Specifies an additional characteristic of the adjustment reason
Type
ID
Length
Max 2 / Min 1
Codes
<> 1
Primary Disability - Frozen
<> 2
Primary Disability - Non-frozen
<> 3
Dependent Disability - Frozen
<> 4
Dependent Disability - Non-frozen
<> 5
Retirement - Frozen
<> 6
Retirement - Non-frozen
<> 7
Permanent
<> 8
Temporary
<> 9
Canadian
<> 10
Joint
<> 11
Deferred
<> 12
Eligible
<> 13
Applied
<> 14
Receiving
<> 15
Defense Medical Evaluation
<> 16
Delayed Reporting Penalty (Insured)
<> 17
Engineering Services
<> 18
Expert Test (Trial)
<> 19
Expert Fees and Expenses (excluding tests and testimony)
<> 22
Fee Schedule Savings
<> 23
Fatal
<> 24
Permanent Total
<> 25
Permanent Total Supplemental
<> 26
Permanent Partial Scheduled
<> 27
Permanent Partial Unscheduled
<> 28
Temporary Total
<> 29
Temporary Partial
<> 30
Employer Liability
<> 31
Permanent Partial Disfigurement
<> 32
Unspecified Employer Payments
<> 34
Funeral Expenses
<> 35
Penalties
<> 36
Interest
<> 37
Employer's Legal Expenses
<> 38
Claimant's Legal Expenses
<> 39
Payments to Physicians
<> 40
Hospital Costs
<> 41
Other Medical
<> 42
Vocational Rehabilitation Evaluation
<> 43
Vocational Rehabilitation Education
<> 44
Other Vocational Rehabilitation
<> 45
Total Temporary Catastrophic
<> 46
Unknown Payment Type
<> 57
Vocational Rehabilitation Maintenance
<> 58
Claim Value Recovery
<> 60
Deductible Recovery
<> 61
Additional Living Expense
<> 62
Alternative Dispute Resolution Services
<> 63
Anesthesiologist
<> 64
Annuity
<> 65
Attorney Expenses
<> 66
Attorney Fees
<> 67
Auto Liability Subrogation
<> 69
Not Eligible
<> 71
Catastrophic Benefits
<> 72
Central Index Bureau Filing Fees
<> 73
Chiropractor
<> 74
Indemnity Reserves
<> 75
Medical Reserves
<> 76
Expense Reserves
<> 77
Vocational Rehabilitation Reserves
<> 78
Indemnity Payments
<> 79
Medical Payments
<> 80
Expense Payments
<> 81
Vocational Rehabilitation Payments
<> 82
Claim Payment
<> 83
Claim Reserve
<> 84
Bodily Injury Payment
<> 85
Bodily Injury Reserve
<> 86
Property Damage Payment
<> 87
Property Damage Reserve
<> 88
Comprehensive Payment
<> 89
Comprehensive Reserve
<> 90
Collision Payment
<> 91
Collision Reserve
<> 92
Salvage
<> 93
Expert Witness Fees
<> 94
Claimant Legal Expense
<> 95
Claimant Medical Evaluation
<> 96
Commercial Photographers
<> 97
Mandated Medical Exam
<> 98
Death Benefits
<> 99
Defense Attorney Fees and Expenses
<> A1
Funeral Benefits
<> A2
Hearing Attendance or Representation Fees
<> A3
Hospital - Inpatient Charges
<> A4
Hospital - Outpatient Charges
<> A5
Hospital Bill Audit
<> A6
Impairment Income Benefits
<> A7
Independent Adjustor Expense
<> A8
Independent Medical Exam
<> A9
Legal Expenses - Miscellaneous
<> AA
Chiropractic Expenses
<> AB
Dental Expenses
<> AC
Physical Therapy Costs
<> AD
Pharmaceutical Costs
<> AE
Durable Medical Costs
<> AF
Medical Travel Costs
<> AG
Employee Medical-Legal Costs
<> AH
Employer-Claim Administrator Medical-Legal Costs
<> AI
Agreed upon or Directed Medical-Legal Costs
<> AJ
Unallocated Funds
<> AK
Future Credit Recovery
<> B1
Liability Settlement
<> B2
Life Pension
<> B3
Lump Sum Remarriage Payment
<> B4
Lump Sum Settlement Amount
<> B5
Major Case of Individual Case Reporting
<> B6
Medical Equipment
<> B7
Peer Review Board Expenses
<> B8
Medical Management Services
<> B9
Medical Records or Reports
<> C1
Medical Rehabilitation
<> C2
Medical Test (Trial)
<> C3
No-fault benefit or expense (Non-Workers Compensation)
<> C4
Nursing Care
<> C5
Extended Care Facility
<> C6
State Fund - Other
<> C7
Penalties Paid on Medical Benefits
<> C8
Penalties Paid on Indemnity Benefits
<> C9
Pension Indemnity Benefit
<> D2
Personal Property or Contents
<> D3
Pharmacy
<> D4
Photographs other than Commercial
<> D5
Physiotherapy
<> D6
PPO (Preferred Provider Organization) Fees or Expenses
<> D7
Product Liability Subrogation
<> D8
Property Adjustment
<> D9
Provider Bill Audit Expense
<> E1
Radiology
<> E2
Time and Expense Fees
<> E3
Scheduled Award
<> E4
Social Security
<> E5
State Second Injury Fund
<> E6
State Supplemental Fund
<> E7
Supplemental Permanent Total Benefits
<> E9
Employee Interest
<> F1
Testing Lab
<> F2
Third Party Contribution
<> F3
Transportation - Other
<> F4
Transportation - Medical Treatment
<> F5
Treating or Panel Physician
<> F6
Utilization Review - Hospital
<> F7
Utilization Review - Physician
<> F8
Unallocated Indemnity
<> F9
Unallocated Medical
<> G2
Witness Fees and Expenses - Other than Expert Witness
<> G3
Vocational Rehabilitation Training
<> G4
Appraisal Fees
<> G5
Autopsy Fees
<> G6
Surveillance Special Investigation Fees and Expenses
<> G7
Temporary Income Benefits
<> G9
Federal Second Injury Fund
<> H2
Federal Supplemental Fund
<> H3
Flat Rate
<> H4
Employer Paid Temporary Total Disability
<> H5
Employer Paid Temporary Partial Disability
<> H6
Court Reporter Fees
<> H7
Private Investigator Fees
