Objective - NCCI Holdings Inc. · 2015-10-07 · Coverage for workers not required under statute—optional coverage ... • Stop Gap Coverage—Monopolistic Funds •E/L Increased

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11© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Federal Coverages & Niche Programs—Policy Rules & Reporting RequirementsPresented by: Julie Gonzalez and Shani Oulton


Objective

To provide an overview of Niche and Federal type programs, and discuss data reporting requirements across multiple data types.

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Agenda

• Overview of Data Types and Data Usage

• Niche Programs

• Federal Coverages


Data Types

Policy Data• Proof of

Coverage• URC Program• Premium

Trends• Exposure

Trends

Financial Call Data• Statewide

Premium Level Indications

• Industry Results

Unit Statistical Data• Individual

Risk Rating• Class

Rates/Loss Costs

• Legislative Analysis

Detailed Claim Information• Legislative

Analysis• Research

Medical Call Data• Legislative

Analysis• Research

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55© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 2014 Data Educational Program

Niche Programs


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• Production quality• Demographics

• Small market segment

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Topics

• Voluntary Compensation• Employers Liability Insurance• Wrap-Up Programs• Retrospectively Rated Policies• Excess Policies• Minimum Premium Policy• Catastrophe Provisions

• Anniversary Rating Date• Uncooperative Audit• Ratable and Nonratable Groups• Supplemental Diseases• Lump Sum/Settlements• Medicare Secondary Payer• Missouri Mesothelioma• West Virginia Deliberate Intent

Coverage


Voluntary Compensation

Basic Manual Rule 2-I

Coverage for workers not required under statute—optional coverage

Benefits equivalent to statutory benefits

Separate payroll records must be maintained

WC000311A—Voluntary Compensation and Employers Liability Coverage

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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

Rule 2-I (CT and FL Exceptions)Basic Manual


Reporting Voluntary Compensation

Policy and Unit Report

• Type of Nonstandard ID—Code 09—Voluntary Coverage

• Classification Code• Do not report repatriation

coverage charge• Exposure and loss amount• Repatriation losses and

expenses

Financial Call

• Premium for Voluntary Compensation (including Foreign Voluntary Compensation) insurance

• Premium for additional (optional) repatriation coverage

Circular DR-2013-03

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Employers Liability Insurance

Coverages• Workers Compensation and Employers Liability• Employers Liability Without Workers Compensation• Stop Gap Coverage—Monopolistic Funds• E/L Increased Limits

Reporting• Statistical Codes Corresponding to E/L Increased Limits• Statistical Code 9139—Flat Charge for Employers Liability/Voluntary Compensation• Type of Claim

• W/C and E/L• E/L only

Basic Manual Rule 3-A-14Statistical Plan Preface—A–1


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 Projects Reporting

• Policy• Wrap-Up/Owner Controlled Insurance

Program (OCIP) Code 1• Unit Report

• Separate unit reports (exposure/losses) by contractor

• Deductible program type• Loss reimbursement for net deductible

program


Wrap-Up Projects Reporting

Financial Call• Master Wrap-Up Policy that covers multiple years must be

reported as separate policies with individual effective dates for each of the annual components.

• For Wrap-Up Policies Not Written Under a Deductible Program: • Include experience (premiums, losses, and expenses) of all

associated owner/contractor and subcontractors in all Calls. • For Wrap-Up Policies Written Under a Large Deductible Program:

• Experience of all associated owner/contractor and subcontractors must follow the rules for including/excluding Deductible Policies—Large.

• For Wrap-Up Policies Written Under a Deductible Program—Other Than Large:• Experience of all associated owner/contractor and

subcontractors must follow the rules for including/excluding Deductible Policies—Other Than Large.

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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 Policy Policy # Wrapup4 10/1/13–10/1/14

Wrap-Up Policy Policy # Wrapup5 10/1/14–10/1/15


Wrap-Up Policy—Unit Reports


Bob’s PlumbingPolicy # Wrapup1B

10/1/10–5/1/11Payroll/Loss

Bob’s PlumbingPolicy # ABC


Manny’s SteelPolicy # Wrapup1C12/1/10–10/1/11

Payroll/Loss

Manny’s Steel Policy # GHI

1/1/10–1/1/11 Payroll/Loss

Julie’s WiringPolicy # Wrapup1D


Julie’s Wiring Policy # MNO


Richard’s Concrete Policy # Wrapup1E


Richard’s Concrete Policy # XYZ


• Deductible program type

• Reimbursement (Net Programs)

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Wrap-Up Policy—Financial Calls

• Report all premium, loss, and expense in Policy Year 2010

Small Deductible

Policy

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

Large Deductible

Policy



Retrospectively Rated Policies

Adjusts premium on losses incurred during the policy

termPremium reflects actual

experience of the insured

Losses incurred during the policy establishes cost of

insurance, including provisions for premium

expenses and taxes

Includes Loss Sensitive Rating Plan (LSRP)

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Retrospectively Rated Policies

• Policy• Retrospective Rating Code 5

• Unit Reports• Retrospective Rated Policy Indicator = Y• Premium Adjustments—do not report

• Financial• Retrospective Rating Plan Adjustments• Net—in• Company standard and DSR—out


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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Excess Policy Reporting

• Policy and unit report

• Statistical Plan Part 1.R.—Excess Policies

• Not Reportable

• West Virginia exception—Deliberate Intent Coverage

• Financial Call

• If reported in NAIC Page 14, Line 16 (WC Line) reconciliation

• Then, report only on Calls #1 and #1A, and as a reconciliation item in the Reconciliation Call #8


Minimum Premium Policy

Basic Manual Rule 3-A-16:

• If Any Coverage—Potential Exposure

• Subcontractors, Trucking Industry

• Exempt Employers Needing Certificate of Insurance

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• Policy Reporting• Multistate policy

• State Premium Record—at least $1• Exposure Record

• Unit Reporting• Statistical Code 1111• Balance to Minimum Premium• Expense constant• Loss with corresponding exposure


Pick the Answer

Questions

Covers One Job Location

For Potential Exposure

Increased Limits

Coverage Not Required

Above Workers Compensation Coverage

Answers

Employers Liability

Excess Policies

Wrap-Up Policy



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Catastrophe Provisions

Basic Manual

• Rule 3-A-24:

• Catastrophe (other than Certified Acts of Terrorism)

• Terrorism

• Miscellaneous Values

Reporting

• 9741—Catastrophe Provisions for Catastrophe (other than Certified Acts of Terrorism)

• 9740—Catastrophe Provisions for Terrorism

• Exposure, Rate and/or Premium


Anniversary Rating Date


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

• Industry approach

Reporting

• Policy State Premium Record

• Unit Report – Rate Effective Date and Modification Effective Date

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Oklahoma and Tennessee Law-Only Filings

• Premium adjustment for outstanding policies

• Three methods to apply the rating adjustments• Directly to the rates• Total manual premium• Split period method

• Circulars• OK-2014-01• TN-2014-01 and TN-2014-04


Uncooperative Audit or Audit Noncompliance

• Part five of the policy contains audit provisions

• The right of the carrier to examine and audit all policyholder records

• If the employer is uncooperative and the carrier is unable to verify the necessary data

• In some states, the carrier can apply a noncompliance charge

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Uncooperative Audit or Audit Noncompliance

State-specific endorsements:

• If insured refuses to cooperate in completing a final audit, must pay additional funds not to exceed several times the most recent estimated annual premium

• Separate charge if applicable from class code manual premium


Uncooperative Audit or Audit NoncomplianceState 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 None NoMay increase payroll up to a maximum of three times the estimated payroll for purposes of determining the final premium

NC None NoMay increase payroll up to a maximum of three times the estimated payroll for purposes of determining the final premium

GA WC 10 04 02 NoMay utilize a payroll amount of three times the estimated payroll for purposes of determining final premium

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Ratable/Nonratable 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

• FL Example:


Non-Ratable Elements

Statistical Codes for Non-Ratable Portion of Class Code Rate

• Report Exposure, Rate, and Premium

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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, Silicosis

• Not subject to experience rating or retrospective rating

• FL Example:


Supplemental Disease Exposures

• Statistical Codes for Supplemental Disease

• Report Exposure, Rate, Premium and Loss

• 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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Lump Sum/Settlements• Unit Report

• Lump-Sum Settlement—Y/N Indicator• Discounted/Commutative• Claim Status• Allocated between Medical and Indemnity

• Detailed Claim Information

• Lump Sum Amount Paid

• Benefits Covered by Lump Sum Code

• Financial Call• Allocated between Medical and Indemnity

• If subdivision is unknown or unspecified, use case values at the time of settlement to determine proration


Medicare Secondary Payer (MSP)

• Claimant receives benefits under a WC policy and may be entitled to Medicare benefits in the future

• Medicare is not responsible for paying claims associated with a WC injury first—also referred to as coordination of benefits

• Workers compensation pays first, and the secondary payer is Medicare

Reporting:

• Medical loss reported includes “set-aside” to cover future medical costs, management fees

• MSP service provider fees are ALAE/DCCE

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Missouri Mesothelioma

• Additional benefits provided for mesothelioma under Missouri statutes

• Insured may elect to exclude additional benefits for mesothelioma, which eliminates exclusive remedy provisions

• Endorsements (WC 23 03 02 or WC 23 03 03)


Missouri Mesothelioma

DR-2014-01• Policy Reporting

• Endorsement Record Type 7

• Unit Reporting

• Charge for Additional Mesothelioma Benefits—Independent Carrier Filing Statistical Code

• Financial Call Reporting

• Net Earned Premium

• Include the premium for Additional Mesothelioma Benefits

• Company Standard Premium and DSR Level Premium

• Exclude premium for Additional Mesothelioma Benefits

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West Virginia Deliberate Intent Coverage

• 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

• Type of Nonstandard ID Code 05—Excess Policy

• Exposure Act Code 07—Excess Benefits Coverage

• Report corresponding losses under Code 9614

• Loss Condition Code—Type of Claim 05—Excess Benefits

• Financial Call #8—Enter as “Reason for Difference” if included on company’s NAIC Annual Statement


Considerations

• Is the policy reportable on line 16 of the NAIC Annual Statement Exhibit of Premiums and Losses?

• What is the policy term?

• Does the policy cover the entire exposure and/or is the insurer directly responsible for all losses?

• Does the policy include optional coverage(s) for risk(s) outside the scope of the basic policy?

• Is the program administered by NCCI?

• What is the nature of any independently filed carrier program(s)?

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Considerations

• What is the exposure state?

• What is the location of the exposure?

• How is the manual premium determined for each class?

• Can the final charged premium be determined at first audit?

• What is the benefit (jurisdiction) state?

• What Act determines the level of benefits that may be paid?


Considerations

• Is the final claim payment the result of a settlement?

• If so, is there a reasonable allocation of the settlement between indemnity and medical?

• Does the medical portion of the settlement include an amount for a Medicare Set-Aside arrangement?

• If an injured worker is receiving wage loss benefits pursuant to a claim, is the employer or the carrier paying the benefits?

• If the employer is paying the wage loss benefits, what is the level of the benefits and the duration of the payments?

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4343© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 2014 Data Educational Program

Federal Coverages


State vs. Federal Workers Compensation

• Workers compensation laws protect people who are injured on the job

• Designed to ensure that injured employees are provided with fixed monetary awards, eliminating the need for litigation

• State statutes establish this framework for most employment

• Federal statutes are limited to federal employees or workers employed in some aspects of interstate commerce

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Topics

• Federal Employers Liability Act

• Admiralty Law

• USL&HW Act and Extensions

• Texas Classes for Oil and Gas Industry

• Defense Base Act

• Federal Mine Safety and Health Act

• National Defense Projects Rating Plan

• Atomic Energy


Federal Employers Liability Act (FELA)

Basic Manual Rule 3-A-4:• Railroads engaged in interstate commerce are

liable for injuries to, employees if the railroads have been negligent

• Not intended to be awarded automatically• Requires the injured railroader to prove that the

railroad was “legally negligent,” at least in part, in causing the injury

• This Act is the sole and exclusive remedy for an injury to a worker employed by a railroad

• Added to the Standard Policy by attaching Endorsement (WC 00 01 04 A)

• FELA is not available in the residual market where NCCI is the Plan Administrator

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FELA Coverage

FELA Program I

Federal Employers’ Liability Act Coverage

EndorsementWC 00 01 04 A

Standard Workers Compensation and Employers Liability

PolicyWC 00 00 00B


FELA Coverage With Voluntary Compensation

FELA Program II

Federal Employers’ Liability Act Coverage



PolicyWC 00 00 00B Voluntary

Compensation and Employers Liability

Coverage Endorsement

WC 00 03 11 A

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FELA Coverage With Voluntary Compensation and Longshore and Harbor

Workers’ CompensationFederal

Employers’ Liability Act Coverage


Voluntary Compensation and Employers Liability

Coverage Endorsement

WC 00 03 11 A

Longshore and Harbor Workers’

Compensation Act Coverage

EndorsementWC 00 01 06A

FELA Program IIUSL Act


PolicyWC 00 00 00B


Admiralty Law(Merchant Marine/Jones Act)


• Employee benefits—similar to workers compensation for masters and members of crews

• Provides seamen with the same protection from employer negligence as FELA provides railroad workers

• State Act Workers Compensation plans DO NOT cover vessel crew

• Employees can bring action against their employer for negligence

• Transportation Wage Maintenance and Cure (TWMC) coverage may be available

• Added to the Standard Policy by attaching Endorsement (WC 00 02 01 A)

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Maritime Coverage

Maritime Program I

Maritime Coverage EndorsementWC 00 02 01A


PolicyWC 00 00 00B


Maritime Coverage With Voluntary Compensation

Maritime Program II



PolicyWC 00 00 00B


Maritime Coverage EndorsementWC 00 02 03

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Maritime Coverage With Voluntary Compensation and Longshore and Harbor Workers’ Compensation



Maritime Coverage EndorsementWC 00 02 03

Longshore and Harbor Workers’

Compensation Act Coverage

EndorsementWC 00 01 06A

Maritime Program IIUSL Act


PolicyWC 00 00 00B


Summary

• Interstate Railroad Employees• Program I or Program II• Endorsement WC 00 01 04 A

FELA

• Master/Crew Members• Program I or Program II• Endorsement WC 00 02 01 A (TWMC)

Admiralty

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Admiralty Law/FELA Reporting

• Policy and Unit Report

• Program I and II—01 for Exposure Act Code and Loss Conditions Act Code

• Program II—USL Act

• 02 for Exposure Act Code

• 01 or 02 for Loss Conditions Act Code, depending on benefits

• Do not report additional premium for Transportation Maintenance Wages Cure (TMWC)

• Financial Call

• Maritime and FELA classes—Not reportable


Quiz

Railroad workers engaged in interstate commerce need _________ coverage.

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Quiz

__________________ provides seamen with the same protection from employer negligence as FELA.


Quiz

FELA and/or Admiralty coverage are added to the standard WC Policy by ______________.

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United States Longshore and Harbor Workers Compensation Act (USL&HW)


• A federal WC law that applies to workers in maritime employments—including longshore, harborworkers, shipbuilders, ship breakers, and ship repairers

• It does not apply to masters or crews of vessels

• Compensation benefits to workers for an employment-related injury or disease occurring on the navigable waters of the United States or adjoining shore side areas


Status and Situs

• Status is an occupational concept that determines if the “work performed” or “duty” is considered maritime employment

• Situs is a geographical concept that determines if the “place” of injury is considered an area used by an employer for maritime work

• Added to the Standard Policy by attaching Endorsement (WC 00 01 06A)

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Status and Situs

Status Situs

COVERED


USL&HW Extensions

• Defense Base Act

• Nonappropriated Funds Endorsement

• Outer Continental Shelf Lands Act

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Defense Base Act

• Covers workers engaged in employment on overseas defense bases or under contract with the US government



Outer Continental Shelf Lands Act

• Extends benefits when an injury occurs while work is conducted on the Outer Continental Shelf for the purpose of exploring, developing, removing, or transporting natural resources by pipeline

• Added to the Standard Policy by attaching Endorsement (WC 00 01 09B)

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Nonappropriated FundInstrumentalities Act

• Covers morale, welfare, and recreation workers on US military installations in continental Unite States and overseas



Summary

• Navigable waters of the United States• Endorsement WC 00 01 06 A

USL&HW

• Defense Base Act Endorsement WC 00 01 01 A • Nonappropriated Funds Endorsement

WC 00 01 08 A• Outer Continental Shelf Lands Act Endorsment

WC 00 01 09 B

USL&HW Extensions

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Premium Federal Exposure

Basic Manual Rule 3-A-4

Classifications, loss costs, or rates subject to admiralty law, FELA, and USL&HW Act

• F-Classification codes and Admiralty/FELA classifications that include USL&HW Act benefits

• Non-F-Classification codes and Admiralty/FELA classifications that do not include USL&HW Act benefits


USL&HW Example

Found on the NCCI advisory loss cost and/or rate pages in NCCI’s Basic Manual

Classification Payroll Rate LHWCA Factor Adjusted Rate Premium

6872F $75,000 18.36 n/a 18.36 $13,770

5403 $75,000 11.96 2.21 26.43 $19,823

Example using Florida rates effective 01/01/14:

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Federal and State Act

• Concurrent Benefits

• Reporting


USL&HW and Extensions

• Policy and Unit Report• F-Classes (e.g. 9077F)• Industrial class where rate is increased by

USL&HW factor • Exposure Act 02• Loss Condition Act 02 or 01 depending on

benefits• Jurisdiction State 00

• Financial Call• F-Classes—Not reportable• F-Loaded Classes—Reportable

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Texas Classes for Oil, Gas, or other Minerals Over Water

Experience Rating Plan• Classifications for oil, gas, or other minerals on

or over water

Statistical PlanPart 6—Coding ValuesOil, Gas, or other Minerals Over Water Coverage

• G. Exposure Act/Exposure Coverage Codes• State Act (Code 05)• USL&HW (Code 08)

• K-1. Act—Loss Condition Codes• State Act (Code 05)• USL&HW (Code 08)


Federal Coverage Service for USL&HW

• USL&HW and its extensions coverage

• State Premium Record—Record Type 04 (one or more NCCI states on policy)

• Exposure Record—Record Type 05• USLH&W F-Class (refer to Policy and Proof of

Coverage Reporting Guidebook for listingOr• Exposure Act Code 02

• Endorsement Identification Record—Record Type 07 (must include one or more of the federal USL&HW endorsement numbers)

• Daily electronic file to US Department of Labor

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Defense Base Act (DBA)

• Monoline Coverage

• Reporting Service


Federal Coverage Service for DBA

Daily electronic file to US Department of Labor

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Quiz

_________ is a federal coverage that provides workers compensation and employers liability to shipbuilders, ship repairers, and ship breakers.


Quiz

Daily electronic files are sent to the US Department of Labor for reported excess__________________ policies.

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Quiz

The ______________ industry in Texas has federal codes for work done over water.


Quiz

USL&HW has ______________ extensions available through endorsement.

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Federal Mine Safety and Health Act(Coal Mine Disease)


Disease coverage provided for risks subject to the Act

Advisory loss costs/rates and any underlying state law coverage for disease are shown separately on the state pages

In states where there are no coal mines, the state pages will not include information for this coverage

Available by endorsement (WC 00 01 02 A)


Federal Mine Safety and Health Act(Coal Mine Disease)

Coal worker’s pneumoconiosis (black lung) is a lung disease that results from breathing in coal dust over a long period of time.

Refer to US DOL for complete black lung definition.

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Exposure Coverage/Loss Condition Act Description

01 State Act

03 Federal Coal Mine Health and Safety Act

04 Federal Coal Mine Health and Safety Act and the State Act

Black Lung Disease Exposure/Loss


Exposure/Experience Class/Stat CodeExposure Act

(coverage)Loss Condition Act

(benefits paid/payable)UndergroundTraumatic or OD 1016 State 01 State 01

UndergroundBlack Lung Disease Experience 0158

State 01 State 01Fed 03 Fed 03

State/Fed 04State 01Fed 03

State/Fed 04SurfaceTraumatic or OD

1005(1165 – Texas) State 01 State 01

Surface Black Lung Disease Experience 0156



State/Fed 04

Coal Mine Class Codes

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Exposure/Experience Class/Stat CodeExposure Act

(coverage)Loss Condition Act

(benefits paid)

Other Operations(Non-Coal Mine)Traumatic or OD

7228(e.g., Trucking) State 01 State 01

Other OperationsBlack Lung Disease Experience

0164(0161 or 0162 –

Virginia)



State/Fed 04

Non-Coal Mine Class Codes


Loss Condition Act Jurisdiction State03

0004

Federal Black Lung DiseaseLoss Fields

Loss Condition Act Loss Condition—Type of Loss03

02—Occupational Disease04

Loss Condition Act Part of Body Nature of Injury

0360—Lungs(Example)

60—Dust Disease, NOC62—Black Lung

04 64—Silicosis

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Federal Coverage Service forFederal Mine Safety and Health Act

• State Premium Record—Record Type 04 (one or more NCCI states on policy)

• Exposure Record—Record Type 05• Federal Coal Mine Classification or Statistical Code

(refer to Policy and Proof of Coverage Reporting Guidebook for listing)

Or• Exposure Act Code 03 or 04

• Endorsement Identification Record—Record Type 07—must include the Federal Mine Safety and Health Act coverage endorsement number

• Daily electronic file to US Department of Labor


Financial Call Reporting forFederal Mine Safety and Health Act

Financial Call• All states except Virginia do not report any

underground coal mine experience (traumatic, OD, and black lung) except as a reconciliation item.

• All states except Virginia report any surface coal mine experience for traumatic and OD. Do not report any surface coal mine experience for black lung except as a reconciliation item.

• Virginia experience for all coal mine risks is reported on Virginia state-specific coal mine calls.

• 1165—Texas Coal Mine NOC

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National Defense Projects Rating Plan (NDPRP)

Retrospective Rating Plan run by US Department of Defense (DoD)

• Intended to provide insurance to an eligible contractor at lower costs• Covers employees of contractor and all subcontractors working at the

same location

Eligibility

• Government contracts represent at least 90% of the payroll for operations at specific location

• Estimated annual premium for insurance is at least $10,000

Previously Comprehensive Rating Plan; not to be confused with the Defense Base Act


National Defense Experience

Coverage Type Policy/POC Unit FinancialNational Defense Projects Rating Plan (ComprehensiveRating Plan)

Reportable Not Reportable Reportable only in:• Call 1• Call 8• Call 19

Other National Defense Projects (Guaranteed Cost or Other Retro Plan)

Reportable Reportable Reportable

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Atomic Energy

• Work performed for or under the direction of the Nuclear Regulatory Commission (NRC) or government agency• Class Code 9984• Not reportable to NCCI

• Work not performed for or under the direction of the NRC or government agency • Statistical Code 9985• Premium/Loss reported to NCCI

• Nevada state special programs• Cost-plus work performed at atomic energy sites

under contract with the government—9661 • Nuclear research at atomic energy projects—9662


Pick the Answer

QuestionsAnother name for black

lung disease

Retro program run by DoD

Type of work performed for the NRC

State with only one coal class code type

State that doesn’t report surface coal experience

Answers

Atomic Energy

Virginia

Pneumoconiosis

NDPRP

Texas

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Considerations

• Is the policy reportable on line 16 of the NAIC Annual Statement Exhibit of Premiums and Losses?

• Does the policy include optional coverage(s) for risk(s) outside the scope of the basic policy?

• What is the nature of the relationship, if any, of the insured (employer) to an agency of the federal government?

• What is the exposure state?

• What is the location of the exposure?


Considerations

• For a coal mine risk, is the operation on the surface or underground?

• How is the manual premium determined for each class?

• What is the benefit (jurisdiction) state?

• What Act determines the level of benefits that may be paid?

• Is the injury of a traumatic or occupational disease nature, specifically pneumoconiosis (black lung)?

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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 provide industry relationships and 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.

Shani Oulton has worked at NCCI for 11 years in the Regulatory Services Division, currently in the National Policy Development area. She is primarily responsible for monitoring workers compensation industry trends across states, with a strong focus on Professional Employer Organizations.

Shani holds a bachelor of science degree from the University of Florida.

Documents

Objective - NCCI Holdings Inc. · 2015-10-07 · Coverage for workers not required under statute—optional coverage ... • Stop Gap Coverage—Monopolistic Funds •E/L Increased