SAIF.Business.Claim operations and processes

SAIF.Business.Claim is the shared claim-domain business object library. It carries the operations that other claim applications reuse rather than reimplement: stopping benefit payment schedules when claim data changes, moving awards back to pending, maintaining federal awards and their payments, calling the Oracle procedures that calculate statutory wages, aggravation rights, medically stationary dates, and first-payment timeliness, tracking work status and injured body parts, queueing 1502 filings for the Department of Consumer and Business Services, and caching the permanent partial disability and reserve service reference tables.

Each operation below has its own page describing its trigger, ordered steps, per-step rule and SQL citations, branch handling, and failure behavior.

Operation catalog

Operation	Intent	Trigger	Inputs	Outputs	Rules	Tables	SQL
Benefit schedule payment processing	Stop a claim's outstanding payment schedules, truncating released payments and deleting unreleased ones, then task the adjuster	A claim change invalidates the schedule; ProcessBenefitPayment is called	Claim ID, calling application and function, adjuster mail ID, task-suppression flag	Truncated or deleted schedules, adjuster task, #PAYUPD# / #PAYDEL# errors	BR-008, BR-009, BR-010	CL_BENEFIT_SCHEDULE, CL_BENEFIT_PAYMENT	SQL-013, SQL-017, SQL-022, SQL-029, SQL-031, SQL-036, SQL-040, SQL-041, SQL-042, SQL-046
Award payment pending transition	Move a claim's active award to pending and reset its payments for re-approval	GetSetAwardPaymentPending followed by Save()	Claim ID, acting portal user	Award status P, payments returned to in-progress, UpdateError / #PAYUPD#	BR-008, BR-011	CL_AWARD, CL_BENEFIT_PAYMENT	SQL-025, SQL-037
Award benefit payment management	Retrieve, update, and delete the benefit payments attached to a SAIF award	A caller requests a payment or payment collection and saves changes	Claim ID, award number, payment sequence number, benefit type codes	Payment object or collection, updated or deleted payment rows	BR-008, BR-012	CL_BENEFIT_PAYMENT	SQL-015, SQL-016, SQL-030, SQL-041
Federal award management	Retrieve federal awards by claim or worker, hydrate their payments, and persist status changes	A caller requests federal awards and saves the collection	Claim ID or worker ID, award status code, benefit type codes	Federal award collection with attached payments, updated award rows	BR-008, BR-012	CL_FEDERAL_AWARD, CL_BENEFIT_PAYMENT	SQL-016, SQL-021, SQL-035
Statutory weekly wage calculation	Calculate the statutory weekly wage that drives time-loss benefit amounts	GetStatutoryWeeklyWageCalculation	Injury date, wages, pay period, hours per day, days per week	Statutory weekly wage, procedure error message	PR-001, PR-002, PR-003, PR-004, PR-005, PR-006	N/A	SQL-026
Aggravation rights date calculation	Return the start and end of a claim's aggravation rights window	GetAggRightDates	Claim ID	Aggravation right start and end dates, error message, "Claim Not Found"	N/A	N/A	SQL-014
Medically stationary date retrieval	Return a claim's medically stationary date, blanked when the procedure reports an error	GetMedicallyStationaryDate	SAIF claim number	Medically stationary date, procedure error message	N/A	N/A	SQL-024
Timeliness of first payment evaluation	Assemble the dates, flags, and verdict needed to judge whether the first time-loss payment was timely	GetTimelinessOfFirstPayment	Claim ID, claim-detail request flag	Knowledge, disability, authorization, attempt, due and issue dates; timeliness flags and codes	BR-016	N/A	SQL-023
DCBS 1502 transfer management	Queue, list, and mark off the 1502 filings awaiting transfer to DCBS	A caller creates a transfer record or requests the outstanding queue	Claim ID, filing reason, document type, file name and identifier, image sequence	Persisted transfer rows, transfer list collections	BR-001, BR-002, BR-008, BR-014	CL_1502_DCBS_TRANSFER, CLM_DBA.CL_1502_DCBS_TRANSFER, CL_1502_DCBS_TRANSFER_SEQ	SQL-001, SQL-004, SQL-028, SQL-039
Claim list generation	Turn a caller-supplied query into a sortable collection of claim identifiers and SAIF claim numbers	GetClaimListCollection	SQL statement text, a single bind value, optional column-name overrides	Claim list collection of claim ID, claim number, check character, worker ID	N/A	N/A	N/A
Work status and work release tracking	Record and maintain the worker's return-to-work status and the physician's work release status	A claim-maintenance caller creates or retrieves the current status and saves	Claim ID, return-to-work or work release date, status codes	Sequence-numbered status rows, rule failures	BR-003, BR-004, BR-005, BR-008, BR-019	CL_CLAIM_WORK_STATUS, CL_CLAIM_WORK_RELEASE_STATUS, CLAIM_WORK_STATUS_SEQ, CLAIM_WORK_REL_STATUS_SEQ_NUM	SQL-002, SQL-003, SQL-006, SQL-007, SQL-019, SQL-020, SQL-033, SQL-034, SQL-044, SQL-045
Worker injured body part management	Maintain the claim's injured body parts and mirror the primary selection onto the claim header	A caller retrieves the body part collection, edits it, and saves	Claim ID, body part code, body side code, injury nature code, primary flag	Persisted body part rows, updated claim header primary columns	BR-006, BR-007, BR-008, BR-013	CL_WORKER_INJURED_BODY_PART	SQL-008, SQL-027, SQL-038, SQL-047
Claim employee work address management	Maintain the address of the work site where the injury occurred	A caller retrieves or creates the address and saves	Claim ID, address lines, city, state, ZIP, county, foreign flag	Persisted address row, address rule failures	BR-008, BR-015	CL_CLAIM_EMPLOYEE_WORK_ADDRESS	SQL-005, SQL-018, SQL-032, SQL-043
PPD award reference lookups	Load and cache the PPD body part and degree award rate tables and price awards from them	A caller requests a PPD reference table or an award amount	Data portal info, refresh flag, effective date, degree count	Cached body part and rate tables, calculated award amount, calculation proof	BR-017, BR-018	CL_PPD_BODY_PART_CODE, CL_PPD_SCHED_DEGREE_AWARD, CL_PPD_UNSCHED_DEGREE_AWARD	SQL-009, SQL-010, SQL-011
Reserve service reference lookups	Load and cache the vocational and medical service type lists with their service descriptions	A caller requests a reserve service reference list	Data portal info, refresh flag	Cached service type code table and service type collections with descriptions	N/A	CL_RESERVE_VOC_SERV_TYPE_CODE	SQL-012

Process flow diagram

The following diagram shows how the library's operations relate to the claim lifecycle they support.

flowchart TD
    App([Claim application or batch process]) --> Group{What is being done?}
    Group -->|Claim data changed| Stop[Benefit schedule<br>payment processing]
    Group -->|Award re-work| Pend[Award payment<br>pending transition]
    Group -->|Award maintenance| Fed[Federal award management]
    Fed --> Pay[Award benefit<br>payment management]
    Stop --> Task[Claim task posted<br>for the adjuster]
    Group -->|Statutory determination| Proc{Which procedure?}
    Proc --> Wage[Statutory weekly<br>wage calculation]
    Proc --> Agg[Aggravation rights<br>date calculation]
    Proc --> Med[Medically stationary<br>date retrieval]
    Proc --> Time[Timeliness of first<br>payment evaluation]
    Group -->|Claim status upkeep| Status[Work status and<br>work release tracking]
    Group -->|Injury detail upkeep| Body[Worker injured body<br>part management]
    Body --> Header[Claim header primary<br>body part updated]
    Group -->|Employer detail upkeep| Addr[Claim employee work<br>address management]
    Group -->|Regulatory filing| DCBS[DCBS 1502<br>transfer management]
    Group -->|List of claims needed| List[Claim list generation]
    Group -->|Reference data needed| Ref{Which reference set?}
    Ref --> PPD[PPD award<br>reference lookups]
    Ref --> Serv[Reserve service<br>reference lookups]

Inherited operations and processes

Operations in this section come from inherited BOF framework behavior.

From clsBusinessBase (SAIF.Framework.Core)

Operation	Intent	Provided by	Origin
Edit lifecycle †	Supports the begin-edit, cancel-edit, and apply-edit lifecycle used by every mutable business object in this library before Save() is called.*	clsBusinessBase	SAIF.Framework.Core
Rule evaluation †	Runs the property and object rules registered by each object's rule-registration member and exposes the resulting broken-rule state.*	clsBusinessBase	SAIF.Framework.Core
Data portal lifecycle hooks †	Invokes the create, retrieve, insert, update, and delete hooks that each object overrides to bind its Criteria SQL and inspect the affected row count.*	clsBusinessBase	SAIF.Framework.Core

From clsBusinessCollectionBase (SAIF.Framework.Core)

Operation	Intent	Provided by	Origin
Collection traversal †	Supports cursor-style traversal and deleted-item tracking for the award, federal award, body part, transfer list, and claim list collections.*	clsBusinessCollectionBase	SAIF.Framework.Core
Cascading save †	Walks each dirty child item through its own insert, update, or delete path when the collection is saved.*	clsBusinessCollectionBase	SAIF.Framework.Core

Origin: The operations in this section are implemented in SAIF.Framework.Core and inherited by this library's business objects and collections rather than being defined here.

Database interactions

The following table maps catalogued SQL statements back to the operation that executes them.

Operation	SQL	Tables	Type
DCBS 1502 transfer management	SQL-001	CL_1502_DCBS_TRANSFER_SEQ	Read
Work status and work release tracking	SQL-002	CLAIM_WORK_REL_STATUS_SEQ_NUM	Read
Work status and work release tracking	SQL-003	CLAIM_WORK_STATUS_SEQ	Read
DCBS 1502 transfer management	SQL-004	CL_1502_DCBS_TRANSFER	Write
Claim employee work address management	SQL-005	CL_CLAIM_EMPLOYEE_WORK_ADDRESS	Write
Work status and work release tracking	SQL-006	CL_CLAIM_WORK_RELEASE_STATUS	Write
Work status and work release tracking	SQL-007	CL_CLAIM_WORK_STATUS	Write
Worker injured body part management	SQL-008	CL_WORKER_INJURED_BODY_PART	Write
PPD award reference lookups	SQL-009	CL_PPD_BODY_PART_CODE	Read
PPD award reference lookups	SQL-010	CL_PPD_SCHED_DEGREE_AWARD	Read
PPD award reference lookups	SQL-011	CL_PPD_UNSCHED_DEGREE_AWARD	Read
Reserve service reference lookups	SQL-012	CL_RESERVE_VOC_SERV_TYPE_CODE	Read
Benefit schedule payment processing	SQL-013	CL_BENEFIT_SCHEDULE	Read
Aggravation rights date calculation	SQL-014	N/A	Read
Award benefit payment management	SQL-015	CL_BENEFIT_PAYMENT	Read
Award benefit payment management	SQL-016	CL_BENEFIT_PAYMENT	Read
Benefit schedule payment processing	SQL-017	CL_BENEFIT_SCHEDULE	Read
Claim employee work address management	SQL-018	CL_CLAIM_EMPLOYEE_WORK_ADDRESS	Read
Work status and work release tracking	SQL-019	CL_CLAIM_WORK_RELEASE_STATUS	Read
Work status and work release tracking	SQL-020	CL_CLAIM_WORK_STATUS	Read
Federal award management	SQL-021	CL_FEDERAL_AWARD	Read
Benefit schedule payment processing	SQL-022	CL_BENEFIT_SCHEDULE	Read
Timeliness of first payment evaluation	SQL-023	N/A	Read
Medically stationary date retrieval	SQL-024	N/A	Read
Award payment pending transition	SQL-025	CL_AWARD	Read
Statutory weekly wage calculation	SQL-026	N/A	Read
Worker injured body part management	SQL-027	CL_WORKER_INJURED_BODY_PART	Read
DCBS 1502 transfer management	SQL-028	CLM_DBA.CL_1502_DCBS_TRANSFER	Write
Benefit schedule payment processing	SQL-029	CL_BENEFIT_SCHEDULE	Write
Award benefit payment management	SQL-030	CL_BENEFIT_PAYMENT	Write
Benefit schedule payment processing	SQL-031	CL_BENEFIT_SCHEDULE	Write
Claim employee work address management	SQL-032	CL_CLAIM_EMPLOYEE_WORK_ADDRESS	Write
Work status and work release tracking	SQL-033	CL_CLAIM_WORK_RELEASE_STATUS	Write
Work status and work release tracking	SQL-034	CL_CLAIM_WORK_STATUS	Write
Federal award management	SQL-035	CL_FEDERAL_AWARD	Write
Benefit schedule payment processing	SQL-036	CL_BENEFIT_SCHEDULE	Write
Award payment pending transition	SQL-037	CL_AWARD	Write
Worker injured body part management	SQL-038	CL_WORKER_INJURED_BODY_PART	Write
DCBS 1502 transfer management	SQL-039	CL_1502_DCBS_TRANSFER	Write
Benefit schedule payment processing	SQL-040	CL_BENEFIT_SCHEDULE	Write
Award benefit payment management	SQL-041	CL_BENEFIT_PAYMENT	Write
Benefit schedule payment processing	SQL-042	CL_BENEFIT_SCHEDULE	Write
Claim employee work address management	SQL-043	CL_CLAIM_EMPLOYEE_WORK_ADDRESS	Write
Work status and work release tracking	SQL-044	CL_CLAIM_WORK_RELEASE_STATUS	Write
Work status and work release tracking	SQL-045	CL_CLAIM_WORK_STATUS	Write
Benefit schedule payment processing	SQL-046	CL_BENEFIT_SCHEDULE	Write
Worker injured body part management	SQL-047	CL_WORKER_INJURED_BODY_PART	Write

Several statements executed by this library are not represented in the SQL catalog because they are built at runtime or issued through direct portal requests rather than through a Criteria property: the filtered schedule select and partial schedule update used when stopping payments, the benefit payment retrieve and update used by the award pending transition, the claim header cascade used by injured body part management, the worker-scoped federal award join, the two ad-hoc 1502 transfer queue selects, the reserve service type and description join, and the caller-supplied statement executed by claim list generation.*

Stored procedure operations

Operations implemented by referenced Oracle procedures.

Operation	Description	Source	Link
Calculate statutory weekly wage	Calculates the statutory weekly wage from injury date, wage basis, and schedule inputs, applying its own input validation and the pre-1995 three-day minimum	sp82286_statutoryweeklywage	Details
Calculate aggravation rights dates	Returns the start and end dates of a claim's aggravation rights window	sp82046_CalcAggRightDates	Details
Retrieve medically stationary date	Returns the medically stationary date for a SAIF claim number	sp82289_medicallystationarydt	Details
Evaluate timeliness of first payment	Returns the dates, flags, and verdict used to judge whether the first time-loss payment met the statutory deadline	sp82067_TimelinessOf1stPayment	Details

Failure and edge-case behavior

• Every mutable object in this library reports persistence failure by adding an error message rather than raising an exception, so a caller that ignores the error collection will believe a failed save succeeded.
• Optimistic concurrency is expressed by carrying the prior update number in the WHERE clause and incrementing it in the SET clause; a concurrent change therefore appears as an affected row count other than one. The 1502 transfer update is the exception and carries no update number, so it has no concurrency protection.
• Several objects override Save() to return True unconditionally, discarding the framework result — the three benefit schedule objects and the award benefit payment item all behave this way.*
• The stored-procedure wrapper objects catch and discard every exception raised while reading their result cursor, so a schema or type mismatch surfaces as an unset result rather than as a failure.
• Multi-statement operations are not wrapped in an explicit transaction inside this library, so the award pending transition, the federal award cascade, and the injured body part claim-header cascade can each leave a partially applied change.
• Reference data caches are module-level statics with no expiry, so changes to PPD rate tables or reserve service lists are not visible until a caller requests a refresh or the process restarts.
• Retrieval paths generally return an unpopulated object rather than an error when nothing matches, so "not found" and "found but empty" are indistinguishable without inspecting the object's state.
• Only four objects register real business rules — the 1502 transfer, the two work status objects, and the injured body part collection — so most field-level validity in this library is the caller's responsibility.
• Oracle schema, sequence, or procedure changes can alter behavior without any change to this library's code.

Related documentation

• Index
• Overview
• Architecture
• Dependencies
• Business rules
• Database tables
• SQL catalog
• Procedures
• API reference

Note: Statements marked with * were inferred from code structure, naming conventions, or contextual evidence where direct confirmation was not available in source artifacts. Statements marked with † are inherited from a dependency and are documented here for context only.

Sources

• Business\SAIF.Business.Claim\cls1502Transfer.vb
• Business\SAIF.Business.Claim\clsActiveBenefitSchedule.vb
• Business\SAIF.Business.Claim\clsAggRightDates.vb
• Business\SAIF.Business.Claim\clsAwardBenefitPayment.vb
• Business\SAIF.Business.Claim\clsAwardBenefitPaymentCollection.vb
• Business\SAIF.Business.Claim\clsBenefitSchedule.vb
• Business\SAIF.Business.Claim\clsClaimEmployeeWorkAddress.vb
• Business\SAIF.Business.Claim\clsClaimListCollection.vb
• Business\SAIF.Business.Claim\clsClaimListGenerator.vb
• Business\SAIF.Business.Claim\clsClaimListItem.vb
• Business\SAIF.Business.Claim\clsClaimWorkReleaseStatus.vb
• Business\SAIF.Business.Claim\clsClaimWorkStatus.vb
• Business\SAIF.Business.Claim\clsFederalAwardStatus.vb
• Business\SAIF.Business.Claim\clsFederalAwardStatusCollection.vb
• Business\SAIF.Business.Claim\clsFederalBenefitSchedule.vb
• Business\SAIF.Business.Claim\clsITimelinessOfFirstPayment.vb
• Business\SAIF.Business.Claim\clsMedicallyStationaryDate.vb
• Business\SAIF.Business.Claim\clsPPDBodyParts.vb
• Business\SAIF.Business.Claim\clsPPDScheduledDegreeAwards.vb
• Business\SAIF.Business.Claim\clsPPDUnscheduledDegreeAwards.vb
• Business\SAIF.Business.Claim\clsServiceDescription.vb
• Business\SAIF.Business.Claim\clsServiceDescriptionCollection.vb
• Business\SAIF.Business.Claim\clsServiceType.vb
• Business\SAIF.Business.Claim\clsServiceTypeCollection.vb
• Business\SAIF.Business.Claim\clsSetAwardPaymentPending.vb
• Business\SAIF.Business.Claim\clsStatutoryWeeklyWageCalculation.vb
• Business\SAIF.Business.Claim\clsVocationalServicesTypes.vb
• Business\SAIF.Business.Claim\clsWorkerInjuredBodyPart.vb
• Business\SAIF.Business.Claim\clsWorkerInjuredBodyPartCollection.vb
• Business\SAIF.Business.Claim\Enums.vb
• Business\SAIF.Business.Claim\mdlPPD.vb
• Business\SAIF.Business.Claim\mdlReserveServices.vb
• Business\SAIF.Business.Claim\SAIF.BOF.Business.Claim.vbproj
• Business\SAIF.Business\ClaimServices.vb
• Business\SAIF.Business.Tasks.Claim\clsClaimTaskGenerator.vb