that is associated with the Insurer address.
This is a required field. |
| Insurer Address State Code |
228-229 |
2 |
A/N |
This field contains the State alphabetic code that is associated with the Insurer address.
This is a required field. |
| Insurer Address Zip Code |
230-244 |
15 |
A/N |
This field contains the Zip Code that is associated with the Insurer address. U.S. Zip Codes are 5-4 digits, and foreign Zip Codes may be up to 15 characters. |
| Insurer Address Foreign Country Indicator |
245 |
1 |
A/N |
This field contains one of the following values to indicate if the Insurer address provided is a US or
foreign address:
1 - The address of the Insurer is in a foreign country
Space - The address of the Insurer is in the US |
| Insurer Address Foreign Country Name |
246-270 |
25 |
A/N |
If the returned address is in a foreign country, this field contains the name of the foreign country.
If the address is not in a foreign country, this field contains all spaces. |
| Insurer Contact Last Name |
271-300 |
30 |
A/N |
This field contains the last name of the Insurer contact.
If not provided, this field contains all spaces. |
| Insurer Contact First Name |
301-320 |
20 |
A/N |
This field contains the first name of the Insurer contact.
If not provided, this field contains all spaces. |
| Insurer Contact Phone Number |
321-330 |
10 |
A/N |
This field contains the phone number of the Insurer contact.
If not provided, this field contains all spaces. |
| Insurer Contact Phone Extension Number |
331-336 |
6 |
A/N |
This field contains the phone number extension of the Insurer contact.
If not provided, this field contains all spaces. |
| Insurer Contact Fax Number |
337-346 |
10 |
A/N |
This field contains the fax number of the Insurer contact.
If not provided, this field contains all spaces. |
| Insurer Contact Email |
347-386 |
40 |
A/N |
This field contains the email address of the Insurer contact.
If not provided, this field contains all spaces. |
| Insurer Claim Number |
387-416 |
30 |
A/N |
This field contains the claim number assigned by the Insurer. |
| Insurance Product Claim Type |
417-418 |
2 |
A/N |
This field contains the code indicating the type of claim matched by the Insurance Matcher. The valid values are:
00 - Life
01 - Automobile
02 - Automobile - No Fault
03 - Automobile - Medical
04 - Property Liability
05 - Workers' Compensation
06 - Personal Injury
07 - General Liability
08 - Homeowners Liability
09 - Medical Premise/Owners Policy
10 - Product Liability
11 - Slip, Trip and Fall
12 - Other |
| Insurance Claim State Code |
419-420 |
2 |
A/N |
This field contains the alphabetic FIPS code for the State in which the insurance loss occurred.
If not provided, this field contains all spaces. |
| Insurance Claim Loss Date |
421-428 |
8 |
A/N |
This field contains the date of the insurance claim loss by the Claimant. The date is in the CCYYMMDD format.
If not provided, this field contains all spaces. |
| Insurance Claim Beneficiary Indicator |
429 |
1 |
A/N |
This field contains an indicator specifying whether a beneficiary is associated with this life insurance claim.
Y - Yes. A beneficiary is associated with this life insurance claim.
N - No. A beneficiary is not associated with this life insurance claim.
If not provided, this field contains all spaces. |
| Insurance Claim Reported Date |
430-437 |
8 |
A/N |
This field contains the date the claim was reported by the Claimant to the Insurer. The date is in the
CCYYMMDD format.
If not provided, this field contains all spaces. |
| Insurance Claim Status Code |
438 |
1 |
A/N |
This field contains one of the following codes to indicate the status of the claim:
0 - Matched claim open at the time of the match by the Insurer.
1 - Matched claim closed at the time of the match by the Insurer.
If not provided, this field contains all spaces. |
| Insurance Claim Payout Frequency Code |
439 |
1 |
A/N |
This field contains a code associated with the frequency of the Insurer claim payout.
1 - One-Time
2 - Weekly
3 - Bi-Weekly
4 - Monthly
5 - Quarterly
6 - Annually
7 - Other |
| Obligor Match Code |
440-441 |
2 |
A/N |
This field indicates the result of the match performed by the Insurance Matcher that compares the provided obligor's identifying information against insurance claim data. The valid values are:
00 - Name and Address
01 - Name and DOB
02 - Name and SSN
03 - SSN
04 - SSN and Address
05 - SSN and DOB
06 - SSN, Name, and Address
07 - SSN, Name, and DOB
08 - SSN, Address, and DOB
09 - SSN, Name, Address, and DOB
10 - Name, Address, and DOB |
| Claimant Last Name |
442-471 |
30 |
A/N |
This field contains the last name of the Claimant from the insurance data match.
This is a required field. |
| Claimant First Name |
472-491 |
20 |
A/N |
This field contains the first name of the Claimant from the insurance data match.
This is a required field. |
| Claimant Middle Name |
492-507 |
16 |
A/N |
This field contains the middle name of the Claimant from the insurance data match.
If not provided, this field contains all spaces. |
| Claimant ITIN Number |
508-516 |
9 |
A/N |
This field contains the Individual Taxpayer Identification Number for the Claimant.
If not provided, this field contains all spaces. |
| Claimant Birth Date |
517-524 |
8 |
A/N |
This field contains, if available, the date of birth of the Claimant from the insurance data match. The date is in the CCYYMMDD format.
If not provided, this field contains spaces. |
| Claimant Gender Code |
525 |
1 |
A/N |
This field contains the code that indicates the gender of the Claimant as stored in the Insurer data base.
F - Female
M - Male
If not provided, this field contains a space. |
| Claimant Home Phone Number |
526-535 |
10 |
A/N |
This field contains the home phone number of the Claimant.
If not provided, this field contains all spaces. |
| Claimant Business Phone Number |
536-545 |
10 |
A/N |
This field contains the business phone number of the Claimant.
If not provided, this field contains all spaces. |
| Claimant Business Phone Extension Number |
546-551 |
6 |
A/N |
This field contains the business phone number extension of the Claimant.
If not provided, this field contains all spaces. |
| Claimant Cell Phone Number |
552-561 |
10 |
A/N |
This field contains the cell phone number of the Claimant.
If not provided, this field contains all spaces. |
Claimant Driver
License Number |
562-581 |
20 |
A/N |
This field contains the driver license number of the Claimant.
If not provided, this field contains all spaces. |
| Claimant Driver License State Code |
582-583 |
2 |
A/N |
This field contains the State driver's license alphabetic code for the Claimant.
If not provided, this field contains all spaces. |
| Claimant Occupation |
584-623 |
40 |
A/N |
This field contains the occupation of the Claimant.
If not provided, this field contains all spaces. |
| Claimant Professional License Number |
624-638 |
15 |
A/N |
This field contains the professional license number of the Claimant.
If not provided, this field contains all spaces. |
| Claimant Address Line 1 |
639-678 |
40 |
A/N |
This field contains Claimant address information within this first street field.
If not provided, this field contains all spaces. |
| Claimant Address Line 2 |
679-718 |
40 |
A/N |
This field contains Claimant address information within this second street field.
If not provided, this field contains all spaces. |
| Claimant Address City Name |
719-748 |
30 |
A/N |
This field contains the city that is associated with the Claimant address.
If not provided, this field contains all spaces. |
| Claimant Address State Code |
749-750 |
2 |
A/N |
This field contains the State alphabetic code that is associated with the Claimant address.
If not provided, this field contains all spaces. |
| Claimant Address Zip Code |
751-765 |
15 |
A/N |
This field contains the Zip Code that is associated with the Claimant address. U.S. Zip Codes are 5-4
digits, and foreign Zip Codes may be up to 15 characters.
If not provided, this field contains all spaces. |
| Claimant Address Foreign Country Indicator |
766 |
1 |
A/N |
This field contains one of the following values to indicate if the Claimant address provided is a U.S.
or foreign address:
1 - The address of the Claimant is in a foreign country.
Space - The address of the Claimant is in the U.S. |
| Claimant Address Foreign Country Name |
767-791 |
25 |
A/N |
If the returned address associated with the Claimant is in a foreign country, this field contains the
name of the foreign country.
If the country name is not provided, this field contains all spaces.
If the address is not in a foreign country, this field contains all spaces. |
| Attorney Last Name |
792-821 |
30 |
A/N |
This field contains the last name of the Attorney for this claim.
If not provided, this field contains all spaces. |
| Attorney First Name |
822-841 |
20 |
A/N |
This field contains the first name of the Attorney for this claim.
If not provided, this field contains all spaces. |
| Attorney Phone Number |
842-851 |
10 |
A/N |
This field contains the phone number of the Attorney.
If not provided, this field contains all spaces. |
| Attorney Phone Extension Number |
852-857 |
6 |
A/N |
This field contains the phone number extension of the Attorney.
If not provided, this field contains all spaces. |
| Attorney Address Line 1 |
858-897 |
40 |
A/N |
This field contains Attorney address information within this first street field.
If not provided, this field contains all spaces. |
| Attorney Address Line 2 |
898-937 |
40 |
A/N |
This field contains Attorney address information within this second street field.
If not provided, this field contains all spaces. |
| Attorney Address City Name |
938-967 |
30 |
A/N |
This field contains the city that is associated with the Attorney address.
If not provided, this field contains all spaces. |
| Attorney Address State Code |
968-969 |
2 |
A/N |
This field contains the State alphabetic code that is associated with the Attorney address.
If not provided, this field contains all spaces. |
| Attorney Address Zip Code |
970-984 |
15 |
A/N |
This field contains the Zip Code that is associated with the address. U.S. Zip Codes are 5-4 digits, and foreign Zip Codes may be up to 15 characters.
If not provided, this field contains all spaces. |
| Attorney Address Foreign Country Indicator |
985 |
1 |
A/N |
This field contains one of the following values to indicate if the Attorney address provided is US or foreign address:
1 - The address of the Attorney is in a foreign country
Space - The address of the Attorney is in the U.S. |
| Attorney Address Foreign Country Name |
986-1010 |
25 |
A/N |
If the returned address for the Attorney is in a foreign country, this field contains the name of the foreign country.
If the address is not in a foreign country, this field contains all spaces. |
| Third Party Administrator Company Name |
1011-1050 |
40 |
A/N |
This field contains the name of the Third Party Administrator (TPA) company.
If not provided, this field contains all spaces. |
| Third Party Administrator Contact Last Name |
1051-1070 |
30 |
A/N |
This field contains the last name of the TPA contact.
If not provided, this field contains all spaces. |
| Third Party Administrator Contact First
Name |
1071-1100 |
20 |
A/N |
This field contains the first name of the TPA contact.
If not provided, this field contains all spaces. |
| Third Party Administrator Company Phone Number |
1101-1110 |
10 |
A/N |
This field contains the phone number of the TPA company contact.
If not provided, this field contains all spaces. |
| Third Party Administrator Company Phone Extension Number |
1111-1116 |
6 |
A/N |
This field contains the phone extension number of the TPA company contact.
If not provided, this field contains all spaces. |
| Third Party Administrator Address Line
1 |
1117-1156 |
40 |
A/N |
This field contains TPA company address information within this first street field.
If not provided, this field contains all spaces. |
| Third Party Administrator Address Line
2 |
1157-1196 |
40 |
A/N |
This field contains TPA company address information within this second street field.
If not provided, this field contains all spaces |
| Third Party Administrator Address City
Name |
1197-1226 |
30 |
A/N |
This field contains the city that is associated with the TPA company address.
If not provided, this field contains all spaces. |
| Third Party Administrator Address State
Code |
1227-1228 |
2 |
A/N |
This field contains the State alphabetic code that is associated with the TPA company address.
If not provided, this field contains all spaces. |
| Third Party Administrator Zip Code |
1229-1243 |
15 |
A/N |
This field contains the Zip Code that
is associated with the TPA address. U.S. Zip Codes are 5-4 digits, and foreign Zip Codes may be up to 15 characters.
If not provided, this field contains all spaces. |
| Third Party Administrator Address Foreign
Country Indicator |
1244 |
1 |
A/N |
This field contains one of the following values to indicate if the TPA company address provided is US or foreign address:
1 - The address of the TPA is in a foreign country
Space - The address of the TPA is in the
U.S. |
| Third Party Administrator Address Foreign
Country Name |
1245-1269 |
25 |
A/N |
If the returned address associated with the TPA company is in a foreign country, this field contains
the name of the foreign country.
If the address is not in a foreign country, this field contains all spaces. |
| Employer Name |
1270-1309 |
40 |
A/N |
This field contains the name of the Claimant's Employer.
If not provided, this field contains all spaces. |
| Employer Phone Number |
1310-1319 |
10 |
A/N |
This field contains the phone number of the Employer. An additional extension number may be provided as part of this number.
If not provided, this field contains all spaces. |
| Employer Phone Extension Number |
1320-1325 |
6 |
A/N |
This field contains the phone extension number of the Employer.
If not provided, this field contains all spaces. |
| Employer Address Line 1 |
1326-1365 |
40 |
A/N |
This field contains the Employer address information within this first street field.
If not provided, this field contains all spaces. |
| Employer Address Line 2 |
1366-1405 |
40 |
A/N |
This field contains the Employer address information within this second street field.
If not provided, this field contains all spaces. |
| Employer Address City Name |
1406-1435 |
30 |
A/N |
This field contains the city that is associated with the Employer address. If not provided, this field contains all spaces. |
| Employer Address State Code |
1436-1437 |
2 |
A/N |
This field contains the State alphabetic code that is associated with the Employer address.
If not provided, this field contains all spaces. |
| Employer Address Zip Code |
1438-1452 |
15 |
A/N |
This field contains the Zip Code that is associated with the Employer address. U.S. Zip Codes are 5-4
digits, and foreign Zip Codes may be up to 15 characters.
If not provided, this field contains all spaces. |
| Employer Address Foreign Country Indicator |
1453 |
1 |
A/N |
This field contains one of the following values to indicate if the Employer address provided is a US or
foreign address:
1 - The address of the Employer is in a foreign country.
Space - The address of the Employer is in the U.S. |
| Employer Address Foreign Country Name |
1454-1478 |
25 |
A/N |
If the returned address associated with the Employer is in a foreign country, this field contains the
name of the foreign country.
If the address is not in a foreign country, this field contains all spaces. |
| Filler |
1479-1600 |
122 |
A/N |
Reserved for future use. For this version this field contains spaces. |
 
