Federal Coverages & Niche Programs Policy Rules & Reporting Requirements. Presented by: Julie Gonzalez and Shani Oulton. Objective

Transcription

1 Federal Coverages & Niche Programs Policy Rules & Reporting Requirements Presented by: Julie Gonzalez and Shani Oulton Copyright 2015 National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved. 1 Objective To provide an overview of Niche and Federal type programs, and discuss data reporting requirements across multiple data types. 2 1

2 Agenda Overview of Data Types and Data Usage Niche Programs Federal Coverages 3 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 4 2

3 Niche Programs Copyright 2015 National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved 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 Production quality Demographics Small market segment 6 3

4 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 7 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 8 4

5 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 Basic Manual Rule 2-I (CT and FL Exceptions) 9 Reporting Voluntary Compensation Policy and Unit Report Financial Call Type of Nonstandard ID Code 09 Voluntary Coverage Classification Code Do not report repatriation coverage charge Exposure and loss amount Repatriation losses and expenses Premium for Voluntary Compensation (including Foreign Voluntary Compensation) insurance Premium for additional (optional) repatriation coverage Circular DR

6 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-14 Statistical Plan Preface A 1 11 Wrap-Up Construction Projects Basic Manual Rule 3-A-23 Owner/ General Contractor Policies are issued by one carrier to two or more legal entities Classifications assigned to each separate legal entity based on operations Electrician Steel Framers Plumbers Designated Workplace Exclusion Endorsement (WC ) Owner Controlled Insurance Program (OCIP) or Contractor Controlled Insurance Program (CCIP) 12 6

7 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 13 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. 14 7

8 Wrap-Up Policy Example 5 Year Wrap-Up Program Wrap-Up Policy Policy # Wrapup1 10/1/10 10/1/11 Wrap-Up Policy Policy # Wrapup2 10/1/11 10/1/12 Wrap-Up Policy Policy # Wrapup3 10/1/12 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 15 Wrap-Up Policy Unit Reports Bob s Plumbing Policy # Wrapup1B 10/1/10 5/1/11 Payroll/Loss Bob s Plumbing Policy # ABC 1/1/10 1/1/11 Payroll/Loss Wrap-Up Policy Policy # Wrapup1 10/1/10 10/1/11 Deductible program type Reimbursement (Net Programs) Manny s Steel Policy # Wrapup1C 12/1/10 10/1/11 Payroll/Loss Julie s Wiring Policy # Wrapup1D 1/1/11 5/1/11 Payroll/Loss Richard s Concrete Policy # Wrapup1E 6/1/11 10/1/11 Payroll/Loss Manny s Steel Policy # GHI 1/1/10 1/1/11 Payroll/Loss Julie s Wiring Policy # MNO 1/1/11 1/1/12 Payroll/Loss Richard s Concrete Policy # XYZ 1/1/11 1/1/12 Payroll/Loss 16 8

9 Wrap-Up Policy Financial Calls Wrap-Up Policy Policy # Wrapup1 10/1/10 10/1/11 Small Deductible Policy Large Deductible Policy Report all premium, loss, and expense in Policy Year 2010 Exclude all premium, loss, and expense from Policy Year/CAY Calls 17 Retrospectively Rated Policies Adjusts premium on losses incurred during the policy term Premium 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) 18 9

10 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 19 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 20 10

11 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 21 Minimum Premium Policy Basic Manual Rule 3-A-16: If Any Coverage Potential Exposure Subcontractors, Trucking Industry Exempt Employers Needing Certificate of Insurance 22 11

12 Minimum Premium Policy 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 23 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 Minimum Premium Policy Voluntary Compensation 24 12

13 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 25 Anniversary Rating Date Basic Manual Rule 3-A-2: 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 26 13

14 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 TN and TN 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 28 14

15 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 29 Uncooperative Audit or Audit Noncompliance State Endorsement Statistical Code Basic Manual CO WC MT WC FL WC (not part of standard premium) 9757 (not part of standard premium) 9757* (not part of standard premium) *FLJUA Only Audit Noncompliance Charge Amount not specified (carrier must file with DOI for approval) Audit Noncompliance Charge Amount not specified (carrier must file with DOI for approval) Audit Noncompliance Charge Not to exceed three times most recent estimated annual premium MO WC A 9757 (not part of standard premium) Audit Noncompliance Charge Equal to estimated annual premium SC None No NC None No GA WC No May increase payroll up to a maximum of three times the estimated payroll for purposes of determining the final premium May increase payroll up to a maximum of three times the estimated payroll for purposes of determining the final premium May utilize a payroll amount of three times the estimated payroll for purposes of determining final premium 30 15

16 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: 31 Non-Ratable Elements Statistical Codes for Non-Ratable Portion of Class Code Rate Report Exposure, Rate, and Premium 32 16

17 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: 33 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 34 17

18 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 35 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 36 18

19 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 or WC ) 37 Missouri Mesothelioma DR 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 38 19

20 West Virginia Deliberate Intent Coverage Endorsement (WC A) 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 39 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)? 40 20

21 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? 41 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? 42 21

22 Federal Coverages Copyright 2015 National Council on on Compensation Insurance, Inc. Inc. All All Rights Reserved Data Educational Program 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 44 22

23 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 45 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 A) FELA is not available in the residual market where NCCI is the Plan Administrator 46 23

24 FELA Coverage FELA Program I Standard Workers Compensation and Employers Liability Policy WC B Federal Employers Liability Act Coverage Endorsement WC A 47 FELA Coverage With Voluntary Compensation FELA Program II Standard Workers Compensation and Employers Liability Policy WC B Federal Employers Liability Act Coverage Endorsement WC A Voluntary Compensation and Employers Liability Coverage Endorsement WC A 48 24

25 FELA Coverage With Voluntary Compensation and Longshore and Harbor Workers Compensation Federal Employers Liability Act Coverage Endorsement WC A FELA Program II USL Act Standard Workers Compensation and Employers Liability Policy WC B Voluntary Compensation and Employers Liability Coverage Endorsement WC A Longshore and Harbor Workers Compensation Act Coverage Endorsement WC A 49 Admiralty Law (Merchant Marine/Jones Act) Basic Manual Rule 3-A-4: 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 A) 50 25

26 Maritime Coverage Maritime Program I Standard Workers Compensation and Employers Liability Policy WC B Maritime Coverage Endorsement WC A 51 Maritime Coverage With Voluntary Compensation Maritime Coverage Endorsement WC A Maritime Program II Standard Workers Compensation and Employers Liability Policy WC B Voluntary Compensation Maritime Coverage Endorsement WC

27 Maritime Coverage With Voluntary Compensation and Longshore and Harbor Workers Compensation Maritime Coverage Endorsement WC A Maritime Program II USL Act Standard Workers Compensation and Employers Liability Policy WC B Voluntary Compensation Maritime Coverage Endorsement WC Longshore and Harbor Workers Compensation Act Coverage Endorsement WC A 53 Summary FELA Interstate Railroad Employees Program I or Program II Endorsement WC A Admiralty Master/Crew Members Program I or Program II Endorsement WC A (TWMC) 54 27

28 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 55 Quiz Railroad workers engaged in interstate commerce need coverage

29 Quiz provides seamen with the same protection from employer negligence as FELA. 57 Quiz FELA and/or Admiralty coverage are added to the standard WC Policy by

30 United States Longshore and Harbor Workers Compensation Act (USL&HW) Basic Manual Rule 3-A-4: 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 59 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 A) 60 30

31 Status and Situs Status C O V E R E D Situs 61 USL&HW Extensions Defense Base Act Nonappropriated Funds Endorsement Outer Continental Shelf Lands Act 62 31

32 Defense Base Act Covers workers engaged in employment on overseas defense bases or under contract with the US government Added to the Standard Policy by attaching Endorsement (WC A) 63 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 B) 64 32

33 Nonappropriated Fund Instrumentalities Act Covers morale, welfare, and recreation workers on US military installations in continental Unite States and overseas Added to the Standard Policy by attaching Endorsement (WC A) 65 Summary USL&HW Navigable waters of the United States Endorsement WC A USL&HW Extensions Defense Base Act Endorsement WC A Nonappropriated Funds Endorsement WC A Outer Continental Shelf Lands Act Endorsment WC B 66 33

34 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 67 USL&HW Example Found on the NCCI advisory loss cost and/or rate pages in NCCI s Basic Manual Example using Florida rates effective 01/01/14: Classification Payroll Rate LHWCA Factor Adjusted Rate Premium 6872F $75, n/a $13, $75, $19,

35 Federal and State Act Concurrent Benefits Reporting 69 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 70 35

36 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 Plan Part 6 Coding Values Oil, 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) 71 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 listing Or 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 72 36

37 Defense Base Act (DBA) Monoline Coverage Reporting Service 73 Federal Coverage Service for DBA Daily electronic file to US Department of Labor 74 37

38 Quiz is a federal coverage that provides workers compensation and employers liability to shipbuilders, ship repairers, and ship breakers. 75 Quiz Daily electronic files are sent to the US Department of Labor for reported excess policies

39 Quiz The industry in Texas has federal codes for work done over water. 77 Quiz USL&HW has extensions available through endorsement

40 Federal Mine Safety and Health Act (Coal Mine Disease) Basic Manual Rule 3-A-12: 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 A) 79 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

41 Black Lung Disease Exposure/Loss Exposure Coverage/Loss Condition Act 01 State Act Description Federal Coal Mine Health and Safety Act Federal Coal Mine Health and Safety Act and the State Act 81 Exposure/Experience Coal Mine Class Codes Class/Stat Code Exposure Act (coverage) Loss Condition Act (benefits paid/payable) Underground Traumatic or OD 1016 State 01 State 01 Underground Black Lung Disease Experience Surface Traumatic or OD Surface Black Lung Disease Experience (1165 Texas) 0156 State 01 State 01 Fed 03 Fed 03 State/Fed 04 State 01 Fed 03 State/Fed 04 State 01 State 01 State 01 State 01 Fed 03 Fed 03 State/Fed 04 State 01 Fed 03 State/Fed

42 Non-Coal Mine Class Codes Exposure/Experience Other Operations (Non-Coal Mine) Traumatic or OD Other Operations Black Lung Disease Experience Class/Stat Code 7228 (e.g., Trucking) 0164 (0161 or 0162 Virginia) Exposure Act (coverage) Loss Condition Act (benefits paid) State 01 State 01 State 01 State 01 Fed 03 Fed 03 State/Fed 04 State 01 Fed 03 State/Fed Federal Black Lung Disease Loss Fields Loss Condition Act Loss Condition Act Jurisdiction State 00 Loss Condition Type of Loss 02 Occupational Disease Loss Condition Act Part of Body Nature of Injury Lungs (Example) 60 Dust Disease, NOC 62 Black Lung 64 Silicosis 84 42

43 Federal Coverage Service for Federal 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 85 Financial Call Reporting for Federal 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 Texas Coal Mine NOC 86 43

44 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 87 National Defense Experience Coverage Type Policy/POC Unit Financial National Defense Projects Rating Plan (Comprehensive Rating Plan) Other National Defense Projects (Guaranteed Cost or Other Retro Plan) Reportable Not Reportable Reportable only in: Call 1 Call 8 Call 19 Reportable Reportable Reportable 88 44

45 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 Pick the Answer Questions Another 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 90 45

46 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? 91 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)? 92 46

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51 Presenter Biographies Julie Gonzalez, AIDM, has been employed at NCCI since 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.