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
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
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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NCCI’s 2018 Data Educational Program
Agenda
Policy Coverage Rating Programs
Rating and Exposure Topics Claim Topics
State‐Specific Topics
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NCCI’s 2018 Data Educational Program
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
• Legislative Analysis
• Research
Medical Call Data
• Legislative Analysis
• Research
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Policy Coverage
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
Employers Liability (E/L) Reporting
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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NCCI’s 2018 Data Educational Program
Employers Liability (E/L) Reporting
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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NCCI’s 2018 Data Educational Program
Employers Liability (E/L) Reporting
DCI and Medical Data Call:
No unique reporting exceptions or values
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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
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NCCI’s 2018 Data Educational Program
Endorsements
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Forms Manual
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NCCI’s 2018 Data Educational Program
Endorsements
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Forms Manual
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
Endorsements
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Forms Manual
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NCCI’s 2018 Data Educational Program
Endorsements
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Forms Manual
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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DCI and Medical Data Call:
No unique reporting exceptions or values
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
Salary in Lieu of Benefits Reporting
Financial:
No unique reporting DCI and Medical:
No unique reporting exceptions or values
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Rating Programs
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NCCI’s 2018 Data Educational Program
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
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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
DCI and Medical Data Call:
No unique reporting exceptions or values
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NCCI’s 2018 Data Educational Program
Deductible Rating Programs
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
Deductible Program Types
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Basic Manual
Misc. Rules
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NCCI’s 2018 Data Educational Program
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
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NCCI’s 2018 Data Educational Program
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
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NCCI’s 2018 Data Educational Program
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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© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
Unit Statistical Reporting Guidebook–Part 8
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NCCI’s 2018 Data Educational Program
Deductible Program Reporting
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
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
Deductible Program Reporting
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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NCCI’s 2018 Data Educational Program
Deductible Program Reporting
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
DCI and Medical Data Call:
No unique reporting exceptions or values
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
Employer‐Paid Programs Reporting
Report similar to deductible programs
Unit Statistical Reporting Guidebook—Part 9
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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 PolicyPolicy # Wrapup210/1/12–10/1/13
Wrap-Up PolicyPolicy # Wrapup310/1/13–10/1/14
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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NCCI’s 2018 Data Educational Program
Wrap‐Up Policy Example
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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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NCCI’s 2018 Data Educational Program
Wrap‐Up Policy Example
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Wrap-Up PolicyPolicy # Wrapup110/1/15–10/1/16
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
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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)
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
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.
DCI and Medical Data Call:
No unique reporting exceptions or values
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Rating and Exposure Topics
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
Composite Rating
Typically utilized on large employers
Rating premiums on a singular rate
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
Composite Rate Reporting
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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NCCI’s 2018 Data Educational Program
Composite Rate Reporting
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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NCCI’s 2018 Data Educational Program
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
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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
DCI and Medical Data Call:
No unique reporting exceptions or values
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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
DCI and Medical Data Call:
No unique reporting exceptions or values
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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)
© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.
NCCI’s 2018 Data Educational Program
Ratable/Nonratable Groups
Florida Example:
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Class Code Rate Minimum Premium
0771N 0.57 ‐‐‐‐
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NCCI’s 2018 Data Educational Program
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
DCI and Medical Data Call:
No unique reporting exceptions or values
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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:
No unique reporting exceptions or values
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NCCI’s 2018 Data Educational Program
Subrogation
Carrier has received reimbursement from an entity other than the employer, with legal liability for the claim.
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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
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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Subrogation Reporting
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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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NCCI’s 2018 Data Educational Program
Subrogation Allocation
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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 Reporting
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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
Type of Recovery Code 03 (Subrogation) or 04 (Subrogation and SIF)
Subrogation Recovery as of 6th Report
Include calculated subrogation recovery in claim value
Type of Recovery Code 03 (Subrogation) or 04 (Subrogation and SIF)
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NCCI’s 2018 Data Educational Program
Subrogation Reporting
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
DCI and Medical Data Call:
No unique reporting exceptions or values
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NCCI’s 2018 Data Educational Program
Medicare Secondary Payer (MSP) or Set‐Asides (MSA)
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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
DCI and Medical Data Call:
No unique reporting exceptions or values
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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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NCCI’s 2018 Data Educational Program
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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NCCI’s 2018 Data Educational Program
Missouri Mesothelioma Reporting
Financial Calls: Report additional charge in Net Premium; exclude
from Company Standard and DSR Level
Report all applicable losses
DCI and Medical Data Call:
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
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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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West Virginia Deliberate Intent Coverage Reporting
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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NCCI’s 2018 Data Educational Program
West Virginia Deliberate Intent Coverage Reporting
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:
No unique reporting exceptions or values
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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
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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.