Case Number

1

9

$9

CASE-NUMBER

Unique identifier for each case assigned by the responsible District Office

Case Type

10

10

$1

CASE-TYPE

Indicates the relationship between this case and any other cases in the file.

I = Independent
M = Master
S = Subsidiary
D = Duplicate

Case Pointer

11

19

$9

CASE-PTR

Uses the Case Type field to map cases to the master case

If Case Type = M;
Case Pointer = total number of subsidiary cases associated with this master case.
If Case Type = S;
Case pointer = Master Case Number

Employee Name

20

62

$43

EMP-NAME

Employee’s $Claimant Name

Last Name 20-39
First Name 40-49
Middle Name 50-59
Title 60-62

Priority Correspondence

63

63

$1

PRTY-INQUIRY-TYPE

Indicates type of priority correspondence

blank

Sex

64

64

$1

EMP-SEX

Employee’s Gender

M,F

Social Security Number

65

73

$9

EMP-SSN

Employee’s SSN

Date of Birth

74

81

$8

EMP-DOB

Employee’s Date of Birth

YYYYMMDD

Date of Death

82

89

$8

EMP-DOD

Employee’s Date of Death

YYYYMMDD

Address

90

124

$35

ADDR

Claimant’s Street Address

City

125

144

$20

CITY

Claimant’s City Address

State

145

146

$2

STATE

Claimant’s State

Zip Code

147

155

$9

ZIP

Claimant’s Zip Code

Zip
Zip Reserve

Telephone Number

156

165

$10

TELENO

Claimant’s Telephone Number

Area Code
Phone #

Date of Injury

166

173

$8

EMP-DOI

Claimant’s Date of Injury

YYYYMMDD

Date Received

174

181

$8

DATE-RECEIVED

Date initial claim form was received $date stamped

YYYYMMDD

Date Created

182

189

$8

DATE-CASE-CREATED

Date the case was created in the District Office $case number assigned

YYYYMMDD

Case Review Date

190

197

$8

DATE-REVIEWED

Date that the case was most recently reviewed

YYYYMMDD

Last Change Date

198

205

$8

DATE-LAST-CHANGE

Date the case status was most recently changed

YYYYMMDD

Third Party Indicator

206

206

$1

3^RD -PARTY-IND

Indicator of third party status

0 = no 3^RD party insurance
1 = not referred to SOL
2 = referred to SOL
4 = closed; minor, not economical to pursue
5 = closed; other
6 = settled; no refund due
7 = settled; refund not received
8 = settled; refund received, no credit due
9 = settled; refund received, credit due against future compensation

Third Party Date

207

214

$8

3^RD -PARTY-DATE

Date the 3^rd Party Indicator was Entered

YYYYMMDD

Date Closed

215

222

$8

DATE CLOSED

Date the case was closed

YYYYMMDD

Date Reopened

223

230

$8

DATE-REOPEN

Date the case was reopened

YYYYMMDD

Adjudication Status

231

232

$2

ADJUD-STATUS

Current Adjudication Status

AC = Accepted as compensable; COP only, medical benefits authorized
AD = Accepted as compensable; daily roll & medical benefits authorized
AF = Death accepted as compensable; dependent on periodic roll, no medical benefits
AL = Accepted as compensable; leave elected medical benefits authorized
AM = Accepted as compensable; only medical benefits authorized
AO = Case previously accepted; no benefits payable
AP = Accepted as compensable; periodic roll and medical benefits authorized
AT = Accepted as work-related; wage loss compensation denied, medical benefits authorized

DO = Denied; case on appeal/reconsideration
D1 = Denied; untimely
D2 = Denied; not civil service employee
D3 = Denied; no fact of injury
D4 = Denied: not in performance of duty
D5 = Denied; no casual relationship
D6 = Denied; burden of proof
D7 = Denied: case on appeals remand
D8 = Denied; case on hearing remand
D9 = Denied; case in reconsideration
SU = Suspended

Adjudication Date

233

240

$8

AJUD-DATE

Date of most recent adjudication

YYYYMMDD

Case Status

241

242

$2

CURR-CASE-STATUS

Current case pay status

PI/PR = Case on Intermediate Roll
PV/PR = Periodic Roll; in Vocational Rehab
C1= Closed, no time lost
C2 = Closed, leave elected
C3 = Closed, benefits denied
C4 = Closed, COP covered all time lost
C5 = Closed, other - all benefits paid
RT = Case retired or awaiting retirement

Current Status

243

250

$8

CURR-STATUS-DATE

Current status date

YYYYMMDD

Previous Case Status

251

252

$2

PREV-CASE-STATUS

Previous case status

See Case Status Values

Previous Case Date

253

260

$8

PREV-STATUS-DATE

Date of previous status

YYYYMMDD

Current Case Location

261

263

$3

CURR-CASE-LOCN

Current location of case file

Current Case Location Date

264

271

$8

CURR-CASE-LOCN-DATE

Date of current case file location

YYYYMMDD

Previous Case Location

272

274

$3

PREV-CASE-LOCN

Previous location of case file

Previous Location Date

275

282

$8

PREV-CASE-LOCN-DATE

Date file to previous location

YYYYMMDD

Accepted Condition

283

327

$45

REP-ACCPT-COND

Accepted condition or diagnosis

Narrative or ICD-9, up to 6 times

Accepted Condition Flag

328

328

$1

REP-ACC-CONF-FLAG

Indicates whether reported diagnosis was accepted as compensable

N = not accepted as compensable
Y = accepted as compensable

Rehab Indicator

329

329

$1

REHAB-IND

Indicates vocational rehabilitation status

1 = Closed on referral
2 = Closed Rehabilitated
3 = Closed Rehabilitated, New Employer
4 = Closed Rehabilitated, Previously Reemployed
5 = Closed, not rehabilitated,
6 = Closed with post employment services
7 = Returned to work, nurse intervention
8 = Returned to work, without VR assistance
A = Initial Interview held
B = Nurse Intervention
C = Returned to CE
D = Plan Development
E = Employed
G = Placement Assisted Reemployment
I = Plan Approved
L= Part time Light Duty
M = Medical Rehabilitation
N = Placement previous. employer
P = Placement, new employer
Q = Screened
R = Referred to RS $default add status
S = Self-employed
T = Training
U = Closed by nurse, not RTW
V = Employed, assisted reemployment
W = Placement previous. employer with other services.
Y = Closed on referral
Z = Post employment services

Rehab Date

330

337

$8

REHAB-DATE

Date entered current rehabilitation status

YYYYMMDD

COP Type

338

338

$1

COP-TYPE

Indicates whether claimant used continuation of pay $COP benefits

N = COP benefit not used
Y = COP benefit used
Blank

Agency Code

339

344

$6

DEPT-AGENCY-CODE

Employing agency Chargeback code

Injury Zip

345

349

$5

INJ-ZIP

Zip Code of location where injury occurred

Extent of Injury

350

350

$1

EXTENT-OF-INJ

Indicates seriousness of injury

1 = no time lost
2 = first aid
8 = inoculation
X = non-fatal, lost time
0 = fatal

Status of Injury

351

351

$1

STATUS-OF-INJ

Indicates fatal or not

0 = non-fatal
1 = fatal

Location of injury

352

353

$2

ANAT-LOCN-CODE

Indicates the anatomical location of the injury/accepted condition

C1 = Single Ear Internal
C2 = Both Ears Internal
C3 = Single Eye Internal
C4 = Both Eyes Internal
CB = Brain
CC = Cranial Bones
CD =Teeth
CJ = Jaw
Cl = Throat; Larynx
CM = Mouth
CN = Nose
CR = Throat; Other
CT = Tongue
CZ = Not Otherwise Classified
H1 = Single Eye External
H2 = Both Eyes External
H3 = Single Ear External
H4 = Both Ears External
HC = Chin
HF = Face
HK = Neck/Throat
HM = Mouth/Lips
HN = Nose
HS = Scalp
BL = Lower Back
BU = Upper Back
B1 = Single Breast
B2 = Both Breasts
B3 = Single Testicle
B4 = Both Testicles
BA = Abdomen
BC = Chest
BP = Penis
BS = Side
BW = Waist
BX = Undefined
BZ = Not Otherwise Classified
R1 = Single Clavical Collar Bone
R2 = Both Clavicles Collar Bones
R3 = Single Scapula Shoulder Blade
R4 = Both Scapula Shoulder Blades
RB = Rib
RS = Sternum Breast Bone
RV = Vertebrae Spine; Disc
RZ =Trunk, Bones Unclassified
VH = Heart
V1 = Lung, Single
V2 = Lung, Both
V3 = Kidney, Single
V4 = Kidney, Both
VL = Liver
VS = Stomach
VI = Inguinal Hernia
VV = Intestines
VR = Reproductive Organs
VZ = Trunk, Internal Unclassified
AB = Arm And Wrist
AS = Arm Or Wrist
EB = Both Elbows
ES = Single Elbow
F1 = Single First Finger
F2 = Both First Fingers
F3 = Single Second Finger
F4 = Both Second Fingers
F5 = Single Third Finger
F6 = Both Third Fingers
F7 = Single Fourth Finger
F8 = Both Fourth Fingers
MB = Both Hands
MS = Single Hand
SB = Both Shoulders
SS = Single Shoulder
TB = Both Thumbs
TS = Single Thumb
G1 = Single Great Toe
G2 = Both Great Toes
G3 = Single Other Toes
G4 = Multiple Other Toes
KB = Both Knees
KS = Single Knee
LB = Both Legs/Hips/Ankles/Buttocks
LS = Single Leg/Hip/Ankle/Buttock
Pb = Both Feet
PS = Single Foot
99 = Old Converted
00 = Mis-Coded
98 = Mis-Coded 98/All Other

Nature of Injury

354

355

$2

NATURE-CODE

Nature of Injury Code

C = Cardiovascular/circulatory
D = Non-traumatic
R = Respiratory disease
S = Skin disease or condition
T = Traumatic
V = Virological, Infective

Cause of Injury

356

357

$2

CAUSE-CODE

Indicates cause of injury
Pre-OSHA coding system

Forms Received

358

359

$2

FORMS-RECVD

Indicates the type of claim form used at case create

1 = CA-1 6 = CA-6
2 = CA-2 7 = CA-7
5 = CA-5

Responsible Examiner ID

360

362

$2

RESP-EXMNR-ID

Identifies the CE responsible for the claim

Comp Claim Ind.

363

363

$1

CMP-CLM-IND

Indicates whether a CA-7 is on file

7 = CA-7 form is on file

Comp Claim Date

364

371

$8

CA-7 claim date

YYYYMMDD

Pay Disposition

372

372

$1

PAY-DISP

Indicates whether agency has reported to OWCP that pay has been terminated.

N = pay not terminated
Y = pay terminated

Controversion Ind,

373

373

$1

CNTRVTD-IND

Indicates if claim was controverted

N = not controverted
Y = controverted

Wage Loss Date

374

381

$8

WAGE-LOSS

Indicates the date wage loss began

YYYYMMDD

QCM Flag

382

382

$1

QCM-FLAG

Indicates if a QCM case.

Recurrence Number

383

384

$2

REOCURRENCE-NO

Counter the increments 1 with each claim for recurrence

Any integer from 1 - 99

RTW Code

385

386

$2

RETURN-TO-WORK-CODE

Indicates return to work information

blank = no RTW
F4 = Full duty, 4 hr/day
F6 = Full duty/ 6 hr/day
FF = Full duty, full time
FP = Full duty., part time
L4 = Light duty, 4 hr/day
L6 = Light duty, 6 hr/day
LF = Light duty, full time, w/out wage loss
LP = Light duty, Part time
L$ = Light duty, Full time, wage loss
NL = No lost tine
PS = RTW, private sector
XX = Final decision w/no RTW

RTW date

387

394

$8

RETURN-TO-WORK-DATE

Date RTW code entered

YYYYMMDD

PRMS Flag

395

395

$1

PRMS-FLAG

Indicates if case is included in Periodic Roll Management $PRM

N
Y
BLANK

Lost Time/No Lost Time OPN Code

396

396

$1

LT-NLT-OPN-CODE

Lost Time/No Lost Time open code

1 - reopened short form closure: medical bills exceed $1500
2 - reopened short form closure: compensation claim received
3 - reopened short form closure: case controverted
4 - reopened short form closure: other reason
5 - no lost time, no medical expense indicated in item 38 of ca-1 $generated at case create
6 - reopened no lost time, no medical expense: medical bills exceed $1500
7 - reopened no lost time, no medical expense: compensation claim received
8 - reopened no lost time, no medical expense: case controverted
9 - reopened no lost time, no medical expense: other reason
0 - reopened no lost time, no medical expense: "referred" cop/rtw case with no rtw
C - reopened short form closure: "referred" cop/rtw case with no rtw

Lost Time/No Lost Time OPN Date

397

404

$8

LT-NLT-OPN-DATE

Date LT-NLT code entered

YYYYMMDD

Accession Number

405

416

$12

ACCESSION-NO

Indicates accession to which case would be retired

Fatal Indicator

417

417

$1

FATAL-IND

Indicates relationship between claimant’s death and claimed injury

For Death Cases only:
0 = Immediate Death with Injury
1 = Not Related to Injury
2 = Relate to Injury

Occupational Code

418

422

$5

OCC-CODE

Indicates claimants occupation code at Date of Injury

Type of Injury

423

425

$3

TYPE-INJURY

Indicates type of injury

100 = Struck
110 = Struck by
111 - struck by falling object
120 = Struck against
200 = Fall, Slip, Trip
210 = Fell, same level
220 = Fell, different level
230 = Slip, trip, no fall
300 = Caught
310 = Caught on
320 = Caught in
330 = Caught between
400 = Punctured, Lacerated
410 = Punctured by
420 = Cut by
430 = Stung by
440 = Bitten by
500 = Contact
510 = Contact with
511 = Rubbed, abraded
520 = contact by
600 = Exertion
610 = Lifted, strained by
620 = Stressed by
700 = Exposure
710 = inhalation
720 = Ingestion
730 = Absorption
800 = Traveling in
999 = Unclassified

Source of Injury

426

429

$3

SOURCE-INJURY

Indicates source of Injury; OSHA

Site of Injury

430

438

$9

OSHA-SITE-CODE

Indicates injury site; OSHA

Date case was retired

439

446

$8

CASE-RETIRE-DATE

Date file was retired

YYYYMMDD

Assigned Number

447

456

$10

CASE-RETIRE-NO

FRC location number

CA1 signature

457

464

$8

CA1-2-SIG-DATE

Date CA1 was signed

YYYYMMDD

Previous Adjudication Date

465

472

$8

PREV-ADJUD-DATE

Previous date file was adjudicated

YYYYMMDD

Previous Adjudication Status

473

474

$2

PREV-ADJUD-STATUS

Previous Adjudication Status

see Adjudication Status

Current Adjudication

475

477

$3

CURR-ADJ-RCE

Responsible Examiner at the time of initial adjudication

Adjudication Status

478

479

$2

ADJ-ST-POST-UD

The status of adjudication after case has been reopened

see Adjudication Status

Post Ud Adjud. Status

480

487

$8

ADJ-DT-POST-UD

The date of the first adjudication after the case has been reopened

YYYYMMDD

Initial Adjudication Date

488

495

$8

INIT-ADJUD-DATE

Initial adjudication date

YYYYMMDD

Initial Adjudication Status

496

497

$2

INIT-ADJUD-STATUS

Status at initial adjudication

see Adjudication Status

Initial Adjudicating ID

498

500

$2

INIT-ADJUD-EXMNR-ID

Examiner at initial adjudication

Service date

501

508

$8

SVC-COMP-DATE

The date employee entered federal service

YYYYMMDD

Filler

509

525

$17

Blank

Adjud status number

526

527

$2

ADJUD_STATUS_NUM

01 = A0
02 = AC
03 = AD
04 = AL
05 = AM
06 = AP
07 = AF
08 = AT
09 = D0
10 = D1
11 = D2
12 = D3
13 = D4
14 = D5
16 = D7
17 = D8
18 = D9
20 =SU
99 =all other values
 

Case Status Number

528

529

$2

CASE_STATUS_NUM

01 = UN
02 = UD
03 = MC
04 = DR
05 = PR
06 = PN
07 = PW
08 = PS
09 = DE
11 = OP
12 = CL
13 = C1
14 = C2
15 = C3
16 = C4
17 = C5
18 = RT
19 = XX
20 = ON
99 = all other values

Case Location Number

530

532

$3

CASE_LOCN_NUM

001 = ADD
004 = DDD
005 = DDO
006 = DES
007 = FRC
008 = RDO
030 = XIN
032 = DCO
003 = location codes start with C
002 = location codes start with BP
007 = location codes start with DM
008 = location codes start with DP
009 = location codes starts with FA
010 = location codes start with FI
013 = location codes start with IG
014 = location codes start with IQ
015 = location codes start with MR
016 = location codes start with NA
017 = location codes start with NB
018 = location codes start with NP
020 = location codes start with NS
021 = location codes start with OL
022 = location codes start with PY
025 = location codes start with RH
026 = location codes start with SO
027 = location codes start with TA
028 = location codes start with TC
029 = location codes start with WP
031 = location codes start with SN
023 = P48 to P57
999 = all other values

District Office sequence number

533

534

$2

District Office sequence number

District Office number

01 = 01
02 = 02
03 = 03
04 = 06
06 = 09
07 = 10
08 = 11
09 = 12
10 = 13
11 = 14
13 = 16
15 = 25
16 = 50 or 51 or 52

Central Delete Date

535

542

$8

CENT_DELETE_DT

00000000

District Office Alpha code

543

543

$1

CENT-DIST-OWNERS

A = 01
B = 02
C = 03
D = 06
F = 09
G = 10
H = 11
I = 12
J = 13
K = 14
M = 25
N = 50 or 51 or 52
P = 16

Filler

543

549

$6

000000

Central Retire Date

550

557

$8

CENT-RET-DATE

00000000

Central Retire FRC Location

558

560

$3

CENT-RET-FRC-LOCN

000

Central FRC Box

561

567

$7

CENT-FRC-BOX

0000000

Central Error Date

568

575

$8

CENT_ERROR_DATE

00000000