Niche Programs and Unique Reporting Topics...Niche Programs and Unique Reporting Topics NCCI’S...
Transcript of Niche Programs and Unique Reporting Topics...Niche Programs and Unique Reporting Topics NCCI’S...
Niche Programs andUnique Reporting Topics
NCCI’S 2016 DATA EDUCATIONAL PROGRAM
January 26–29, 2016
Palm Beach County Convention CenterWest Palm Beach, FL
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
Niche Programs and Unique Reporting Topics
Presented by: Julie Gonzalez and Renee Retterath
© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.2016 DATA EDUCATIONAL PROGRAM
Objective
To provide an overview of niche type programs and unique topics, and discuss their data reporting requirements across multiple data types.
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Agenda
Niche Programs
Voluntary Compensation
Employers Liability Insurance
Retrospectively Rated Policies
Excess Policies
Wrap-Up Programs
Unique Topics
Catastrophe Provisions Anniversary Rating Date Uncooperative Audit Ratable and Non-Ratable
Groups Supplemental Diseases Lump Sum/Settlements Medicare Secondary Payer State Specific: Missouri Mesothelioma West Virginia Deliberate
Intent Coverage
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Data Types—Usage
Policy Data• Proof of
Coverage• URC
Program• Premium
Trends• Exposure
Trends
Financial Call Data• Statewide
Premium Level Indications
• Industry Results
Unit Statistical Data• Experience
Rating• Class
Rates/Loss Costs
• Legislative Analysis
Detailed Claim Information• Legislative
Analysis• Research
Medical Call Data• Legislative
Analysis• Research
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Niche Programs
© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.2016 DATA EDUCATIONAL PROGRAM
What Is a Niche Market?
Subset of the market on which a specific insurance product is focused
Defines the insurance product features aimed at satisfying: Specific needs Cost Demographics
Small market segment
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Voluntary Compensation
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
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WC 00 03 11 A—Voluntary Compensation and Employers Liability Coverage Endorsement
WC 00 03 12 A—Voluntary Compensation and Employers Liability Coverage for Residence Employees Endorsement
Basic Manual Rule 2-1
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Foreign Voluntary Compensation 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
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WC 09 04 06 A—Florida Foreign Voluntary Compensation and Employers Liability Coverage Endorsement
WC 06 04 02—Connecticut Foreign Voluntary Compensation and Employers Liability Coverage Endorsement
Carrier Independently Filed Endorsement for Foreign Voluntary
Basic Manual Rule 2-I (CT and FL Exceptions)
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Reporting Voluntary and Foreign Voluntary Compensation
Policy: Endorsement Identification Record: WC 00 03 11 A WC 00 03 12 A Florida—WC 09 04 06 Connecticut—WC 06 04 02 Carrier Independently Filed Endorsement
for Foreign Voluntary (appropriate endorsement #)
Type of Nonstandard ID—Code 09: Voluntary and/or Foreign Voluntary Coverage
Applicable for Foreign Voluntary Compensation
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Reporting Voluntary and Foreign Voluntary Compensation
Unit Statistical:
Header Type of Nonstandard ID—Code 09: Voluntary
Coverage Not Mandated by State Act:
Exposure/Premium Classification code Do not report additional repatriation coverage
charge (no statistical code)
Paid/Incurred Losses Report the entire claim amount, including
repatriation losses and expenses
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Reporting Voluntary and Foreign Compensation
Financial Calls: Premium:
Report audited premium for both Voluntary Compensation and Foreign Voluntary Compensation insurance in DSR Level, Co. Standard, Net
Premium for additional (optional) repatriation coverage (Net Premium only), excluded from DSR Level and Co. Standard Premiums
Paid Losses and Case Reserves: Report the entire claim amount, including repatriation
losses and expenses
DCI and Medical Data Call: No unique reporting exceptions or values
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Employers Liability (E/L) Insurance
Coverage to protect employers from negligence claims
Employers Liability (Part B)
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Employers Liability (E/L) InsuranceTypes:
1. Employers Liability With or Without Workers Compensation
Standard Limits of Liability: Accident ($100,000) Employee ($100,000) Policy ($500,000)
2. Increased Limits of Liability: Additional percentage is applied to premium
3. Minimum Premium for Increased Limits
4. Stop Gap Coverage—Monopolistic Funds (ND, WA, WY, OH): E/L coverage—employers buy coverage from private insurers
Basic Manual Rule 3-A-14Statistical Plan Preface—A-1
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Reporting Employers Liability (E/L)
Policy:
Report Limits of Liability Accident Employee Policy
Statistical Codes Corresponding to E/L Increased Limits Balance to Minimum Premium for Increased
Limits—Code 9848
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Reporting Employers Liability (E/L)
Unit Statistical:
Statistical Codes corresponding to E/L Increased Limits
Balance to Minimum Premium for Increased Limits—Code 9848
Statistical Code 9139—Flat Charge for Employers Liability/Voluntary Compensation
ALAE associated with E/L is included in incurred indemnity and paid indemnity loss as appropriate
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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Reporting Employers Liability (E/L)
Financial Calls: E/L and E/L Increased Limits —Include in DSR Level,
Company Standard, and Net Premiums
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 should be 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
DCI and Medical Data Call: No unique reporting exceptions or values
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Retrospective Rated Policies
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) and Large Risk Alternative Rating Option (LRARO)
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Reporting Retrospective Rating
Policy: Retrospective Rating Code 5
Unit Statistical: Retrospective Rated Policy Indicator = Y
Report audited payroll/premium on 1st report Do not report:
– Premium Adjustments—No statistical code, no corrections to 1st report
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Reporting Retrospective Rated Policies
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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Wrap-Up Construction ProjectsBasic Manual Rule 3-A-23
Policies are issued by one carrier to two or more legal entities
Classifications assigned to each separate legal entity based on operations
Designated Workplace Exclusion Endorsement (WC 00 03 02)
Owner Controlled Insurance Program (OCIP) or Contractor Controlled Insurance Program (CCIP)
Owner/General Contractor
Electrician Steel Framers Plumbers
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Wrap-Up Policy Example
5-Year Wrap-Up Program
2010–2015
Wrap-Up PolicyPolicy # Wrapup110/1/10–10/1/11
Wrap-Up PolicyPolicy # Wrapup210/1/11–10/1/12
Wrap-Up PolicyPolicy # Wrapup310/1/12–10/1/13
Wrap-Up Policy Policy # Wrapup4 10/1/13–10/1/14
Wrap-Up Policy Policy # Wrapup5 10/1/14–10/1/15
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Wrap-Up Policy
Wrap-Up PolicyPolicy # Wrapup110/1/10–10/1/11
Bob’s PlumbingPolicy # Wrapup1B10/1/10–5/1/11
Bob’s PlumbingPolicy # ABC
1/1/10–1/1/11
Manny’s SteelPolicy # Wrapup1C12/1/10–10/1/11
Manny’s Steel Policy # GHI
1/1/10–1/1/11
Julie’s WiringPolicy # Wrapup1D
1/1/11–5/1/11
Julie’s Wiring Policy # MNO
1/1/11–1/1/12
Richard’s Concrete Policy # Wrapup1E 10/1/10–10/1/11
Richard’s Concrete Policy # XYZ
1/1/11–1/1/12
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Wrap-Up Policy
Wrap-Up PolicyPolicy # Wrapup110/1/10–10/1/11Deductible Program
Bob’s PlumbingPolicy # Wrapup1B10/1/10–5/1/11
Manny’s SteelPolicy # Wrapup1C12/1/10–10/1/11
Julie’s WiringPolicy # Wrapup1D
1/1/11–5/1/11
Richard’s Concrete Policy # Wrapup1E 10/1/10–10/1/11
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Reporting Wrap-Ups Policy: Wrap-Up/Owner-Controlled Insurance Program (OCIP)—
Code 1 (Master and Subcontractors) Designated Workplace Endorsement (WC 00 03 02) Deductible Endorsement
Unit Stat: Separate unit reports (exposure/losses) by contractor Deductible program type (mirror Master Policy) Deductible Credit Stat 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
•Exclude all premium, loss, and expense from Policy Year/CAY Calls*
Large Deductible
Policy
•Report all premium, loss, and expense in Policy Year 2010
Other Than Large
Deductible Policy
Wrap-Up PolicyPolicy # Wrapup110/1/10–10/1/11
*Exception—FL Calls 20/21 (Large Deductible)
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Reporting Wrap-Ups Financial Call: Deductibles*:
If No 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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Excess Policies
Insurance that doesn’t pay until the loss exceeds an agreed upon amount—Typically above the loss limit in the insured’s Workers Compensation policy
This amount may or may not be insured elsewhere
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Excess Policies
Offered to qualified self-insured employers; coverage for losses above a set amount
Target markets—contractors, oil field service industry, and maritime operations
Often combined with claims administration and safety and loss programs
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Reporting Excess Policies
Excess policies are generally NOT reportable on any NCCI data type
Two Exceptions: Excess policy tied to West Virginia Deliberate
Intent Coverage Financial Calls—Report only if you report
Excess data to NAIC, Page 14, Line 16 (WC Line) Calls #1, #1A, #8 (reconciliation item), #14,
#19, and #26 (Addendum to Call #19 only) Exclude Excess data from all other Calls
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Pick the Answer
Questions
Covers One Job Location
Increased Limits
Coverage Not Required
Above Workers Compensation
Coverage
Answers
Employers Liability
Excess Policies
Wrap-Up Policy
Voluntary Compensation
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Unique Reporting
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Catastrophe Provisions Premium surcharge for catastrophe or terrorism-related
programs NCCI evaluates premium surcharges as part of its
ratemaking process
Types: DTEC (Domestic Terrorism, Earthquakes, and
Catastrophic Industrial Accidents) TRIA (Terrorism Risk Insurance Act of 2002) TRIEA (Terrorism Risk Insurance Extension Act of
2005) TRIPRA (Terrorism Risk Insurance Program
Reauthorization Act of 2007 and 2015)
Basic Manual Rule 3-A-24 and Miscellaneous Values
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Reporting Catastrophe Provisions Policy:
Endorsements: 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) Record Type 07 (Endorsement Identification Record)
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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Reporting Catastrophe Provisions 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: Premium not applicable
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Uncooperative Audit or Audit Noncompliance
Carrier has the right to examine and audit all policyholder records
Certain states allow carriers to charge additional funds if insured is: Uncooperativeand Carrier is unable to verify the necessary data
for a final audit
Additional funds cannot exceed several times the most recent estimated annual premium
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Uncooperative Audit or Audit Noncompliance
State-Specific Endorsements:
If insured refuses to cooperate in completing a final audit, they must pay additional funds not to exceed several times the most recent estimated annual premium
Separate charge if applicable from class code manual premium
Note: Countrywide Item Filing B-1429—Establishment of Audit Noncompliance Charge
Effective 1/1/2017
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Reporting Uncooperative Audit or Audit Noncompliance
StatePolicy
Endorsement Statistical Code Basic Manual
CO WC 05 04 049757
(not part of standard premium)Audit Noncompliance Charge—Amount not specified (carrier must file with DOI for approval)
MT WC 25 04 019757
(not part of standard premium)Audit Noncompliance Charge—Amount not specified (carrier must file with DOI for approval)
FL WC 09 04 079757*
(not part of standard premium) *FLJUA Only
Audit Noncompliance Charge—Not to exceed three times most recent estimated annual premium
MO WC 24 06 04 A9757
(not part of standard premium)Audit Noncompliance Charge—Equal to estimated annual premium
SC None9656
(Independent Carrier Filing)
May increase payroll up to a maximum of three times the estimated payroll for purposes of determining the final premium
GA WC 10 04 029656
(Independent Carrier Filing)
May utilize a payroll amount of three times the estimated payroll for purposes of determining final premium
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Reporting Uncooperative Audit orAudit Noncompliance
Policy: Applicable endorsement
Unit Statistical: Report applicable Statistical Code 9757 for CO, MT, FL, and MO Use Statistical Code 9656 (Independent Carrier Filing—
Premium Debit Not Part of Standard Premium) for SC, NC, and GA
Do not apply the additional charge to payroll/premium
Financial Calls: Report data associated with Statistical Code 9757 or 9656 in
Net premium, (only if included in the NAIC Annual Statement), exclude from DSR Level and Co Standard Premiums
DCI Medical Data Call: Premium not applicable
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Anniversary Rating Date
Basic Manual Rule 3-A-2:
Effective month and day of policy in effect unless a different date has been established
Countrywide Item Filing B-1430—Elimination of Anniversary Rating Date (ARD)
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Anniversary Rating Date (ARD)
Policy:
ARD field on Policy State Premium Record
Unit Statistical:
Rate Effective Date and Modification Effective Date
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Anniversary Rating Date (ARD)
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:
Premium not applicable
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Ratable/Non-Ratable Groups
Basic Manual Rule 3-A-17 (non-ratable element):
Class codes designated with an “N” have corresponding statistical codes (non-ratable element)
Non-ratable element is a supplementary loading in the manual rate for a classification
Adjusts for the classification’s potential for occupational disease/catastrophic losses
Premium for a non-ratable element is not subject to experience rating or retrospective rating
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Ratable/Non-Ratable Groups
Florida Example:
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Policy: Report exposure, rate, and premium
Unit Statistical: Report exposure, rate, and premium
Financial Calls: Included in all Calls
DCI and Medical Data Call: Premium not applicable
Non-Ratable Groups
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Supplemental Disease Exposures
Basic Manual Rule 3-A-7 (Disease Loading): Supplemental disease loading may be added
Incidental Foundry, Asbestos, Abrasive, Sandblasting, Atomic Energy Radiation Exposure, Silicosis
Not subject to experience rating or retrospective rating
Florida Example:
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Supplemental Disease Exposures
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
Policy: Report exposure, rate, and premium
Unit Statistical: Report exposure, rate, premium, and loss
Financial Calls: Included in all Calls
DCI and Medical Data Call: No unique reporting exceptions or values
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Settlements
Agreement between carrier and claimant regarding WC payments and future medical care
Lump-Sum Settlement:
Final settlement which allows benefits to be paid all at once instead of over time
Discounted or commuted value of a specific award or benefit
It’s possible to finalize some types of benefits and leave other benefits (e.g., medical) open
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Reporting Lump-Sum Settlements
Policy: Not applicable for losses
Unit Statistical: Lump-Sum Settlement—Y/N Indicator
Settlement Type—Discounted/Commutative
Claim Status
Allocated between Medical and Indemnity (should not be an automatic 50/50 split)
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Reporting Lump-Sum Settlements
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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Medicare Secondary Payer (MSP) or Set-Asides (MSA)
Funds set aside to cover expenses for futuremedical services related to a condition or injury covered by a plan or policy other than Medicare (i.e., workers compensation medical benefits)
Workers compensation pays first, and the secondary payer is Medicare
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Reporting MSPs or Set-Asides (MSA)
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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Reporting MSPs or Set-Asides (MSA)
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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Missouri Mesothelioma
Additional benefits for occupational diseases due to toxic exposure diagnosed as Mesothelioma—results in Death or Permanent Total Disability (SB1—Effective 1/1/2014)
WC 24 03 02—Missouri Notification of Additional Mesothelioma Benefits Endorsement
WC 24 03 03—Missouri Exclusion of Additional Mesothelioma Benefits Endorsement
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Charge or Credit for Additional Mesothelioma Benefits
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Reporting Missouri Mesothelioma
Policy: Applicable endorsements
Applicable credit or charge, if any
Unit Statistical: Charge for Additional Mesothelioma Benefits—
Independent Carrier Filing statistical code
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Reporting Missouri Mesothelioma
Financial Calls: Report additional charge in Net Premium;
exclude from Company Standard and DSR Level Report all applicable losses
DCI and Medical Data Call: Not applicable for premium No unique reporting exceptions or values for
losses
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West Virginia Deliberate Intent Coverage
Additional Coverage to cover acts (injuries) deemed intentional or acts caused by deliberate intention by the employer
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Reporting West Virginia Deliberate Intent Coverage
Policy: Endorsement (WC 47 03 01A) Provided via WC/EL policy endorsement or “excess” policy Code 9614—Exposure 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
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
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Reporting West Virginia Deliberate Intent Coverage
Financial Call: Exclude any experience associated with the optional West
Virginia Deliberate Intent (Mandolidis) 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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Additional Benefits for Mesothelioma
Name the State
Florida1
Missouri2 West
Virginia3
Has an Audit Noncompliance Endorsement
Deliberate Intent as an Excess Coverage
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Supplemental Information
Presenter Biographies
Julie Gonzalez, AIDM, has been employed at NCCI since 1992. As a 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 data reporting requirements, and enhancing NCCI’s external training programs and data tools. In addition, Julie actively participates on industry committees and association forums to forge industry relationships and provide subject matter expertise.
Prior to joining Data Services, Julie was a senior underwriting analyst, responsible for filing workers compensation rules and programs, 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.
Renee Retterath has worked at NCCI for 13 years and is a senior data consultant in the Data Quality and Compliance Department. She is responsible for the development, implementation, and monitoring of the various quality assurance programs for the collection and validation of customer data.
Renee has a master of science degree in school psychology from the University of Wisconsin- Stout.