SAIF.Business.Claim.Maintenance business rules¶

This page captures business rules enforced by SAIF.Business.Claim.Maintenance.

BR-CM-001: Optimistic concurrency — updates fail if RowsAffected ≠ 1¶

Field	Value
Statement	Optimistic concurrency — updates fail if RowsAffected ≠ 1
Trigger	All `After*` lifecycle methods
Enforcement	All business objects
Outcome	`AddErrorMessage` with DB contention error
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AfterUpdate`; `Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrder.vb` — `AfterUpdate`; `Business\SAIF.Business.Claim.Maintenance\clsMedicalCondition.vb` — `AfterUpdate`

BR-CM-002: Support order cannot be deleted if awards exist for the SUO claim¶

Field	Value
Statement	Support order cannot be deleted if awards exist for the SUO claim
Trigger	Delete validation
Enforcement	`clsClaimSupportOrder` — `PK82141_SUPPORT_ORDER.AwardExistsForSUOClaim`
Outcome	Prevents deletion
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrder.vb` — `ValidSelectedClaims`, `AwardForOrderExists`

BR-CM-003: Support order cannot be deleted if payments exist for the SUO claim¶

Field	Value
Statement	Support order cannot be deleted if payments exist for the SUO claim
Trigger	Delete validation
Enforcement	`clsClaimSupportOrder` — `PK82141_SUPPORT_ORDER.PaymentExistsForSUOClaim`
Outcome	Prevents deletion
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrder.vb` — `ValidSelectedClaims`, `PaymentForOrderExists`

BR-CM-004: Support order validates payment-about-to-be-issued status before changes¶

Field	Value
Statement	Support order validates payment-about-to-be-issued status before changes
Trigger	Pre-update check
Enforcement	`clsClaimSupportOrder` — `PK82141_SUPPORT_ORDER.PaymentAboutToBeIssued`
Outcome	Prevents update
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrder.vb` — `PaymentIssueWarning`, `PaymentAboutToBeIssued`

BR-CM-005: Benefit payee must exist for support order before payment processing¶

Field	Value
Statement	Benefit payee must exist for support order before payment processing
Trigger	Pre-payment check
Enforcement	`clsClaimSupportOrder` — `PK82141_SUPPORT_ORDER.BenfitPayeeForOrderExists`
Outcome	Validation check
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrder.vb` — `DetermineTodoTasks`, `BenifitPayeeReferencesOrder`

BR-CM-006: Award reduction validation before support order modification¶

Field	Value
Statement	Award reduction validation before support order modification
Trigger	Pre-update check
Enforcement	`clsClaimSupportOrder` — `PK82141_SUPPORT_ORDER.AwardReductionExists`
Outcome	Validation check
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrder.vb` — `AwardReductionExists`

BR-CM-007: Void, combine, transfer, restore are mutually exclusive adjustment operations¶

Field	Value
Statement	Void, combine, transfer, restore are mutually exclusive adjustment operations
Trigger	Adjustment type selection
Enforcement	`clsClaimAdjustment` — operation type parameter
Outcome	Only one operation per call
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimAdjustment.vb` — `Save`, `IsValid`

BR-CM-008: Claims with status 'I' (in-progress) or 'V' (voided) are excluded from support order claim¶

Field	Value
Statement	Claims with status 'I' (in-progress) or 'V' (voided) are excluded from support order claim lists
Trigger	Claim query filter
Enforcement	`clsClaimSupportOrder` — inline SQL WHERE clause
Outcome	Filters out non-active claims
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrder.vb` — `CreateConnections`

BR-CM-009: Injury occupational disease code must be I or D¶

Field	Value
Statement	`InjOccupationalDiseaseCode` must be `I` (injury) or `D` (occupational disease).
Trigger	`InjOccupationalDiseaseCode` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `InjOccupationalDiseaseCodeValid` (`clsClaimDetail01`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `InjOccupationalDiseaseCodeValid`

BR-CM-010: Active claim flag must be Y or N¶

Field	Value
Statement	`ActiveClaimFlag` must be `Y` or `N`.
Trigger	`ActiveClaimFlag` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ActiveClaimFlagValid` (`clsClaimDetail02`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ActiveClaimFlagValid`

BR-CM-011: Knowledge date is required and bounded by injury date and today¶

Field	Value
Statement	`KnowledgeDate` must be populated, must not be in the future, and must not precede `InjuryDate`.
Trigger	`KnowledgeDate` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `KnowledgeDateValid` (`clsClaimDetail03`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `KnowledgeDateValid`

BR-CM-012: Disability date must not precede injury date or be in the future¶

Field	Value
Statement	A populated `DisabilityDate` may not precede `InjuryDate` unless the claim is an occupational disease claim, and may not be in the future.
Trigger	`DisabilityDate` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `DisabilityDateValid` (`clsClaimDetail04`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `DisabilityDateValid`

BR-CM-013: Coverage code must be A B C or E¶

Field	Value
Statement	`CoverageCode` must be one of `A`, `B`, `C`, or `E`.
Trigger	`CoverageCode` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `CoverageCodeValid` (`clsClaimDetail05`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `CoverageCodeValid`

BR-CM-014: Handicap worker reserve flag must be Y or N¶

Field	Value
Statement	`HandicapWorkerReserveFlag` must be `Y` or `N`.
Trigger	`HandicapWorkerReserveFlag` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `HandicapWorkerReserveFlagValid` (`clsClaimDetail06`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `HandicapWorkerReserveFlagValid`

BR-CM-015: WCD claim number must be unique across claims¶

Field	Value
Statement	A non-blank `WCDClaimNum` may not already be assigned to another claim.
Trigger	`WCDClaimNum` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `WCDClaimNumValid` (`clsClaimDetail07`, Error) via `GetWCDClaimNumberCount`
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `WCDClaimNumValid`, `GetWCDClaimNumberCount`

BR-CM-016: Claim status code must be New Open Closed or Denied¶

Field	Value
Statement	`ClaimStatusCode` must be one of New (`N`), Open (`O`), Closed (`C`), or Denied (`D`).
Trigger	`ClaimStatusCode` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ClaimStatusCodeValid` (`clsClaimDetail08`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ClaimStatusCodeValid`

BR-CM-017: State occupational disease PPD or PTD claims require a disability or initial treatment date¶

Field	Value
Statement	For state-jurisdiction (`1`) occupational-disease claims of type PPD (`5`) or PTD (`7`), either `DisabilityDate` or `InitialTreatmentDate` must be populated.
Trigger	`DisabilityDate`, `InitialTreatmentDate`, or `ClaimTypeCode` set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `DisabilityTreatmentDateValid` (`clsClaimDetail09`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `DisabilityTreatmentDateValid`

BR-CM-018: Aggravation decision on a disabling claim requires a closed status¶

Field	Value
Statement	An aggravation decision (`ClaimDecisionTypeToA`) on a disabling claim type (`4`, `5`, or `7`) requires a current or prior Closed claim status.
Trigger	Claim decision or claim type change, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `AggDisablingClosedValid` (`clsClaimDetail10`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `AggDisablingClosedValid`

BR-CM-019: OWCP claim number must be unique per worker¶

Field	Value
Statement	A non-blank `OwcpClaimNum` may not already be assigned to another claim for the same worker.
Trigger	`OwcpClaimNum` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `OWCPClaimNumValid` (`clsClaimDetail11`, Error) via `GetOWCPClaimNumberCount`
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `OWCPClaimNumValid`, `GetOWCPClaimNumberCount`

BR-CM-020: Claim status may not change without at least one condition¶

Field	Value
Statement	`ClaimStatusCode` may not change to Closed, Open, or Denied while the claim has zero medical conditions.
Trigger	`ClaimStatusCode` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ClaimStatusChangedWithoutCondition` (`clsClaimDetail12`, Error) using the retrieve-time conditions count
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ClaimStatusChangedWithoutCondition`, `GetConditionsCount`

BR-CM-021: Claim status may not close while the latest decision is deferred¶

Field	Value
Statement	`ClaimStatusCode` may not be set to Closed when the latest claim decision is a deferred original-injury request.
Trigger	`ClaimStatusCode` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ClaimStatusClosedAndDeferred` (`clsClaimDetail13`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ClaimStatusClosedAndDeferred`

BR-CM-022: Medicare ORM termination date must fall between injury date and seven days ahead¶

Field	Value
Statement	A populated `MedicareORMTermDate` may not precede `InjuryDate` and may not exceed seven days past today.
Trigger	`MedicareORMTermDate` property set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ORMExpirationDateValid` (`clsClaimDetail14`, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ORMExpirationDateValid`

BR-CM-023: Disabling occupational disease claims should have a disability date¶

Field	Value
Statement	A disabling occupational-disease claim (`ClaimTypeCode` = `4`) should carry a `DisabilityDate`.
Trigger	`ClaimTypeCode` or `DisabilityDate` set, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `DisabilityDateRequired` (`clsClaimDetail100`, Warning)
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `DisabilityDateRequired`

BR-CM-024: Disability date changes require wage re-verification¶

Field	Value
Statement	Changing `DisabilityDate` on an occupational-disease claim warns the user to re-verify claim-cost wages.
Trigger	`DisabilityDate` property changed, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `DisabilityDateChanged` (`clsClaimDetail101`, Warning)
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `DisabilityDateChanged`

BR-CM-025: Aggravation request after aggravation rights end date warns of own motion¶

Field	Value
Statement	When an aggravation decision's request date falls after `AggRightsEndDate`, the user is warned of a possible own-motion decision.
Trigger	Claim decision change, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ClaimDecisionChanged` (`clsClaimDetail102`, Warning)
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ClaimDecisionChanged`

BR-CM-026: Non-disabling to disabling change within 365 days warns the user¶

Field	Value
Statement	Changing a non-disabling claim (`3`) to a disabling type (`4`, `5`, `7`) while the claim is Closed and the last non-disabling effective date is within 365 days raises a warning.
Trigger	`ClaimTypeCode` property changed, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `NonDisablingToDisabling` (`clsClaimDetail103`, Warning)
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `NonDisablingToDisabling`

BR-CM-027: Closing a claim without a medically stationary date warns the user¶

Field	Value
Statement	Changing `ClaimStatusCode` to Closed while accepted conditions still lack a medically-stationary date raises a warning.
Trigger	`ClaimStatusCode` property changed to Closed, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ClaimStatusClosedWithoutMedStatDate` (`clsClaimDetail104`, Warning) using the retrieve-time accepted-condition count
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ClaimStatusClosedWithoutMedStatDate`, `GetAcceptCondMedStationaryCount`

BR-CM-028: Aggravation decision change warns of a possible aggravation decision¶

Field	Value
Statement	The inverse condition of the own-motion check warns the user of a possible aggravation decision on the claim.
Trigger	Claim decision change, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ClaimDecisionAggChanged` (`clsClaimDetail105`, Warning)
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ClaimDecisionAggChanged`

BR-CM-029: Closing or denying a claim sets pharmacy eligibility to ineligible¶

Field	Value
Statement	When `ClaimStatusCode` changes to Closed (`C`) or Denied (`D`) and an existing pharmacy-eligibility record is not already Ineligible (`I`), the pharmacy eligibility status is forced to `I` with today's effective date.
Trigger	`IsValid()` evaluation before save, after a claim-status change
Enforcement	`clsClaimDetail` — `IsValid` derivation onto `WorkerPharmacyEligibilityReport`
Outcome	Pharmacy eligibility record is updated and persisted with the claim
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `IsValid`

BR-CM-030: Denying a claim sets the Medicare ORM termination date and reopening clears it¶

Field	Value
Statement	A status change to Denied (`D`) sets `MedicareORMTermDate` to the claim-status-activity effective date; a change to Open (`O`) clears it.
Trigger	`IsValid()` evaluation before save, after a claim-status change
Enforcement	`clsClaimDetail` — `IsValid` derivation of `MedicareORMTermDate`
Outcome	`MedicareORMTermDate` is derived automatically and written with the claim update
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `IsValid`

BR-CM-031: Reopening a claim with a CDA order warns the user¶

Field	Value
Statement	Reopening a claim (`ClaimStatusCode` = `O`) that is flagged with a CDA order (`CdaFlag` = `Y`) raises a warning.
Trigger	`ClaimStatusCode` set to Open, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `ClaimHasCDAOrder` (`clsClaimDetail107`, Warning)
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `ClaimHasCDAOrder`

BR-CM-032: OHS or suspended pharmacy status requires Majoris enrollment¶

Field	Value
Statement	A pharmacy eligibility status of OHS (`O`) or Suspended (`S`) requires the MCO plan to be Majoris (`FF`) and the MCO eligibility status to be enrolled (`Y`).
Trigger	Pharmacy eligibility status change, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `PharmacyEligibilityStatusCodeValid` (`clsClaimDetail08` reused, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `PharmacyEligibilityStatusCodeValid`

BR-CM-033: Caremark or denied pharmacy status requires Caremark enrollment¶

Field	Value
Statement	A pharmacy eligibility status of Caremark (`C`) or Denied (`D`) requires the MCO plan to be Caremark (`AA`) and the MCO eligibility status to be enrolled (`Y`).
Trigger	Pharmacy eligibility status change, and again during `IsValid()`
Enforcement	`clsClaimDetail` — rule `PharmacyEligibilityCaremarkCodeValid` (`clsClaimDetail09` reused, Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `AddBusinessRules`, `PharmacyEligibilityCaremarkCodeValid`

BR-CM-034: Formal MCO enrollment sets the matching pharmacy formulary code¶

Field	Value
Statement	When MCO eligibility is saved as formally enrolled or pending credentialing (status and reason `1Y` or `3Y`), pharmacy eligibility is set to the matching formulary code — `O` for Majoris (`FF`) or `C` for Caremark (`AA`) — with today's effective date.
Trigger	`Save()` when `ClaimMcoEligibility` is dirty
Enforcement	`clsClaimDetail` — `Save` derivation onto `WorkerPharmacyEligibilityReport`
Outcome	Pharmacy eligibility record is updated and saved with the claim
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `Save`

BR-CM-035: Accepted claim decision derives pharmacy eligibility from MCO plan¶

Field	Value
Statement	When the latest or pending claim decision is to Accept, there is no date of death, the jurisdiction is not Inmate (`2`), the claim type is not Fatal (`8`), and the status is Open or New, pharmacy eligibility is set to `C` (Caremark), `O` (Majoris/OHS), or `E` (Extended, default) with today's effective date — unless the pharmacy record is already Ineligible or already dirty.
Trigger	`Save()` following a claim-decision change
Enforcement	`clsClaimDetail` — `Save` derivation onto `WorkerPharmacyEligibilityReport`
Outcome	Pharmacy eligibility record is updated and saved with the claim
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `Save`

BR-CM-036: Reopening a closed claim resets pharmacy eligibility status¶

Field	Value
Statement	When the claim status changes from Closed (`C`) to Open (`O`) and a pharmacy record exists, the pharmacy eligibility status is set to `D` (Caremark), `S` (Majoris), or `L` (Limited) depending on MCO enrollment, with today's effective date.
Trigger	`Save()` following a Closed-to-Open status change
Enforcement	`clsClaimDetail` — `Save` derivation onto `WorkerPharmacyEligibilityReport`
Outcome	Pharmacy eligibility record is updated and saved with the claim
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `Save`

BR-CM-037: First accept or deny decision copies responsible adjuster to compensability adjuster¶

Field	Value
Statement	When the first claim decision transitions to Accept or Denied, `ClaimRespCode` is copied into `CompensabilityRespCode`.
Trigger	`Save()` when `GetIsFirstDeniedAcceptedDecision` is true
Enforcement	`clsClaimDetail` — `Save` derivation of `CompensabilityRespCode`
Outcome	The compensability adjuster code is derived automatically and persisted with the claim
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `Save`

Field	Value
Statement	Changing `JurisdictionCode` clears or defaults the identifier fields tied to the old and new jurisdiction: leaving Inmate (`2`) zeroes `InmateNum`; entering Inmate forces `PolicyNum` = 8 with a blank sub-code and creates a claim-policy-history row; leaving State (`1`) clears `WCDClaimNum`; leaving Federal clears `OwcpClaimNum` and resets `OwcpServiceOfficeCode` to `0`.
Trigger	`Save()` when `JurisdictionCode` was modified
Enforcement	`clsClaimDetail` — `ProcessJurisdictionCodeChanges`
Outcome	Dependent identifier fields are cleared or defaulted before the claim update is issued
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `Save`, `ProcessJurisdictionCodeChanges`

BR-CM-039: Deactivating a claim auto-terminates open legal representation¶

Field	Value
Statement	When `ActiveClaimFlag` changes from `Y` to `N`, any open legal-representative row for the claim is expired with `EXP_DATE` = today and end-reason code `1`.
Trigger	`Save()` when `ActiveClaimFlag` changed from `Y` to `N`
Enforcement	`clsClaimDetail` — `ProcessLegalRep`
Outcome	The open legal-representative row is closed as a side effect of the claim save
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb` — `Save`, `ProcessLegalRep`

BR-CM-040: Injury date is required when modified¶

Field	Value
Statement	`InjuryDate` may not be left empty once it has been modified.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury00` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-041: Injury date more than one year in the past warns the user¶

Field	Value
Statement	An `InjuryDate` more than one year before today raises a warning.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury02` (Warning)
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-042: Another claim within fourteen days for the same worker warns the user¶

Field	Value
Statement	If the worker has another claim with an injury date within plus or minus fourteen days of this claim's injury date, a warning naming the duplicate claim is raised.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury04` (Warning) via `CheckForMultipleClaimsForWorker`
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`, `CheckForMultipleClaimsForWorker`

BR-CM-043: Initial treatment date change on a disease claim requires wage re-verification¶

Field	Value
Statement	Changing `InitialTreatmentDate` on a disease claim (`InjOccupationalDiseaseCode` = `D`) warns the user to re-verify claim-cost wages.
Trigger	`InitialTreatmentDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury06` (Warning)
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-044: Injury date may not follow the knowledge date¶

Field	Value
Statement	`InjuryDate` may not be later than a populated `KnowledgeDate`.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury10` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-045: Injury date may not follow the 801 received date¶

Field	Value
Statement	`InjuryDate` may not be later than `Received801Date`.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury12` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-046: Injury date may not follow the stamped-in received date¶

Field	Value
Statement	`InjuryDate` may not be later than `ReceivedDate` (the stamped-in date).
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury14` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-047: Injury date may not follow the leave work date¶

Field	Value
Statement	`InjuryDate` may not be later than `LeaveWorkDate`.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury16` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-048: Injury date may not precede the worker birth date¶

Field	Value
Statement	`InjuryDate` may not be earlier than the worker's `BirthDate`.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury18` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-049: Injury date may not follow the worker death date¶

Field	Value
Statement	`InjuryDate` may not be later than the worker's `DeathDate`.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury20` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-050: Injury date may not follow a work release date¶

Field	Value
Statement	`InjuryDate` may not be later than any recorded work release date for the claim.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury22` (Error) via `GetWrkRelDtGTInjDtCount`
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`, `GetWrkRelDtGTInjDtCount`

BR-CM-051: Injury date may not follow a decision request effective date¶

Field	Value
Statement	`InjuryDate` may not be later than any claim decision-request effective date.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury24` (Error) via `GetReqDecDtGTInjDtCount`
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`, `GetReqDecDtGTInjDtCount`

BR-CM-052: Injury date may not follow a disability authorization activity date¶

Field	Value
Statement	`InjuryDate` may not be later than any disability-authorization activity date for the claim.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury26` (Error) via `GetDisabAuthDtGTInjDtCount`
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`, `GetDisabAuthDtGTInjDtCount`

BR-CM-053: Injury date may not follow a medically stationary date¶

Field	Value
Statement	`InjuryDate` may not be later than any medically-stationary date recorded on the claim's conditions.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury28` (Error) via `GetMedStatDtGTInjDtCount`
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`, `GetMedStatDtGTInjDtCount`

BR-CM-054: Injury date may not follow the disability date on injury claims¶

Field	Value
Statement	For injury claims (`InjOccupationalDiseaseCode` = `I`), `InjuryDate` may not be later than `DisabilityDate`.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury30` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-055: PPD or PTD occupational disease claims require a disability or initial treatment date¶

Field	Value
Statement	Claims of type PPD (`5`) or PTD (`7`) with `InjOccupationalDiseaseCode` = `D` require either a disability date or an initial treatment date.
Trigger	`InjuryDate` or `InitialTreatmentDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury32` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-056: Initial treatment date must fall between 1850 and today¶

Field	Value
Statement	`InitialTreatmentDate` may not be in the future and may not precede the `MIN_DATE` constant of 01/01/1850.
Trigger	`InitialTreatmentDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury34` (Error)
Outcome	Broken rule; save is blocked until corrected
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`

BR-CM-057: Injury date may not change while unposted payments or adjustments exist¶

Field	Value
Statement	`InjuryDate` may not be changed while the claim has unposted payments or adjustments.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury36` (Error) via `ClaimServices.HasUnpostedPaymentsOrAdjustments`
Outcome	Broken rule; save is blocked until the financials are posted
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`, `CanInjuryDateChange`

BR-CM-058: Missing policy coverage at injury date warns the user¶

Field	Value
Statement	When `PolicyNum` is greater than 17 and no policy coverage exists at the injury date, a warning is raised.
Trigger	`InjuryDate` modified, evaluated during `IsValid()`
Enforcement	`clsAccidentInjury` — rule `clsAccidentInjury37` (Warning) via `PolicyServices.CoverageExists`
Outcome	Warning surfaced to the caller; the save may still proceed
Confidence	Source-backed
Source	`Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb` — `AddBusinessRules`, `ValidPolicyCoverageAtInjury`

BR-PROC-001: Claim void requests must provide the claim identifier, current update number, and acting u¶

Field	Value
Statement	Claim void requests must provide the claim identifier, current update number, and acting user.
Trigger	Package specification parameters `inClaimID`, `inUpdateNum`, and `inUserID`.
Enforcement	PK82140_CLAIM_ADJUSTMENTS.VoidClaim
Outcome	The package exposes a version-aware claim-void contract to the .NET caller.
Confidence	Source-backed
Source	PK82140_CLAIM_ADJUSTMENTS.VoidClaim

BR-PROC-002: Claim combine requests must identify both the source claim and the claim to combine into¶

Field	Value
Statement	Claim combine requests must identify both the source claim and the claim to combine into.
Trigger	Package specification parameters `inClaimID` and `inCombineClaimID`.
Enforcement	PK82140_CLAIM_ADJUSTMENTS.CombineClaim
Outcome	The package contract prevents a combine operation from running without both claim identifiers.
Confidence	Source-backed
Source	PK82140_CLAIM_ADJUSTMENTS.CombineClaim

BR-PROC-003: Claim transfer and restore flows require a target worker identifier in addition to claim v¶

Field	Value
Statement	Claim transfer and restore flows require a target worker identifier in addition to claim version inputs.
Trigger	Package specification parameters `inWorkerID`, `inUpdateNum`, and `inUserID`.
Enforcement	PK82140_CLAIM_ADJUSTMENTS.TransferClaim
Outcome	The contract shows that worker reassignment is part of both transfer and restore operations.
Confidence	Source-backed
Source	PK82140_CLAIM_ADJUSTMENTS.TransferClaim

Notes¶

Procedure-derived rules are mirrored here so claim-domain readers do not have to open procedure pages to see active constraints.
Rules without BOF rule attributes are enforced by lifecycle methods, helper methods, or stored-procedure contracts.

Sources¶

Business\SAIF.Business.Claim.Maintenance\clsAccidentInjury.vb
Business\SAIF.Business.Claim.Maintenance\clsAttendingPhysician.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimAdjustment.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimDetail.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimDisabilityActivity.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrder.vb
Business\SAIF.Business.Claim.Maintenance\clsVocationalDetail.vb
Business\SAIF.Business.Claim.Maintenance\clsVocationalDetailCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsHelper.vb
Business\SAIF.Business.Claim.Maintenance\enums.vb
Business\SAIF.Business.Claim.Maintenance\packages.config
Business\SAIF.Business.Claim.Maintenance\SAIF.BOF.Business.Claim.Maintenance.nuspec
Business\SAIF.Business.Claim.Maintenance\Pipelines\build-vars.yml
Business\SAIF.Business.Claim.Maintenance\CCClaimDataApi\AttendingPhysicians.vb
Business\SAIF.Business.Claim.Maintenance\CCClaimDataApi\ClaimContactsResponse.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimDisabilityActivityCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimMcoEligibility.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimMcoEligibilityCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimPolicy.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimPolicyHistory.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimPolicyHistoryCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimRequestDecision.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimRequestDecisionCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimStatusActivity.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimStatusActivityCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrderCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrderConn.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimSupportOrderConnCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimTypeActivity.vb
Business\SAIF.Business.Claim.Maintenance\clsClaimTypeActivityCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsConditionDecision.vb
Business\SAIF.Business.Claim.Maintenance\clsConditionDecisionCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsCovid19TestingHistory.vb
Business\SAIF.Business.Claim.Maintenance\clsCovid19TestingHistoryCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsDisabilityAuthActivity.vb
Business\SAIF.Business.Claim.Maintenance\clsDisabilityAuthActivityCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsMedicalCondition.vb
Business\SAIF.Business.Claim.Maintenance\clsMedicalConditionCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsOmittedCondition.vb
Business\SAIF.Business.Claim.Maintenance\clsOmittedConditionCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsTDThreeDayWait.vb
Business\SAIF.Business.Claim.Maintenance\clsTDThreeDayWaitCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkRelease.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkReleaseCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkStatus.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkStatusCollection.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkStatusInjuryClaim.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkerClaimBenefitPayment.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkerClaimBenefitSchedule.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkerInjuryClaim.vb
Business\SAIF.Business.Claim.Maintenance\clsWorkerPharmacyEligibilityReport.vb

SAIF.Business.Claim.Maintenance business rules¶

BR-CM-001: Optimistic concurrency — updates fail if RowsAffected ≠ 1¶

BR-CM-002: Support order cannot be deleted if awards exist for the SUO claim¶

BR-CM-003: Support order cannot be deleted if payments exist for the SUO claim¶

BR-CM-004: Support order validates payment-about-to-be-issued status before changes¶

BR-CM-005: Benefit payee must exist for support order before payment processing¶

BR-CM-006: Award reduction validation before support order modification¶

BR-CM-007: Void, combine, transfer, restore are mutually exclusive adjustment operations¶

BR-CM-008: Claims with status 'I' (in-progress) or 'V' (voided) are excluded from support order claim¶

BR-CM-009: Injury occupational disease code must be I or D¶

BR-CM-010: Active claim flag must be Y or N¶

BR-CM-011: Knowledge date is required and bounded by injury date and today¶

BR-CM-012: Disability date must not precede injury date or be in the future¶

BR-CM-013: Coverage code must be A B C or E¶

BR-CM-014: Handicap worker reserve flag must be Y or N¶

BR-CM-015: WCD claim number must be unique across claims¶

BR-CM-016: Claim status code must be New Open Closed or Denied¶

BR-CM-017: State occupational disease PPD or PTD claims require a disability or initial treatment date¶

BR-CM-018: Aggravation decision on a disabling claim requires a closed status¶

BR-CM-019: OWCP claim number must be unique per worker¶

BR-CM-020: Claim status may not change without at least one condition¶

BR-CM-021: Claim status may not close while the latest decision is deferred¶

BR-CM-022: Medicare ORM termination date must fall between injury date and seven days ahead¶

BR-CM-023: Disabling occupational disease claims should have a disability date¶

BR-CM-024: Disability date changes require wage re-verification¶

BR-CM-025: Aggravation request after aggravation rights end date warns of own motion¶

BR-CM-026: Non-disabling to disabling change within 365 days warns the user¶

BR-CM-027: Closing a claim without a medically stationary date warns the user¶

BR-CM-028: Aggravation decision change warns of a possible aggravation decision¶

BR-CM-029: Closing or denying a claim sets pharmacy eligibility to ineligible¶

BR-CM-030: Denying a claim sets the Medicare ORM termination date and reopening clears it¶

BR-CM-031: Reopening a claim with a CDA order warns the user¶

BR-CM-032: OHS or suspended pharmacy status requires Majoris enrollment¶

BR-CM-033: Caremark or denied pharmacy status requires Caremark enrollment¶

BR-CM-034: Formal MCO enrollment sets the matching pharmacy formulary code¶

BR-CM-035: Accepted claim decision derives pharmacy eligibility from MCO plan¶

BR-CM-036: Reopening a closed claim resets pharmacy eligibility status¶

BR-CM-037: First accept or deny decision copies responsible adjuster to compensability adjuster¶

BR-CM-038: Jurisdiction code transitions cascade related identifier fields¶

BR-CM-039: Deactivating a claim auto-terminates open legal representation¶

BR-CM-040: Injury date is required when modified¶

BR-CM-041: Injury date more than one year in the past warns the user¶

BR-CM-042: Another claim within fourteen days for the same worker warns the user¶

BR-CM-043: Initial treatment date change on a disease claim requires wage re-verification¶

BR-CM-044: Injury date may not follow the knowledge date¶

BR-CM-045: Injury date may not follow the 801 received date¶

BR-CM-046: Injury date may not follow the stamped-in received date¶

BR-CM-047: Injury date may not follow the leave work date¶

BR-CM-048: Injury date may not precede the worker birth date¶

BR-CM-049: Injury date may not follow the worker death date¶

BR-CM-050: Injury date may not follow a work release date¶

BR-CM-051: Injury date may not follow a decision request effective date¶

BR-CM-052: Injury date may not follow a disability authorization activity date¶

BR-CM-053: Injury date may not follow a medically stationary date¶

BR-CM-054: Injury date may not follow the disability date on injury claims¶

BR-CM-055: PPD or PTD occupational disease claims require a disability or initial treatment date¶

BR-CM-056: Initial treatment date must fall between 1850 and today¶

BR-CM-057: Injury date may not change while unposted payments or adjustments exist¶

BR-CM-058: Missing policy coverage at injury date warns the user¶

BR-PROC-001: Claim void requests must provide the claim identifier, current update number, and acting u¶

BR-PROC-002: Claim combine requests must identify both the source claim and the claim to combine into¶

BR-PROC-003: Claim transfer and restore flows require a target worker identifier in addition to claim v¶

Notes¶

Related documentation¶

Sources¶