AGENCY: Labor Commission. Industrial Accident Division

SERIES: 14569
TITLE: Insurance carrier or self-insured employer annual statement of losses files
DATES: 1988-1992.
ARRANGEMENT: Alphabetical by insurance carrier

DESCRIPTION: These files document any payments made on workers' compensation claims. They are submitted by insurance carriers to the Labor Commission on an annual basis. The file consists of the Annual Statement of Losses and the Worker's Compensation Individual Claim Log. The Annual Statement of Losses consists of a breakdown of the losses reported during a calendar year. Including total lost work days, number of cases, costs for vocational rehabilitation, attorney fees, reimbursement from Employers' Reinsurance Fund and the name and address of the carrier/self-insured employer. The Individual Claim Log contains the name of the employee, name of the employer, social security number, type of benefits, amount paid, the status of the claim and the name and address of the carrier/self insurer.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

FORMAT MANAGEMENT

Paper: Retain in Office for 2 years and then destroy.

APPRAISAL

Administrative

PRIMARY DESIGNATION

Private. UCA 63G-2-302 (2008) Name of employer and amount paid on employee claim.

SECONDARY DESIGNATION

Public. UCA 63G-2-301 (2008) Aggregate dollars paid on industrial injury claims by insurance carriers.

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