Accidents at Work and Occupational Diseases (AWOD) Sector

Guidelines for the use
of SEDs, Flows and the Portable Document (PD) DA1in

Accidents at Work and Occupational Diseases (AWOD) sector

February 2011

Version 1.0

CONTENT

1. HOW TO USE THE GUIDELINES

2. GENERAL INFORMATION:

3. ITEMS COMMON FOR ALL SEDs

4. BUSINESS FLOWS AND SEDs INVOLVED:

5. PORTABLE DOCUMENT – DA1

6. HORIZONTAL SEDs

ANNEX I – Flow table

ANNEX II – Correlation table

ANNEX III – Glossary of terms

1. HOW TO USE THE GUIDELINES

The overall aim of the Guidelines is to provide staff and institutions with general information and guidance concerning the use and completion of the SEDs, in paper or electronic environment, as well as of the Portable Documents (PDs).

While not being exhaustive, the Guidelines form nevertheless a comprehensive foundation on which social security institutions from Member States will be able to base any more detailed instructions they wish to prepare for their staff.

Each SED is accompanied by a corresponding "Explanatory notes" document, where the main terms used in the SED are explained and instructions for the type of information required are provided. Therefore the guidelines are not to be seen as an exhaustive manual for the completion of the SEDs but only as an additional instrument providing guidance and further information on the completion of certain ”tricky points” from the SEDs.

In the Guidelines, the use of each Flow and SED is first explained in general terms. By reading this general description, one will be able to acquire an overall picture of the use of each flow and each SED within each flow.

Following the description of the Flow, there is a short description of each SED.

These guidelines do not provide an official interpretation of the provisions of the social security regulations (Regulation (EC) no 883/2004 and Regulation (EC) no 987/2009) and any examples of business cases included herewith are solely intended to illustrate the use of the SEDs in certain situations.

The PD DA1 and the SEDs likely to be associated with its use are also explained.

The Guidelines also contain a section briefly describing the Horizontal SEDs, which the users of the current guidelines may have to use for obtaining or providing certain types of information. For detailed guidance on the use and completion of the Horizontal SEDs, reference should be made to the "Horizontal SEDs and Flows Guidelines".

A short glossary of generic terms has also been included in these guidelines.

NOTE: The current guidelines refer to the first version of the SEDs and flows, as approved by the Administrative Commission for the Coordination of Social Security Systems on the 5th of October 2010. The authorised versions of the paper SEDs to be used during the transitional period are available on the European Commission website in the following location:

2. GENERAL INFORMATION:

Structured electronic documents (SEDs), grouped in the so-called business flows, were created for the purpose of electronic transmission of data between the institutions or between the liaison bodies.

Flows and SEDsprepared for the sector of Accidents at Work and Occupational Diseases (AWOD), are related to the following articles of the regulations on coordination of social security systems:

1)articles 36-41 of Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems[1];

2)articles 33-41 of Regulation (EC) No 987/2009 of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems[2].

The main purpose of all SEDs is to enable Member States to exchange information on the rights of the insured person due to accident at work or occupational disease.

The scope of each document is determined by the name of SED,the reference to a specific part of the regulations, and a number starting with letters DA, which indicates the AWOD sector.

All SEDs are arranged in the order of articles in the Regulation EC No 987/2009. Since article 33 of Regulation No 987/2009 – which is the first in the AWOD chapter –includes a reference to the parts of Regulations for which sickness SEDs were created, new AWOD SEDs(separate from sickness SEDs) were created for articles 24-27 and articles 62, 66-68, and placed as the first ones in flow table.

Moreover, because the above mentioned provisions apply both to accidents at work and occupational diseases, almost all documents include the possibility to indicate whether the SED is related toan accident at work or to an occupational disease.

Although most of the items in SEDs were established as not mandatory, it is important to remember that whenever a MemberState sends a document, it must provide as much information as possiblein order to allow swift procedures and effective communication.

It should be noted that in the absence of information which allows Member State to identify a person, to determine if the person is insured, or to link the person with a particular accident at work or occupational disease, a Member State will not be able to provide the answer.

3. ITEMS COMMON FOR ALL SEDs

Regardless of the data, individual for each SED,all documents include some fields which are common for all of them, such as:

“Attachments”

Number of attachments / ......
Date sent / ......

This field allows to indicate how many files are attached to a SED. In any case, when it is necessary to include additional annexes, which might contain decisions, reports etc., the sending MemberState may indicate the number of attachments – in order to ascertain, that all of them are received.

Attachments shall provide additional data indispensable to consider the particular SED, e.g. official documents to certify a piece of information or a fact, if necessary. The Competent Institution verifies the substance of the attachment, e.g. the legal value of a document, under the legislation applicable in the Competent MS

As various and numerous documents may be attached to the SED, it is assumed not to rewrite the content of an attached document into the SED. It is also inadvisable when information given in the “Additional Information” section duplicates the entire content of an attached document.

The attachments may be listed in a separate file, if necessary.

So-called “envelope”

Sending institution:
Country code* / ......
Institution code* / ......
Institution name* / ......
Street / ......
Town / ......
Postal code / ......
Region / ......
Country / ......
Phone / ......
Fax / ......
Email / ......
Receiving institution:
Country code* / ......
Institution code* / ......
Institution name* / ......
Street / ......
Town / ......
Postal code / ......
Region / ......
Country / ......
Phone / ......
Fax / ......
Email / ......

The “envelope” describes the “sender” and the “receiver”.

It is important to remember that the position of the “sender” and “receiver” should be changed in subsequent stages of the business flows. For example:

• when MemberState A (MS A) sends a request for an entitlement document to Member State B (MS B) with DA001, MS A is a sending institution and MS B is a receiving one;
• when MSB replies to request from MS A with DA002, MS B is a sending institution on DA002 and MS A is the receiving institution.

“Sending institution” always indicates the institution of MemberState that literally sends the SED.

“Receiving institution” always indicates the institution of MemberState which isthe recipient of SED.

If under relevant provisions a SED is transferred between Member States indirectly via the liaison body (receiving institution), it is recommended to provide additional informationabout the institution which would have been the receiving institution if the SED had beentransferred between Member States directly by the institutions themselves.

“Case number”

1. Case numbers
1.1 Case number of the sending institution1* / ......
1.2 Case number of the receiving institution2 / ......

“Case number” is a field, which was created to make it possible to indicate the number of the case to which the MemberState, providing the answer, can refer to.

The sending institution indicates the numbers of case in the field “sending institution” andalso in the field “receiving institution” (if it is known).

It is important to remember that the field “case number” should also be changed in subsequent stages of the business flows. For example:

• when Member State A (MS A) sends a SED with request for entitlement document with DA001to Member State B (MS B), MS A gives the “case number of sending institution” (point 1.1);
• when MS Breplies to a request from MS A with DA002, MS B gives “the case number of sending institution” (point. 1.1), and the “case numberof receiving institution” (point. 1.2) is the case number, which was indicated in DA001 as a “case number of sending institution”;
• when MS A might have to send the third SED in business flows – if there is the third SED - then the “case number of the sending institution” in point 1.1 of the third SED should be the same as was indicated in the first SED from business flow, and “case number of receiving institution” is the case number indicated by MS B in reply in the field “case number of sending institution”.

“The case number of receiving institution” in the first SED from business flowis usually blank.

“Person identification field”

2. Person
2.1 Person3
2.1.1 Family name(s)* / ......
2.1.2 Forename(s)* / ......
2.1.3 Birth date* / ......
2.1.4 Sex*
 / Female
 / Male
 / Unknown
2.1.5 Family name(s) at birth / ......
2.1.6 Forename(s) at birth / ......
2.1.7 If you have the Personal Identification Number of the person, please fill in the following:
Identification of the person with Personal Identification Number
2.1.7.1 Personal identification number in the sending institution / ......
2.1.7.2 Personal identification number in the receiving institution / ......
2.1.8 If you do not have the Personal Identification Number of the person, please fill in the following:
Identification of the person, without Personal Identification Number
2.1.8.1 Place of birth4* / ......
2.1.8.2 Father family name at birth5 / ......
2.1.8.3 Mother family name at birth6 / ......
2.1.8.4 Forename of father / ......
2.1.8.5 Forename of mother / ......
2.2 Additional information on the person
2.2.1 Nationality7 / ......

Person identification data set, which allows to recognize the person, was established by the Administrative Commission, as a horizontal set for all sectors.

Each sector independently defined which fields should be mandatory within the said set, due to their necessity in the process of identification of a person. Mandatory fields are marked with the symbol “ * “ (see above).

Mandatory character of field means that the person record cannot be traced without the item of data.

Optional character of field means that the person record can be traced without the item of data but that the item of data is helpful to trace the record.

Identification data set imposes an obligation to provide the following mandatory data to identify a person:

• Family name,
• Forename,
• Birth date,
• Sex – if the sending institution doesn’t collect/record this data or it is not available, it is recommended to choose “unknown”.
• Place of birth is mandatory only if the PIN number is unknown – whenever PIN number is unknown sending the Member State is obliged to provide information about the place of birth, however as it is a text field it is possible to write “unknown”.

Personal Identification Number (PIN)was defined as a unique personal identification number issued by a state or organization.

Whenever it is possible the number entered should be a number given to the person under a National Registration scheme.Where no National Registration Number is available, a sectored number(i.e. Social security, Health Registration Number) should be entered.

It is important to remember that the field “Personal Identification Number” should be changed in subsequent stages of the business flows, just like case number (see above).

“Address”

3. Address of the insured person
3.1 Street / ......
3.2 Town / ......
3.3 Postal code / ......
3.4 Region8 / ......
3.5 Country / ......

As, in some cases, it might be necessary for the Competent Member State to get in contact with the person concerned, the address of the person if it is known should be indicated,.

Symbol  allows to repeat all the section and indicate various addresses of a person, for example one in the CompetentMemberState, and a second one in Member State of Stay / Residence.

“Reference to accident at work or occupational diseases”

4. This SED is related to
4.1 This SED is related to*
 / An accident at work
 / An occupational disease
4.2 Of / ......
4.3 Accident/disease code / ......
4.4 Accident/disease coding system / ......
4.5 Consequences of the accident / kind or short description of the disease / ......
4.6 Status of the person
 / Employee
 / Self-employed
 / Civil servant
 / Frontier worker
 / Other
Please fill in the following if "Status of the person" = "Other" :
4.7 Status of the person (if "Other") / ......
4.8 Employer
4.8.1 Employer name / ......
4.8.2 Employer address
4.8.2.1 Street / ......
4.8.2.2Town / ......
4.8.2.3 Postal code / ......
4.8.2.4 Region8 / ......
4.8.2.5 Country / ......
4.8.3 Employer PIN / ......

Since the regulation on the coordination of social security systems applies to both accidents at work and occupational diseases, all SEDs include the possibility to indicate whether the SED is related to an accident at work or an occupational disease.

This information might be necessary, particularly when the MemberState has two different institutions, one of them in charge of accidents at work and the other oneof occupational diseases.

What is more, as, the person might have various accidents at work or several occupational diseases, it is highly important to indicate data such as the date of accident, the code of the disease and consequences of accidents, the status of the person, which can all be crucial for the purpose of establishing the status of the person in the Member State in question, as soon as it is possible.

Information about employer are necessary because if the Member State does not have a central register of insured persons, and if there is more than one AWOD insurance institution, the employer is the only source of information about the insurance institution which is a competent for the employee.

In case of accidents at work, the most important is the employer at the time of the accident. However it is important to remember that in some SEDs for occupational disease it might be necessary to give information about the full career of the person who applies to get a benefit in order to determine which country is the competent one in case of multiple exposureto the risk of occupational disease.

It is recommended to give the Employer PIN especially when no PIN of the person concerned is available.

 “Additional information”

7. Additional information9
7.1 Additional information / ......

Whenever a Member State, which is sending a SED or replying to a request, needs to give some additional information, which cannot be given in any other parts of the SEDs, it is possible to give a written description in the additional information field.

It could be, for example, information with detailed explanationssuch as a calculation of the degree of disability, etc.If more space is needed it could be included as an attachment

Signature

Signature of the sending institution
Date / ......
Signature / Stamp

“Signature” is a field, which was created due to the fact that in the two-year transitional period, the SEDs will be exchanged in paper versions. Therefore, it was necessary to make it possible to sign the document for the sending institution, in order to ensure the credibility of the document.

4. BUSINESS FLOWS AND SEDs INVOLVED:

F-DA001 „Certification Right Benefits in Kind”

This flow allows to request for a confirmation ofthe person’s right to benefits in kind in case of accidents at work or occupational diseases.

It is related to articles: 36 (1), (2), (2a), 17, 19 (1) of Regulation 883/2004 and 33(1) (2), 24(1), 25(1)of Regulation 987/2009.

As a part of this flowwe have the following SEDs:

1. DA001 - Request for Certification of the Right to Benefits in Kind:

• this is a request bythe Member State of Residence / Stay for a document confirming the right of a person to benefits in kind in case of an accident at work or an occupational disease;
• while indicating the time for which the SED should be valid, the MemberState should give the beginning date on which such certification is required. It could be the first day when treatment was given or the day when the person started to reside in this country;

This could be used when, for example:

an insured person had an accident at work in the Member State of Stay or Residence, and it is necessary to confirm her/his rights to benefits in kind;

an insured person came to a Member State for a Stay and she / he needs medical treatment connected with an accident at work or an occupational disease, but does not have an entitlement document;

an insured person decided to reside in a MemberState and needs an entitlement document;

1. DA002 - Certification of the right to benefits in kind:

• It is a SED issued by the CompetentMemberStateconfirming the person’s right to benefits in kind in case of an accident at work or an occupational disease;

In a situation where a MemberStatemight have doubts whether the application of accident at work and occupational disease legislation is correct, flow F-DA024“Contestation of Application of Legislation” provides the possibility to contest this fact.

F-DA001flow chart:

The CompetentMemberState delivers a portable document DA1 to the person always at the direct request of the person concerned, or at the request forwarded by the Member State of Stay.

F-DA002 „Certification Right Benefits in Kind”

This flow allows to confirm the person’s right to benefits in kind in case of accidents at work or occupational diseases without a request as defined in DA001. This flow might be used when the person asks directly for a certification of her/his rights to the institution of the CompetentMemberState.If theCompetentMemberStateissued DA1, it can also send a DA002 to the institution of the Member State of Residence or Stay, if it is known.

It is related to articles: 36 (1), (2), (2a), 17, 19 (1) of Regulation 883/2004 and 33(1) (2), 24(1), 25(1)of Regulation 987/2009.

As a part of this flowwe have the following SED:

DA002 - Certification of the right to benefits in kind:

• It is a SED issued by the CompetentMemberStateconfirming the person’s right to benefits in kind in case of an accident at work or occupational disease;

This could be the situation when, for example:

• an insured person,who had an accident at work or occupational diseases diagnosed, decides to reside in a Member Stay (MS A) - other than the competent Member State - and the Competent Member State (MS B) sends a confirmation of his/her right to the Member State of residence;

F-DA002flow chart: