Name | Description | Type | Additional information |
---|---|---|---|
name_of_injured_employee | string |
None. |
|
time_employee_began_work | date |
None. |
|
date_of_injury_illness | string |
None. |
|
time_of_occurrence_cannot_be_determined | boolean |
None. |
|
time_of_occurrence | date |
None. |
|
last_work_date | string |
None. |
|
date_employer_notified | string |
None. |
|
date_disability_began | string |
None. |
|
contact_name | string |
None. |
|
contact_phone | string |
None. |
|
contact_id | globally unique identifier |
None. |
|
type_of_injury_illness | string |
None. |
|
part_of_body_affected | string |
None. |
|
equipment_materials_or_chemicals_employee_was_using | string |
None. |
|
activity_employee_was_engaged | string |
None. |
|
work_process_employee_was_engaged | string |
None. |
|
how_injury_or_illness_occurred | string |
None. |
|
cause_of_injury_code | string |
None. |
|
date_return_to_work | string |
None. |
|
date_of_death | string |
None. |
|
were_safeguards_or_safety_equipment_provided | boolean |
None. |
|
were_they_used | boolean |
None. |
|
injury_occured_on_employers_premises | boolean |
None. |
|
type_of_injury_illness_code | string |
None. |
|
part_of_body_affected_code | string |
None. |
|
database_id | globally unique identifier |
None. |
|
claim_number | string |
Required |
|
status | string |
None. |
|
street | string |
None. |
|
city | string |
None. |
|
state | string |
None. |
|
zip | string |
None. |
|
county | string |
None. |
|
date_of_loss | string |
None. |
|
describe_location | string |
None. |
|
police_or_fire | string |
None. |
|
report_number | string |
None. |
|
additional_comments | string |
None. |
|
description_of_loss | string |
None. |
|
insured_database_id | globally unique identifier |
None. |
|
insured_email | string |
None. |
|
insured_first_name | string |
None. |
|
insured_last_name | string |
None. |
|
insured_commercial_name | string |
None. |
|
policy_number | string |
None. |