unique policy coverage and rating programs - ncci.com · pdf fileto provide an overview of...

NCCI’s 2018 Data Educational ProgramJanuary 30–February 2, 2018

Palm Beach County Convention CenterWest Palm Beach, FL

The Path to Data Excellence

Unique Policy Coverage and Rating

Programs

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© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unique Policy Coverage and Rating Programs

Presented by:Julie Gonzalez and Veruschka Zachtshinsky


NCCI’s 2018 Data Educational Program

Objective

To provide an overview of unique programs and topics,

and discuss their data reporting requirements across

multiple data types.

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2



Agenda

Policy Coverage Rating Programs

Rating and Exposure Topics Claim Topics

State‐Specific Topics

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Data Types

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Policy Data

• Proof of Coverage

• URC Program

• Premium Trends

• Exposure Trends

• Federal Coverage Service

Unit Statistical Data

• Experience Rating

• Class Rates/Loss Costs

• Legislative Analysis

Financial Call Data

• Statewide Premium Level Indications

• Industry Results

Detailed Claim Information


• Research

Medical Call Data


• Research

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Policy Coverage



Employers Liability (E/L) Insurance

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Part Two—Employers Liability

Coverage for liability to employees for work‐related bodily injury or disease

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Employers Liability

Employers Liability With or Without Workers

Compensation

Standard Limits of Liability:

• Accident ($100,000)• Employee ($100,000) • Policy ($500,000)

Increased Limits of Liability:

Additional percentage is applied to premium

Minimum Premium for Increased Limits

Stop Gap Coverage—Monopolistic Funds (ND, OH, WA, WY):Employers Liability

Coverage purchased from private carriers

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Basic Manual

Rule 3-A-14



Employers Liability

Employers Liability With or Without

Workers Compensation

Standard Limits of Liability:

• Accident ($100,000)

• Employee ($100,000)

• Policy ($500,000)

Increased Limits of Liability:

Additional percentage is

applied to premium

Minimum Premium for Increased Limits

Stop Gap Coverage—Monopolistic Funds (ND, OH, WA, WY):

E/L Coverage purchased from private carriers

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Basic Manual

Rule 3-A-14

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Employers Liability Statistical Codes

Statistical Plan—Part 6

Statistical Codes Subject to Experience Rating

With or without workers compensation

Corresponding to Employers Liability Increased Limits

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Employers Liability Statistical Codes Workers Compensation and Employers Liability

Less than $1,000,000/1,000,000/10,000,000

Statistical Code 9837—Increased Limits—All Other Limits of Liability

Greater than $1,000,000/1,000,000/10,000,000

Statistical Code 9816—Increased Limits With Workers Compensation Coverage

Employers Liability Only

Less than $1,000,000/1,000,000/10,000,000

Statistical Code 9837—Increased Limits—All Other Limits of Liability

Greater than $1,000,000/1,000,000/10,000,000

Statistical Code 9836—Increased Limits Without Workers Compensation Coverage

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Employers Liability Statistical Codes

Statistical Code 9848—Balance to Minimum Premium for Increased Limits

Statistical Code 9139—Flat Charge for Employers Liability/Voluntary Compensation

Stop Gap Coverage

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Employers Liability (E/L) Reporting

Policy:

Header Record Report Limits of Liability

Accident

Employee

Policy

Exposure Record Employers Liability Statistical Codes

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Unit Statistical:

Exposure Record Employers Liability Statistical Codes

Loss Record Incurred and Paid Indemnity—Include ALAE associated

with Employers Liability claims

Claim with WC and E/L—Report as one claim

Type of Claim—Loss Conditions E/L only—Code 02

WC with E/L—Code 03

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Financial Calls: E/L and E/L Increased Limits—Include in DSR Level, Company

Standard, and Net Premiums

Balance to Minimum Premium

DSR Level is rates

DSR level is loss costs and Texas

Stop Gap Coverage—Don’t include in any premium columns

Indemnity Claim Count/Large Loss Claims

Report as one claim when there’s WC and E/L (Increased Limits) coverage

DCCE associated with E/L is reported in the Indemnity Losses (use as a Reason for Difference on Call #8)

Call #19—Ensure that losses and expenses are reported in the same fashion as the NAIC Annual Statement data

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DCI and Medical Data Call:

No unique reporting exceptions or values

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Voluntary Compensation

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Coverage for workers not required under statute—optional coverage

Examples: Domestic workers, farmers, casual worker

Benefits equivalent to statutory benefits

Separate payroll records must be maintained

Basic Manual Rule 2-I

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Foreign Voluntary Compensation

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Coverage for employees who are hired within the United States but travel and work outside of the United States

Employees in a specific country for a designated maximum number of consecutive days

Optional additional coverage for repatriation expenses

Basic Manual Rule 2-I



Endorsements

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Forms Manual

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Endorsements

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Forms Manual



Endorsements

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Forms Manual

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Endorsements

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Forms Manual



Voluntary and Foreign Voluntary Compensation Reporting

Policy:

Endorsement Identification Record

Header Record Type of Nonstandard ID—Code 09: Voluntary and/or

Foreign Voluntary Coverage

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Voluntary and Foreign Voluntary Compensation Reporting

Unit Statistical:

Header Record Type of Nonstandard ID—Code 09: Voluntary Coverage

Not Mandated by State Act

Exposure Record Classification code Do not report additional repatriation coverage charge

(no statistical code)

Loss Record Paid/Incurred Losses Report the entire claim amount, including repatriation

losses and expenses

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Voluntary and Foreign Compensation Reporting

Financial Calls:

Premium: Report audited premium for both Voluntary Compensation

and Foreign Voluntary Compensation insurance in DSR Level, Company Standard, Net Premiums

Premium for additional (optional) repatriation coverage (Net Premium only), excluded from DSR Level and Company Standard Premiums

Paid Losses and Case Reserves: Report the entire claim amount, including repatriation losses

and expenses

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Salary in Lieu of Benefits

May also be referred to as Wage Continuation

Some states allow an employer to continue paying wages to an injured worker in lieu of the worker receiving indemnity benefits provided by the policy

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Salary in Lieu of Benefits Reporting

Policy:

No reporting impact

Unit Statistical:

Insurer is required to report the full value of the indemnity loss in accordance with jurisdiction state

workers compensation benefit levels

The total loss (paid and outstanding) must be reported without any consideration for wage continuation

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14



Salary in Lieu of Benefits Reporting

Financial:

No unique reporting DCI and Medical:


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Rating Programs

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Retrospective Rating Plan

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Premium based ultimately on employers’ loss experience during applicable policy year

Annual loss review and premium adjustment for a preset number of years after policy expires

Includes Loss Sensitive Rating Plan (LSRP) (assigned risk only) Retrospective

Rating Plan Manual



Retrospective Rating Reporting

Policy:

Header Record

Retrospective Rating Code 5

Unit Statistical:

Header Record

Retrospective Rated Policy Indicator = Y

Exposure Record

Report audited payroll/premium on 1st report

Do Not Report: Premium Adjustments—No statistical code, no corrections to

1st report

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Snapshot in Time

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Retrospective Rating Reporting

Financial Calls:

Report Audited premium in DSR Level, Company Standard, and Net Premiums

Retro Adjustments—Included in Net Premium only; excluded from DSR Level and Company Standard Premiums



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Deductible Rating Programs

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Deductible Program Types

Vary by State

NCCI vs. Carrier‐filed

Small vs. Large

Program– Basic Manual

Miscellaneous Rules

Components

Medical or Medical/Indemnity

Claims

Coinsurance

Deductible Amounts

Specific Amounts Outlined in Program

Experience Rating Split Point Value

(CO, MO)

Incentives

Deductible Credit

Experience Rating Gross vs. Net

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Deductible Program Types

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Basic Manual

Misc. Rules

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Deductible Program Reporting

Deductible Reimbursement

Reporting depends on whether deductible program is gross or net

Gross—Report 0 in the Deductible Reimbursement Amount field

Net—Report deductible reimbursement amount subject to the policy deductible

Experience Rating Calculation

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USRGPart 8




Deductible Reimbursement

Reporting depends on whether deductible program is gross or net

Gross—Report 0 in the Deductible Reimbursement Amount field

Net—Report deductible reimbursement amount subject to the policy deductible

Experience Rating Calculation

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USRGPart 8

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Deductible Credit Statistical Code

Based on Premium Placement

9664—Deductible Reporting—Subject to Experience Modification Factor

9663—Deductible Reporting—Not Subject to Experience Modification Factor

9657—Deductible Reporting—Not Part of Standard Premium

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Unit Statistical Reporting Guidebook–Part 8

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Policy Data:

Deductible Endorsement Record—Record Type Code 43

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State Code Losses Subject to Deductible Code

Record Type Code 43 Basis of Deductible Calculation Code

Endorsement Number Deductible Percentage

Bureau Version Identifier Deductible Amount per Claim/Accident

Carrier Version Identifier Deductible Amount—Aggregate

Endorsement Effective Date

Deductible Credit Statistical Code

See Part 14–Policy Data

Dictionary for reporting values




Unit Statistical Data:

Header Record Deductible Type Code

Type of Deductible Type of Plan Part 6 for Coding Values

Deductible Percent

Deductible Amount Per Claim/Accident

Deductible Amount Aggregate

Deductible Credit Statistical Code Deductible Reimbursement Amount

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Financial Call:

Policies with other than large deductible program Include data in ratemaking calls

Policies with large deductible program

Exclude data from ratemaking calls

Include data in Call 8

Florida Exception—Large Deductible Calls

Deductible premium credit—Include in Net Premium and exclude from DSR Level and Company Standard



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Employer Paid Programs

Compensation Reimbursement

Available in Idaho

For claims under $1,000

Employer Paid Medical Program

Available in Missouri

Prohibits adjustment to rating if certain conditions are met

Available in Oregon

For medical costs up to $1,500

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Employer‐Paid Programs Reporting

Report similar to deductible programs

Unit Statistical Reporting Guidebook—Part 9

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Wrap‐Up Construction Projects

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Owner Controlled Insurance Program (OCIP) or Contractor Controlled Insurance Program (CCIP)

Policies are issued to each separate legal entity working on the project

Classifications assigned to each separate legal entity based on operations

Designated Workplace Exclusion Endorsement (WC 00 03 02)

Owner/General

Contractor

Electrician Steel Framers Plumbers

Basic Manual

Rule3-A-23

Basic Manual

Rule 3-A-23

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Wrap‐Up Policy Example

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5-Year Wrap-Up Program

2011–2016

Wrap-Up PolicyPolicy # Wrapup110/1/11–10/1/12



Wrap-Up Policy Policy # Wrapup4 10/1/14–10/1/15

Wrap-Up Policy Policy # Wrapup5 10/1/15–10/1/16




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Wrap-Up PolicyPolicy # Wrapup110/1/15–10/1/16Deductible Program

Bob’s PlumbingPolicy # Wrapup1B10/1/15–5/1/16

Manny’s SteelPolicy # Wrapup1C12/1/15–10/1/16

Julie’s WiringPolicy # Wrapup1D

1/1/16–5/1/16

Richard’s Concrete Policy # Wrapup1E 10/1/15–10/1/16

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Bob’s PlumbingPolicy # Wrapup1B10/1/15–5/1/16

Bob’s PlumbingPolicy # ABC

1/1/15–1/1/16

Manny’s SteelPolicy # Wrapup1C12/1/15–10/1/16

Manny’s Steel Policy # GHI

1/1/15–1/1/16

Julie’s WiringPolicy # Wrapup1D

1/1/15–5/1/16

Julie’s Wiring Policy # MNO

1/1/16–1/1/17

Richard’s Concrete Policy # Wrapup1E 10/1/15–10/1/16

Richard’s Concrete Policy # XYZ

1/1/16–1/1/17



Wrap‐Up Reporting Policy:

Wrap‐Up/Owner‐Controlled Insurance Program (OCIP)—Code 1 (Master and Subcontractors)

Designated Workplace Exclusion Endorsement (WC 00 03 02)

Deductible Endorsement

Unit Statistical:

Separate unit reports (exposure/losses) by contractor

Deductible program type (mirror Master Policy)

Deductible Credit Statistical Code, if applicable: Code 9664—Subject to Experience Modification Factor Code 9663—Not Subject to Experience Modification Factor Code 9657—Not Part of Standard Premium

Loss reimbursement for net deductible program

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Wrap‐Up Policy—Financial Calls

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•Exclude all premium, loss, and expense from Policy Year/CAY Calls*

Large Deductible

Policy

•Report all premium, loss, and expense in Policy Year 2015

Other Than Large

Deductible Policy

Wrap-Up PolicyPolicy # Wrap-Up 110/1/15–10/1/16

*Exception—FL Calls 20/21 (Large Deductible)



Wrap‐Up Reporting

Financial Call:

Deductibles:* If no deductible or other than Large, include premiums, losses,

DCCE in Ratemaking Calls

If Large, exclude from premiums, losses, DCCE, and account for data on Call #8 (FL exception—LD calls)

Premium Credits—Include in Net Premium and exclude from DSR Level and Company Standard

*Follow reporting instructions on what to include/exclude

Master Wrap‐Up Policy that covers multiple years must be reported as separate policies with individual effective dates for each of the annual components. Mirror Policy Effective Dates reported on units.



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Rating and Exposure Topics



Audit Noncompliance Charge

Charge applies to employers that do not allow audit (at least two attempts)

Optional charge applied to estimated annual premium

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Basic Manual

Rule 3-A-13

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Audit Noncompliance Charge

Employers that pay the charge and later allow an audit will be refunded or outstanding balance credited

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Basic Manual

Rule 3-A-13



Reporting Audit Noncompliance Charge

Unit Statistical Reporting Example:

A policy effective 01/01/17, with Audit Noncompliance Charge Endorsement where employer did not respond to the carrier’s requests for audit.

1st unit report valuation, carrier applies a charge in the amount of $1,000. In 09/2018, the 1st unit statistical report is submitted to include the following information:

Estimated Audit Code: N

Class Code 6834

Exposure Amount: $50,000 (Estimated)

Rate: 7.69

Premium Amount: $3,845 (Estimated)

Statistical Code 9757 (Audit Noncompliance Charge)

Premium Amount: $1,000

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Reporting Audit Noncompliance Charge

Unit Statistical Reporting Example (cont’d):

Subsequent to the 1st unit report, but before the 2nd unit report valuation, the employer allows the final audit to be conducted, which results in audited exposure of $65,060

This requires an Exposure correction to be reported, including the following Revised Exposure Record information:

Class Code 6834

Exposure Amount: $65,060 (Audited)

Manual Rate: 7.69

Premium Amount: $5,003 (Final)

Code 9757—Remove with corresponding premium

Also, in accordance with the reporting rules, the Estimated Audit Code remains as an “N”

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Consent to Rate

With written consent of the employer, the carrier may use a rate in excess of filed rates—Per‐risk basis

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Consent to Rate Reporting

The effects of this deviation are included in the Net and Company Standard Premium, but must be removed when calculating the DSR Level Premium

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Consent to Rate Example

Component of Standard and Net premium, but not DSR

Potential impact deviation reporting—Keep track

Loss Cost/Rate 8810 = $.50

Carrier LCM = 1.5

Actual company rate = $.75

Deviated Rate = $.80

$1,000,000 Exposure

$5,000 Loss Cost

$7,500 Actual company rate

$8,000 Negotiated Amount with Consent Rate (Deviated Rate)

To calculate DSR premium, remove $500 from Company Standard Premium prior to applying average deviation

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Composite Rating

Typically utilized on large employers

Rating premiums on a singular rate

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Composite Rate Reporting

Statistical Plan Rule Part 3.T.

Report directly the authorized (deviated) rates in the rate field for each applicable classification code, or

Report each applicable classification code with its corresponding exposure/rate/premium without any adjustments for a Composite Rating plan

Report premium adjustment resulting from composite rating (based on the calculated‐at‐audit composite rate adjustment (– or +) under the appropriate Statistical Code

Statistical Codes (not applicable to TX and VA)

Adjustment is Subject to Experience Rating

9037—Rate Deviation Premium Adjustment (Credit)

9039—Rate Deviation Premium Adjustment (Debit)

Adjustment is Not Subject to Experience Rating

9034—Rate Deviation Premium Adjustment (Credit)—All States

9036—Rate Deviation Premium Adjustment (Debit)—Applicable to All States Except TX and VA

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TX Exception—Authorized (deviated) rate(s) must be reported in the Manual Rate field

VA Exception—Statistical Plan rule and Statistical Codes for Carrier Deviation are not applicable

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Financial Data

Premium that is based on composite rates must be brought back up to the Designated Statistical Reporting (DSR) Level Premium

DSR Level Premium is the standard earned premium that would result if business were written at NCCI approved loss costs or rates instead of at the company rates

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Catastrophe/Terrorism Provisions

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Basic Manual

Rule 3-A-24

Premium is calculated on the basis of payroll and the appropriate advisory loss cost



Catastrophe Provisions Reporting

Policy:

Endorsements:

Report Endorsements on Record Type 07 (Endorsement Identification Record)

Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B)

Florida Terrorism Risk Insurance Program Reauthorization Act Endorsement (WC 09 04 03 B)

Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement (WC 00 04 21 D)

Statistical Codes:

Code 9740—Catastrophe Provisions for Terrorism Rating (TRIPRA)

Code 9741—Catastrophe Provisions for Catastrophe (Other Than Certified Acts of Terrorism)

Reporting of exposure, rate, and/or premium

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Catastrophe Provisions Reporting

Unit Statistical: Include appropriate statistical code

Report exposure, rate, and/or premium

Financial Data: Exclude from DSR Level, Company Standard, and Net

Premiums on Calls #3, #3A, #5, #5A, #20, and #21

Report as a line item on Call #8

Include on Calls #1, #1A, #1B, #1C, #1D, and #14



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Anniversary Rating Date (ARD)

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Effective month and day of the policy in effect unless a different date has been established.

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ARD Reporting

Policy:

ARD field on Policy State Premium Record

No changes in reporting

Unit Statistical:

Rate Effective Date and Modification Effective Date

No changes in reporting

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ARD Reporting

Financial Call:

If ARD is different from the PED

ARD determines the appropriate DSR Level

PED determines which policy year to report experience



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Ratable/Nonratable Groups

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Basic Manual

Rule 3-A-17

Adjusts for the classification’s potential for occupational disease/catastrophic losses

Nonratable element is a supplementary loading for a classification

Class codes designated with an “N” have corresponding statistical codes (nonratable element)



Ratable/Nonratable Groups

Florida Example:

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Class Code Rate Minimum Premium

0771N 0.57 ‐‐‐‐

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Nonratable Groups Reporting

Policy:

Ratable Classification Code—Report exposure, rate, and premium

Nonratable Statistical Code—Report exposure, rate, and premium

Unit Statistical:

Report exposure, rate, and premium

Financial Calls:

Ratable Premium Included

Nonratable Premium Excluded



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Supplemental Disease Exposures

Supplemental disease loading based on carrier’s evaluation of the following types of operations:

Incidental Foundry

Abrasive

Sandblasting

Loss cost/rate applied to the payroll of employee’s exposed to these hazards

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Basic Manual

Rule 3-A-7

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Supplemental Disease Exposures Reporting

Statistical Codes for Supplemental Disease

0059—Abrasive or Sandblasting

0065—Incidental Foundries—Steel

0066—Incidental Foundries—Non‐Ferrous Metals

0067—Incidental Foundries—Iron

0133—Supplemental Disease Experience—in Connection With Asbestos Exposure

0179—Disease Experience—Supplemental

9985—Atomic Energy—Radiation Exposure NOC

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Supplemental Disease Exposures Reporting

Policy: Ratable Nonratable Report exposure, rate, and premium

Unit Statistical: Report exposure, rate, premium, and loss

Financial Calls: Excluded in all Calls but would be accounted for on

Call 8

DCI and Medical Data Call: No unique reporting exceptions or values

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Claim Topics



Lump‐Sum Settlements

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Agreement between carrier and claimant regarding WC payments and future medical care

Represents the discounted or commuted value of a specific award or benefit

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Lump‐Sum Settlements Reporting

Policy: Not applicable for losses

Unit Statistical: Lump‐Sum Settlement—Y/N Indicator

Settlement Type (Discounted/Commuted)

Claim Status

Allocated between Medical and Indemnity (should not be an automatic 50/50 split)

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Lump‐Sum Settlements Reporting

Financial Call:

Losses: Allocated between Medical and Indemnity (should not be an automatic 50/50 split)

If subdivision is unknown or unspecified, use case values prior to the settlement adjustment to determine proration

Detailed Claim Information:

Lump‐Sum amount paid

Benefits covered by Lump‐Sum Code

Medical Data Call:


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Subrogation

Carrier has received reimbursement from an entity other than the employer, with legal liability for the claim.

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Waiver of Subrogation

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Basic Manual

Rule3-A-22

Basic Manual

Rule 3-A-22Premium Credit may be applicable

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The gross incurred loss must be reduced by the recovery less recovery expenses.

Subrogation Reporting

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Type of Recovery—Loss Conditions

Code Description

03 Subrogation Only (Third Party)

04 Subrogation and Second Injury Fund Reimbursement




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Determine Which Units Require Corrections

Compare Net Incurred Loss to previous report levels

When was the recovery received?

Calculate Net Incurred Cost

Total Incurred Loss – (Subrogation Recovery – Subrogation Expenses) = Net Incurred Loss

Determine Total Incurred Loss

Total Incurred Loss = Total Incurred Indemnity + Total Incurred Medical

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Subrogation Allocation

83

Subrogation Allocation Is Not Known

Allocate to Indemnity and/or Medical, based on the proportion of original loss amounts

Subrogation Allocation Is Known

Allocate to Indemnity and/or Medical, based on the allocation




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Subrogation Recovery Prior to 1st Report

Include calculated subrogation recovery in claim value

Type of Recovery Code 03 (Subrogation) or 04 (Subrogation and SIF)

Subrogation Recovery After 1st but Before 6th Report

Calculate the Net Incurred Loss (as of latest report level)

Determine if correction reports are needed


Subrogation Recovery as of 6th Report

Include calculated subrogation recovery in claim value


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For Financial Call reporting, include, as a reduction to paid losses, all actual loss recoveries due to subrogation

Report net incurred loss—gross incurred loss minus the amount recovered (reduced by recovery expenses). This may also include a reduction to case loss reserves for all anticipated loss recoveries from a third party.

Subrogation and other recoveries should not be applied to Defense and Cost Containment Expense (DCCE)

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Waiver of Subrogation

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Basic Manual

Rule3-A-22

Unit Statistical and Policy Data Statistical Codes—0930, 9115, and 9118 for

Waiver of Subrogation premium reporting

Financial Calls Premium for Waiver of Subrogation is included

in Net, Company Standard, and DSR Level Premium



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Medicare Secondary Payer (MSP) or Set‐Asides (MSA)

87



Medicare Secondary Payer or Set‐Asides Reporting

Policy: Not applicable to losses

Unit Statistical: Medical loss reported includes “set‐aside” to cover

future medical costs, management fees

MSP service provider fees are reported under ALAE

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Medicare Secondary Payer or Set‐Asides Reporting

Financial Calls: Medical Losses—Report MSP or Set‐Asides to

appropriate Claim/PY/AY

MSP service provider fees reported in DCCE



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State‐Specific Topics

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Missouri Mesothelioma

Additional benefits for occupational diseases due to toxic exposure diagnosed as Mesothelioma and results in Death or Permanent Total Disability.

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Charge or Credit for Additional Mesothelioma Benefits

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Missouri Mesothelioma Reporting

Policy: Applicable endorsements

Applicable credit or charge, if any

Quarterly reports to MO DOL

Unit Statistical: Charge for Additional Mesothelioma Benefits—

Independent Carrier Filing statistical code

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Missouri Mesothelioma Reporting

Financial Calls: Report additional charge in Net Premium; exclude

from Company Standard and DSR Level

Report all applicable losses


No unique reporting exceptions or values for losses

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West Virginia Deliberate Intent Coverage

Additional coverage to insure acts (injuries) deemed intentional or acts caused by deliberate intention by the employer.

95



West Virginia Deliberate Intent Coverage Reporting

Policy:

Endorsement (WC 47 03 01A)

Provided via WC/EL policy endorsement or “excess” policy

Code 9614—Exposure and Premium

Flat Premium—Report “1” for exposure, “0” for rate, and “Flat Charge” for premium

No Premium—Report “1” for exposure, “0” for rate, and “0” for premium

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Unit Statistical:

Type of Nonstandard ID Code 05—Excess Policy

Exposure Act Code 07—Excess Benefits Coverage

Report corresponding premium, losses, and expenses under Code 9614

Loss Condition Code—Type of Claim 05—Excess Benefits

Must correct employers liability claim to deliberate intent once determined

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Financial Call:

Exclude any experience associated with the optional West Virginia

Deliberate Intent Coverage from all Calls

Adjusting and Other Expenses—Excluding any fees associated with

determination of West Virginia Deliberate Intent coverage

If any experience associated with West Virginia Deliberate Intent

coverage is reported on your company’s NAIC Annual Statement, it will

be a Reason for Difference on Call #8

DCI:

Exclude claims solely with West Virginia Deliberate Intent Coverage

Medical Data Call:


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MD and VA Excess Benefits Part of union contracts, employers subject to the MD/VA workers

compensation law agree to provide their injured employees with DC benefits

Carriers may extend the coverage to insure the liability to pay these excess benefits

Maryland—manual rate for each classification will be the rate in force in DC, except when DC rate is lower, in which case MD rate applies

Virginia—manual rate for each classification must be increased by the DC additional benefits percentage shown in the Miscellaneous Values section of the Virginia state loss cost or rate pages—Effective 4/1/17, DC percentage:

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MD and VA Excess Benefits Reporting

Exposure Coverage Act Code

07 (Excess Benefits Coverage)

Loss Conditions—Type of Claim Code

05 (Excess Benefits)

Each loss must be valued separately under the Maryland Workers Compensation Law.

The valuation on the basis of the Maryland law must be reported according to the rules of this Plan.

The valuation under the excess benefits (e.g., Maryland law subtracted from the valuation under the District of Columbia law) must be reported.

Part 7‐C—Unit Statistical Reporting Guidebook

100

Unit Statistical:

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Questions?

Thank you for participating!

Supplemental Information

Presenter Biographies

Julie Gonzalez, AU, AIDM, has worked at NCCI since 1992. As a senior data consultant and project manager in the Data Services Department, her main responsibilities include managing NCCI’s Data Educational Program, overseeing major compliance projects, developing new reporting rules and data requirements, and enhancing NCCI’s external training programs and data reporting tools. In addition, Julie actively participates on industry committees and association forums to forge industry relationships and provide subject-matter expertise. She is a member of the Insurance Data Management Association’s Educational Committee, which is responsible for developing the formal certification program for insurance data management.

Prior to joining Data Services, Julie was a senior underwriting analyst, responsible for filing workers compensation rules and programs, maintaining the classification system, and managing the appeals board mechanism for several NCCI states.

Julie has earned both her Associate in Commercial Underwriting (AU) and Associate Insurance Data Manager (AIDM) designations.

Veruschka Zachtshinsky is currently a regulatory services manager in NCCI’s Regulatory Assurance Department. She is responsible for preparing national and state item filings and providing technical support to regulators, carriers, employers, and agents on NCCI’s manual rules.

Veruschka has more than 18 years of insurance industry experience, including 13 years with NCCI. At NCCI, she has served on the Experience Rating Modifications, Data, and Classification Teams in Customer Operations.

She has a bachelor’s of business administration from Florida Atlantic University.

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