1 COMMERCIAL LIABILITY STATISTICAL PLAN MANUAL General Insurance Statistical Agency/ Agence statistique d assurance generale 17 th floor 5160 Yonge Street Toronto, Ontario M2N 6L9 asag.ca
2 REVISION HISTORY Date Version Comments Number August, 2011 V1.0 Initial Release October, 2011 V Chapter 4 Minor Changes 2. Rearrange Appendix A (A1, A2, A3) January, 2012 V Chapter 4 Premium Location (New Footnote and Formatting Changes)
4 4 Table of Contents Contents REVISION HISTORY... 2 CHAPTER 1 INTRODUCTION... 7 General... 7 Scope... 8 Jurisdiction of the Plan... 8 Statistical Agency... 9 Statistical Agency Service Provider... 9 Roles and Responsibilities of Insurers... 9 Need for Statistical Data... 9 Reporting Basis for Annual Statistical Reports Reporting Requirements for Inactive Companies Reporting Requirements for Fronting Companies Reporting Requirements Regarding Self Insured Side Agreements Reporting Requirements involving Portfolio Transfers of Business CHAPTER 2 DATA QUALITY Data Quality for Insurers and Service Provider Edit Exceptions Validity and Consistency Checks Reasonability Checking By Service Provider Insurer Responsiveness to Reasonability/Accuracy Issues Report(s) to Statistical Agency (GISA) CHAPTER 3 GENERAL INSTRUCTIONS Record Formats Revisions to the Plan Reinsurance Package Policies Ontario Policies Cancellations and Endorsements... 17
5 Table of Contents 5 Outstanding Reserves Reporting Media Submission Due Dates Reconciliation Monthly Annual Balance Reconciliation Return Error Transactions Deficiency Fees Contact Information CHAPTER 4 FIELD DEFINITIONS Submission Control Policy Classification Coverage Claim Detail CHAPTER 5 FIELD CODES Accident Date Basis of Claim Claim Control ID Claim Count Claim Identification Claim Identification Digit Claim Location Company Identification Coverage/ Policy Form code Deductible Amount Deductible Type Entry Date Event Category Expense Amount Expense Type Exposure Amount... 48
6 6 Table of Contents Exposure Base Unit Exposure Type Industry Classification Kind of Loss Line Loss Amount Notice of Claim Date Notice of Occurrence Date Percent Participation Policy Control ID Date Policy Expiry Date Policy Identification Policy Identification Digit Policy Limit Policy Type Premium Amount Premium Location Record Format Version Number Retroactive Date Statistical Plan Transaction Effective Date Transaction Type Appendix A Industry Classification s Appendix B Premium Record Layout Appendix C Claim Record Layout
7 Chapter 1 Introduction 7 CHAPTER 1 INTRODUCTION General A number of Insurance regulatory authorities across Canada have the authority under their respective insurance legislation to collect experience from all licensed insurers in a form approved by the regulatory authority. The Commercial Liability Statistical Plan ( the Plan ) Manual sets out the statistical data reporting requirements of each participating jurisdiction. Currently only Ontario participates in this Plan. Insurance legislation also allows the regulatory authorities to appoint a statistical agency to collect the experience of the licensed insurers. The General Insurance Statistical Agency ( GISA ) was established to carry out the activities of a statistical agent on behalf of Alberta, New Brunswick, Newfoundland & Labrador, Nova Scotia, Ontario, Prince Edward Island, Yukon, Nunavut and the Northwest Territories. GISA is a federally incorporated, not for profit corporation governed by a Board of Directors, with representation from the nine participating insurance regulatory authorities, the property and casualty insurance industry and the public. On April 1, 2006, GISA was appointed as a statistical agent by the participating insurance regulatory authorities to provide governance, accountability and oversight of the mandated statistical plans. As the statistical agent, GISA : promotes the timeliness of statistical data collection, analysis and reporting mechanisms; acts on behalf of the participating insurance regulators to coordinate and harmonize the statistical data filing requirements for insurers regarding the experience of their business in such jurisdictions; and promotes the quality and value of statistical data generated by licensed insurers. Insurance legislation also allows the regulatory authorities to appoint a statistical agency to collect the experience of the licensed insurers. Concurrent with its appointment as a statistical agent, GISA entered into a service agreement with the Insurance Bureau of Canada ( IBC ) to provide statistical plan services under specified terms and conditions and to receive the information prescribed by the Plan, from insurers. Further information regarding GISA is available through its website at asag.ca. All correspondence and matters pertaining to the Plan should be directed to the Director, Government Products and Services, Insurance Bureau of Canada, 2235 Sheppard Avenue East, Atria II, Suite 1100, Toronto, Ontario, M2J 5B5.
8 8 Chapter 1 Introduction Scope The Commercial Liability Statistical Plan, previously known as the Commercial Casualty Statistical Plan, is mandatory and applies to all companies writing Commercial Liability Insurance, and includes any unincorporated group, exchange or pool of organizations providing such insurance to members that is licensed and monitored on a continuous basis by the Ontario Superintendent of Insurance. Jurisdiction of the Plan The Commercial Liability Statistical Plan was first introduced in July 1987 as a voluntary reporting requirement for all companies who were members of IBC. Subsequent to the 6 month transition period, the Plan became a mandatory requirement for all member companies of IBC writing Commercial Liability Insurance. In January 1990 the Ministry of Financial Institutions for the province of Ontario mandated the Plan to all insurers writing Commercial Liability Insurance in the province. The following classes of liability insurance business are covered by the Plan: 1. Commercial general liability including the following coverages: a. Bodily injury and property damage liability b. Personal injury liability c. Products and completed operations liability d. Employers' liability and voluntary compensation (injury not covered by workers' compensation) e. Contractual liability f. Owners', landlords' and tenants' liability 2. Tenants' legal liability 3. Professional liability a. Errors and omissions insurance b. Malpractice insurance 4. Other business liability coverages a. Directors' and officers' liability b. Pollution liability c. Wrap up liability 5. Excess or umbrella liability
9 Chapter 1 Introduction 9 The Plan applies to all Direct Written business transacted for the above mentioned. The Plan does not apply to reinsurance business assumed. All transactions are to be reported gross of reinsurance ceded. The purpose of the Plan is to compile comprehensive industry and individual company data for commercial liability business, and to produce annual standard exhibits and, when requested, customized exhibits. Companies are required to submit data as prescribed in Chapter 3 General Instructions. Insurance company data records are subject to onsite audit from time to time by the Statistical Agency or their designated Service Provider. Statistical Agency The General Insurance Statistical Agency (GISA) was appointed by the participating insurance regulatory authorities as statistical agent on April 1, Statistical Agency Service Provider GISA has entered into a service agreement with the Insurance Bureau of Canada (the Service Provider ) under which the latter provides statistical plan services under specified terms and conditions including data collection, quality assurance, compilation and reporting services. The agreement includes certain schedules for reporting to GISA regarding data collection issues and specific data quality issues as well as compilation of industry statistical exhibits. (Refer to Chapter 2, Data Quality) Roles and Responsibilities of Insurers Insurers are required to report to the designated Service Provider in accordance with the requirements set out in the Commercial Lines Statistical Plan Manual. Insurers are directed to the Data Quality section of this manual, which identifies the importance of quality data and procedures employed by the Service Provider related to data quality. Insurers are expected to co operate with the Service Provider to resolve any data quality issues in a timely fashion. Need for Statistical Data Statistical data captured through the Plan is used by both industry and government. Statistical data, which is captured on an accident year basis, matches premiums and claims costs based on the year that the accident occurred, to provide a more accurate picture of experience to estimate future costs and is used in the process of determining rates. As certain types of claims take a long time to settle, insurers must revise estimates of claims liabilities on a regular basis. Claims costs in any financial period reflect claims payments made and adjustments to claims
10 10 Chapter 1 Introduction liabilities in the financial period, for accidents that occurred in the current and prior years. Financial data does not provide the proper basis for estimating costs for determining rates. By having data available at an industry wide level, there is a broader statistical basis on which to make estimations of costs.
11 Chapter 1 Introduction 11 Reporting Basis for Annual Statistical Reports The Service Provider prepares annual statistical exhibits on behalf of GISA using the statistical data reported on an Accident Year basis, which matches premiums earned during a 12 month period with claims incurred resulting from accidents that occurred during that same period. Reporting Requirements for Inactive Companies Companies which have stopped writing business voluntarily or have been ordered by a court to be wound up, in any of the participating jurisdictions (refer to the section Jurisdiction of the Plan) must continue to report subsequent business activities such as payment of claims and refund of unearned premiums. Any dispensation from reporting requirements must be obtained from the Regulatory Authority in the applicable jurisdiction(s), who will notify GISA of such decisions. Reporting Requirements for Fronting Companies Where a company is fronting for another entity, which will usually not be a licensed insurer, the fronting insurer is responsible for statistical reporting to GISA in accordance with this Plan. Reporting Requirements Regarding Self Insured Side Agreements Where an insurer provides a Commercial Liability policy to an entity that, in turn, self insures part of the coverage by side agreement with the insurer, the insurer is responsible for statistical reporting to GISA in accordance with this Plan. Premiums collected in respect to such policy should be reported under this Plan, and all claims payable by the insurer, i.e., exceeding the self insured retention (SIR) layer, must be reported under this Plan. Reporting Requirements involving Portfolio Transfers of Business Portfolio transfers involve companies who have sold their business to another company. Both companies must co ordinate matters to ensure a smooth transition in statistical plan reporting to the Service Provider.
12 12 Chapter 2 Data Quality CHAPTER 2 DATA QUALITY Data Quality for Insurers and Service Provider Insurers are required to report data in accordance with the Plan. Intentionally inaccurate coding is prohibited and data reported to the Service Provider must reflect accurate information related to a policy or claim transaction. The Service Provider is also required to undertake a variety of validity and reasonability checks and follow up with insurers where issues are identified to ensure the quality of data. Insurers are also required to respond in a timely manner to queries raised by the Service Provider about issues related to such data. Edit Exceptions Insurers are responsible for examining edit exceptions identified by the Service Provider. Where it determines that the cause of an edit exception is erroneous information, the insurer must correct the erroneous data in a timely manner using error correcting processes as established by the Service Provider. If the edit exception reveals a condition that could produce systematic errors, the insurer must correct this condition in a timely fashion and correct all erroneously reported data using the error correcting process established by the Service Provider. Validity and Consistency Checks Validity checks are required to detect invalid coding, i.e., codes that are not valid for a certain data element as well as codes that are not valid (consistent) when used in conjunction with another data element code. Insurers are required to correct invalid codes as identified by the Service Provider.
13 Chapter 2 Data Quality 13 Reasonability Checking Reasonability checks are generally more difficult to apply and understand, because a significant amount of knowledge of the underlying business conditions is required. Reasonability checks do not ascertain with certainty that a given set of data contains errors. Reasonability checks do indicate potential problems and show whether the respective insurance company needs to do further research and analysis. For this reason, it is important that the Service Provider considers the time and expense required by insurers to investigate and verify or correct the reported data. By Service Provider The Service Provider conducts reasonability checks that include the comparison of both aggregate and company experience for various data elements for the current period to profiles from prior periods. In addition, the Service Provider compares average premiums, premium distributions, loss ratios, claims frequencies and loss development for major data elements to expected profiles for both individual companies and in aggregate. Results that indicate a significantly higher than average chance that a set of data may contain errors will be reported to insurers with an explanation of the unusual finding and its possible significance. When the possible or probable errors appear to be of a significant nature, the Service Provider will indicate to the insurer that the situation is critical. A critical situation involves an uncorrected or unconfirmed error, or errors, that cause the Service Provider to question whether the data should be used in reports to regulatory authorities. The Service Provider shall have reasonable flexibility in implementing error correction processes, which rely on their experience with data collection and knowledge of underlying business scenarios. Insurer Responsiveness to Reasonability/Accuracy Issues Insurers shall acknowledge and respond to all inquiries regarding reasonability issues identified by the Service Provider. This includes immediate and specific responses to issues raised as critical. Unresolved issues may trigger regulatory action. If data are identified as erroneous, corrections shall be made and provided to the Service Provider. Errors that are identified as critical issues may result in correction of historical data. For this purpose, insurers must maintain past data for at least five years, unless specific laws provide for a shorter retention period. Accurate coding of the policy and claim identification fields are required so that companies can investigate data quality problems and the Service Provider can link all activity for the same claim together for compilation of size of loss exhibits.
14 14 Chapter 2 Data Quality Report(s) to Statistical Agency (GISA) The Service Provider shall provide GISA with reports concerning data quality issues. These reports may identify insurers whose data was excluded from exhibits for any reason, including: that it fell outside the tolerance for missing or invalid data; or that the insurer was unable to reconcile its statistical and financial data with acceptable tolerances. These reports are made available to GISA on a regular basis, to facilitate discussion and resolution of issues in a timely manner.
15 Chapter 3 General Instructions 15 CHAPTER 3 GENERAL INSTRUCTIONS Record Formats There are two types of record formats used to report Commercial Liability experience to GISA. The Premium record format is used for reporting information related to the policy and includes the following business subject segments: Submission Control Policy Information required for the control of the submission, including: Company Identification Entry Date Statistical Plan Etc. Identification of the policy, including: Classification Policy Identification Date Policy Expiry Date Etc. Information related to the Classification of risk, such as: Coverage Premium Location Industry Classification Exposure Etc. Information related to the coverage(s), and premium charged/refunded, such as: Policy Limit Policy Premium Amount Percent Participation Deductible
16 16 Chapter 3 General Instructions The Claim record format is used for reporting all claims and claims details including several of the subject segments identified in the premium record, such as: Submission Control Policy Classification Coverage One additional business subject segment is reported in the claims record. Claim Detail Revisions to the Plan This segment includes information related to the specific claim, including: Claim Identification Kind of Loss Claim Amount Etc. Reinsurance The Plan is applicable to all premium and claim transactions for policies with effective dates on or after the date indicated for each required data element. All transactions (i.e., premiums and claims) must be submitted in accordance with the codes effective at the time of policy inception unless specifically stated otherwise. The experience to be reported is on DIRECT WRITTEN business. Therefore the reports of experience must not include premiums received or losses paid to other companies on account of Reinsurance Assumed. No deductions are to be made by the reporting company for premiums ceded to or losses received from other companies as a result of Reinsurance Ceded. Package Policies Neither premiums nor claims are to be reported for Indivisible Package Policies that include Direct Damage, Crime and Liability as combined basic coverage unless a separate Liability premium is internally identified on a per policy basis. Ontario Policies Ontario Package Policies that include a form of Automobile Liability Coverage (i.e. Non Owned Automobile S.P.F. 6, Excess Automobile Liability S.P.F. 7, Contingent Lessors Liability S.P.F. 8), may be reported on a separate transaction with the appropriate coverage codes contained in
17 Chapter 3 General Instructions 17 Schedule E. Alternatively, these coverages may be reported under the Automobile Statistical Plan. Cancellations and Endorsements Cancellations Report the unexpired term of the policy and the actual return premium (whether on a short rate or pro rata basis). Endorsements Report all endorsements in full detail on a debit/credit basis. Only report Endorsements which contain a premium amount (debit or credit). Discounts and Additional Premiums All premium discounts and surcharges, whether due to preferred classifications, experience rating or any other condition, shall be deducted from or added to the reported premium and the premium reported shall be the net premium received by the company from the insured. Outstanding Reserves Estimates of outstanding claims should include the estimated allocated claim expense. The outstanding reserves and allocated claim expense should be reported and coded in separate fields in accordance with the instructions given in this manual. Reporting Media The statistical data reported under the Plan must be filed electronically using the communication method specified by the Service Provider. For more information, please refer to the Data Submission Requirements Manual or contact the Data Quality Analyst assigned to you by the Service Provider. Submission Due Dates Completed data shall be sent to the Service Provider monthly. Monthly submissions shall include the transactions (writings, cancellations, losses and salvage) reportable under this Plan and must be received by the Service Provider within 30 days after the end of the month in which the transaction was entered into the company s records. Outstanding claims shall be reported to the Service Provider annually at the end of December and must be received by the Service Provider within 30 days after the end of December each year.
18 18 Chapter 3 General Instructions Reconciliation Monthly All insurers are required to confirm their submissions on a monthly basis, within 30 days after the end of each month. The totals in the data submitted must agree and balance with the insurer s books. The Service Provider has provided a web application for insurers to facilitate this monthly reconciliation. For more information, please contact the Data Quality Analyst assigned to you by the Service Provider. Annual Balance Reconciliation Return The purpose of the Annual Balance Reconciliation (ABR) Return is to verify that the Service Provider has received all data that is subject to statistical reporting. Companies are required to derive the expected amount of direct written premiums, direct claims paid and individual case outstanding losses on direct business to be reported to the Service Provider by disclosing adjustments that need to be made to the corresponding amounts on the financial statements. The Service Provider compares these expected amounts to the actual amounts submitted by each company on the statistical plan transactions. Discrepancies are communicated to the insurance companies involved. Error Transactions The Service Provider provides reporting companies with a web application to facilitate electronic error corrections. Insurers are required to correct their statistical data errors or resubmit transactions within the timelines specified by the Service Provider. Deficiency Fees Processing delays, frequently caused by late and inaccurate submissions, can compromise the timeliness and value of information available to the statistical agency. The statistical agency has authorized the Service Provider to levy deficiency fees against insurers who do not meet certain quality standards. Deficiency fees are designed to act as an incentive to improve the quality of submitted data. Please refer to the Deficiency Fee Manual for further details or contact the Data Quality Analyst assigned to you by the Service Provider.
19 Chapter 3 General Instructions 19 Contact Information For assistance with data reporting, the various data quality tools or the process employed, please contact the Data Quality Analyst assigned to you by the Service Provider.
20 20 Chapter 4 Field Definitions CHAPTER 4 FIELD DEFINITIONS This section provides definitions of the field requirements for the Commercial Liability Statistical Plan. The following field definitions are arranged in the same order as the record formats, which can be found in Appendix B and C. Each field definition provides a link to the appropriate table in the Field s section, which gives specific codes and values. The definition of each field is also labelled Premiums and/or Claims to indicate whether the field is required for premium submissions, claim submission or both.
21 Chapter 4 Field Definitions 21 Submission Control The following fields are included for submission control purposes. They are used by the Service Provider to control the efficient processing of submission batches from each insurer. Record Format Version Number This field is used to identify the particular record format being used. Premiums Claims Company Identification Premiums Claims A unique identifier assigned by the Service Provider to each reporting insurer to be used in all reporting under the Commercial Liability Statistical Plan. Entry Date Premiums Claims This field identifies the reporting period related to when the specific transaction was entered in the insurer s accounting records. Statistical Plan This field contains a code identifying the specific statistical plan. Premiums Claims Transaction Type Premiums Claims This field identifies the specific type of transaction and is also used to determine the financial values of the corresponding premium or claim amount fields (i.e. debit or credit).
22 22 Chapter 4 Field Definitions Policy This segment includes the identification of the policy contract including policy number, policy dates and policy level details. Policy Control ID Premiums This field is used by insurers to aid error handling and may contain a branch code or any other code that the insurer may find useful when handling error transactions. Policy Identification Digit Premiums Claims This field is used by insurers to facilitate error handling. It may be used in addition to Policy Control ID and contains a unique code that the insurer may find useful when handling error transactions. Policy Identification Premiums Claims This field contains the policy number, i.e., a unique number that the company has assigned to identify the specific policy. The policy number MUST identify the specific policy and is used by the Service Provider for the matching of claims transactions with their appropriate premium transactions. Note: To enable matching of claims to premiums, the same policy number MUST be reported on claims transactions. Date This is the date on which the policy becomes effective. Premiums Claims Retroactive Date Premiums Claims A claims made policy may be written by an insurer to cover accidents incurred prior to policy inception date. The date on and after which accidents are covered is called the Retroactive Date. Transaction Effective Date Premiums For endorsements affecting a mid term policy change, enter the effective date of the endorsement. In the case of cancellations, enter the date on which the cancellation is effective.
23 Chapter 4 Field Definitions 23 This date coincides with the Date on endorsements effective on the Policy Effective Date and on flat cancellations. Policy Expiry Date Enter the date the policy expires. Premiums
24 24 Chapter 4 Field Definitions Classification This section contains details related to the classification of the risk Premium Location Premiums Claims Enter the location code signifying the jurisdiction to which the premium has been allocated. Industry Classification Premiums Claims Enter the appropriate Industry Classification ; a complete list of the Standard Industry Classification codes can be found in Appendix A. Line This field signifies the Line of Business (i.e. Liability) Premiums Claims Exposure Type Premiums Claims This field identifies the Type of the exposure being reported; to maintain uniformity for reporting the exposure type, the Industry Classification codes in Appendix A contains the standard Exposure Type for each classification. Exposure Base Unit Premiums Claims Enter the appropriate unit used in determining the Exposure Amount. Exposure Base 2 ($000,000s) is to be used only in instances where annual revenue is $1 Billion or greater. Exposure Amount Premiums Claims Enter the number of unit of exposure as measured in terms of the Exposure Base Unit code reported. Where Exposure Base Unit is reported as 0 or 9 report in this field.
25 Chapter 4 Field Definitions 25 Coverage This segment contains information related to coverages in effect and their limits, deductibles and premiums. Coverage / Policy Form Report the applicable Coverage/ Policy Form code, noting: Premiums Claims Tenants Legal Liability is coverage for which a specified premium is charged, whether provided by a coverage extension or a stand alone policy; Excess Liability is to be used for policies that provide pure excess coverage over other separate policies, regardless of the type of liability coverage provided. Where additional coverages are made available under a Comprehensive/ Commercial General Liability Policy, report transactions for these coverages only if a specific premium is charged/ allocated to such coverage Commercial Liability policies that provide additional Automobile Liability coverage (i.e. Non Owned Automobile S.P.F. 6, Excess Automobile Liability S.P.F. 7, Contingent Lessors Liability S.P.F. 8) may be reported on separate transactions under the Automobile Statistical Plan. If a claim occurs on such policy, it must be reported under the statistical plan where the premium was reported Policy Type Premiums Claims This field is used to identify policies issued on a claims made or on an occurrence basis. Claims made are policies under which coverage applies to claims that are reported during the policy period. Occurrence basis are policies under which coverage applies to an occurrence, accident or event that happened during the policy period.
26 26 Chapter 4 Field Definitions Policy Limit Premiums Claims Insert the unsigned (absolute value) limit of liability. Where there are separate (split) limits, for example, Bodily Injury/Property Damage per occurrence or per claim basis, report the aggregate limit in this field. Percent Participation Premiums Claims If no other insurer is participating in the risk, insert "100" in this field. However, if you are involved in a percentage only, then insert this percentage to the nearest integer (i.e. 7 1/2 percent shall be coded 008.). Premium Amount Premiums Insert the unsigned (absolute value) amount of premium or return premium in WHOLE DOLLARS ONLY. Deductible Type This field is used to identify the type of deductible being reported, noting: Premiums Claims Per Occurrence includes "per accident" as distinct from "per claimant" and applies to all policies whether written on a claims made or occurrence basis. Includes Umbrella polices where the umbrella is in excess of only one underlying limit, or where the underlying limits are the same. Per Claimant; a per claimant deductible is one which applies to each claimant involved in an accident or occurrence. Other Includes but is not limited to franchise, disappearing, aggregate, variable, multiple, etc. deductibles. where the umbrella policy has different underlying limits, the Deductible Type should be reported as Other S.I.R.'s: Premium Entries S.I.R.'s on umbrellas are not to be coded as deductibles.
27 Chapter 4 Field Definitions 27 Claim Entries S.I.R.'s applied to a claim must be coded as deductibles, otherwise the applicable underlying policy limit is coded. Deductible Amount Premiums Claims Insert the unsigned (absolute value) deductible or underlying limit amount in WHOLE DOLLARS ONLY.
28 28 Chapter 4 Field Definitions Claim Detail This segment contains information related to the insured loss, the claims identification, date of loss, kind of loss and loss amounts. Claim Control ID Claims This field is used by insurers to aid in error handling and may contain a branch code or any other code that the insurer may find useful when handling error transactions. Claim Identification Digit This field is used by insurers to aid in error handling and may be used in addition to Claim Control Id to report a unique code that the insurer may find useful when handling error transactions. Claim Identification Report a uniform and unique identification number by coverage within an accident. Claims Claims A claim identification which is unique to the accident occurrence and the same for all kind of loss within any given coverage for any one occurrence, must be used. A further identification of payments and reserve amounts by Kind of Loss coding as provided in the Plan is also required for purposes of assigning claim count. All claim amounts must be reported under the most appropriate Coverage/Policy Form provided in the Plan and coding of claims must follow coding of premiums. The purpose of such coding is to allow the preparation of exhibits that correspond to the rating of the coverage. For example, liability limit is generally established as a single limit to analyze this experience on the basis of a single limit, all such claims arising from a single occurrence must be combined for exhibit purposes. Hence the requirement of a common identification number within coverage for an occurrence for a given company (policy). Accident Date Report the date on which the accident occurred. Claims Notice of Occurrence Date Claims Report the date on which insurer received notice of an occurrence of loss which eventually led to the claim being made.
29 Chapter 4 Field Definitions 29 This applies to all policy types including occurrence basis policies. Basis of Claim Report a code signifying the basis for the claim, noting: Claims Negligence is the failure to do something which a reasonable person would do, or the doing of something which a reasonable and prudent person would not do under ordinary circumstances. Nuisance interference with the lawful use or enjoyment of one s property. Contractual Liability is liability assumed under contract (either written or implied) which would not normally exist without the contract. Vicarious Liability is liability imposed upon a party which is not directly a party to a particular occurrence. Strict Liability is liability imposed without the need to prove negligence, good or bad faith, nor lack of knowledge. Voluntary Payments are amounts paid to another party for injury or damage caused by an accident for which the insured is not legally liable. Notice of Claim Date Report the date the insurer received notice that a claim was being filed. Claims This applies to all policy types including occurrence basis policies. Event Category Report a code signifying the Loss control event category, noting that: Claims EVENT is the categorization of the occurrence giving rise to the claim. OPERATIONS/FAILURE OF EQUIPMENT excludes products/completed operations exposures. DEFECTIVE PRODUCT OR WORK excludes premises/operations exposures.
30 30 Chapter 4 Field Definitions LIBEL is a published statement damaging to a person s reputation. SLANDER is a spoken statement damaging to a person s reputation. Claim Location Report a code signifying the claims location noting that the claim location should be the jurisdiction under which the claim is being settled, not necessarily the accident location. Claims Claim Count Claims A claim count of 1 is to be reported on certain claim records whenever a loss payment has been made or a loss reserve has been established for any Kind of Loss for any coverage and occurrence. A claim partly paid and partly outstanding shall be counted only once; On Credit or Salvage Loss entries insert '1' only if the amount of Pure Loss recovered completely reverses the total amount of Pure Loss (excludes Expense) previously reported; in all other cases insert '0'. Kind of Loss Report a code signifying the cause of loss. Claims Loss Amount Insert the loss amount IN WHOLE DOLLARS ONLY associated with this transaction Claims The reporting of Salvage and Subrogation amounts recovered must be reported separately from expense amounts recovered and any expenses incurred in making the recovery. Expense Type Report the type of expense observing these definitions: Claims LEGAL EXPENSES (Including Disbursements) defence expenses incurred in the use of outside legal counsel on a specific claim. This will include the lawyer's fee in addition to expenses incurred by the lawyer in handling the claim, but will exclude any costs described in "Expert Fees" or Adjusting/Investigating Expenses" below. expenses of the insurer's employed legal staff that have been attached to a specific claim.
31 Chapter 4 Field Definitions 31 EXPERT FEES (Including Disbursements) external fees and expenses of an outside expert or professional whether billed directly to the insurer or through another party, incurred in acquiring the opinions or views of an expert or professional on a specific claim. ADJUSTING/INVESTIGATING EXPENSES (Including Disbursements) external fees and expenses incurred in the use of outside adjusters and investigators. OTHER EXPENSES (Including Disbursements) external fees and expenses not otherwise classified above. Expense Amount Claims Enter the allocated loss adjustment expense amount paid or outstanding that is associated with the transaction and allocated to the claim.
32 32 Chapter 5 Field s CHAPTER 5 FIELD CODES This section contains the valid codes for each required field. It also includes references to specific requirements for different Premium Locations and Start and Stop dates for a particular field or field value. The symbol is used to indicate that a field is required and O is used to indicate that a field is optional under the specific circumstance. Other nomenclature used in the Field tables is: Field Format this defines the format of the field as either: CHAR can contain any valid character, including number NUM can only contain numbers 0 9 DATE Can contain a date in the relevant format i.e., (CCYYMMDD, CCYYMM as specified in each table) Field Alignment this specifies whether the information in the field must be left or right justified if the value entered is less than the size of the field. Fill Character this specifies the character to use if the value entered is less than the size of the field. Field Size Self explanatory Field Position Self explanatory s in the tables are frequently associated with either a stop date or a start date, which signifies if the code is valid only for a particular time period. Fields associated with the policy are, generally, using Dates and fields associated with a particular claims event are, generally, using Accident Dates. Where a start date is specified, it must be interpreted as including the specified date. Where a stop date is specified, it must be interpreted as NOT including the specified date. Standard characters; where the Field tables are referring to Standard characters, they are: A Z, a z, 0 9, blank, period (.), plus (+), ampersand (&), dollar sign ($), asterisk (*), dash ( ), slash (/), comma (,), percent sign (%), number sign (#) and at sign Additionally, the document includes hyperlinks between Field Definitions and the corresponding Field s. Each field code is linked to its corresponding validity error code via a hyperlink.
33 Chapter 5 Field s 33 Accident Date Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims Date N/A N/A 8 N/A Description Enter the applicable Accident Date CCYYMMDD START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
34 34 Chapter 5 Field s Basis of Claim Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A 1 N/A Description Negligence (simple or gross) 1 Nuisance 2 Contractual Liability 3 Other Vicarious Liability 4 Strict Liability 5 Voluntary Payment 6 START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
35 Chapter 5 Field s 35 Claim Control ID Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR Left Blank 2 N/A Description Any standard characters START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
36 36 Chapter 5 Field s Claim Count Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A 1 N/A Description First Paid Pure Loss entry (with or without expense) Additional or Subsequent Paid Pure Loss entries (with or without expense) Expense Payment Only Entry (Not accompanied by pure loss entry) Outstanding Reserve Entry where no Paid Loss Entry has been made Outstanding Reserve Entry where a Paid Loss Entry has been made START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
37 Chapter 5 Field s 37 Claim Identification Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR Left Blank 20 N/A Description START date Unique claim identification 1 20 characters Jan. 1, 2012 Unique claim identification 1 11 characters STOP date Jan. 1, 2012 Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
38 38 Chapter 5 Field s Claim Identification Digit Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A Blank 1 N/A Description Any standard characters START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
39 Chapter 5 Field s 39 Claim Location Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A 2 N/A Description Alberta 01 British Columbia 02 Manitoba 03 New Brunswick 04 Newfoundland and Labrador 20 Northwest Territories 30 Nova Scotia 05 START date Nunavut 15 April 1, 1999 Ontario 07 Prince Edward Island 06 Quebec 08 Saskatchewan 09 Yukon 10 Unites States of America 80 All Other 90 STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
40 40 Chapter 5 Field s Company Identification Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A Description Unique company identification as assigned by the Statistical Agency START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
41 Chapter 5 Field s 41 Coverage/ Policy Form code Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR Left Blank Description Comprehensive/ Commercial General Liability with product/ completed operations 10 Without product/ completed operations 20 Tenants Legal Liability 30 Excess Liability 40 START date Umbrella Liability 41 Jan. 1, 1990 Automobile Liability Province of Ontario Excess Liability 42 Jan. 1, 1994 Non owned Automobile 43 Jan. 1, 1994 Contingent Lessors Liability 44 Jan. 1, 1994 Wrap up Liability 50 Professional Liability 60 Professional Liability (other than Jan. 1, Directors & Officers Liability) Directors and Officers Liability 62 Jan. 1, 1990 Pollution Liability Written as a separate policy (e.g. Environmental 70 Impairment Liability) Buy back 71 Employers Liability (including Voluntary compensation) 80 May 1, 1989 STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT Jan. 1, 1990
42 42 Chapter 5 Field s Deductible Amount Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims NUM Right Zero Description Actual deductible amount (WHOLE DOLLARS) Type of Deductible Other PREMIUM entries only Value START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
43 Chapter 5 Field s 43 Deductible Type Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A Description START date No deductible 1 Jan. 1, 1990 Per Occurrence basis 2 Jan. 1, 1990 Per Claimant basis 3 Jan. 1, 1990 Other 4 Jan. 1, 1990 STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
44 44 Chapter 5 Field s Entry Date Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A Description Enter the appropriate Entry Date for this submission CCYYMM START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
45 Chapter 5 Field s 45 Event Category Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A 3 N/A Description START date Premises Housekeeping and/ or maintenance 100 Jan. 1, 1990 Operations and/or Failure of Equipment 200 Jan. 1, 1990 Defective Products or Work 300 Jan. 1, 1990 Libel 410 Jan. 1, 1990 Slander 420 Jan. 1, 1990 Wrongful Dismissal 430 Jan. 1, 1990 Discrimination 440 Jan. 1, 1990 Wilful Conduct 510 Jan. 1, 1990 Human Error 520 Jan. 1, 1990 Other 999 Jan. 1, 1990 STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
46 46 Chapter 5 Field s Expense Amount Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims NUM Right Zero 10 N/A Description Expense Amount (Whole dollars) value START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
47 Chapter 5 Field s 47 Expense Type Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A 1 N/A Description START date Legal Expenses 1 Expert Fees 2 Jan. 1, 1990 Adjusting/ Investigation expenses 3 Jan. 1, 1990 Other Expenses 9 STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT Jan. 1, 1990
48 48 Chapter 5 Field s Exposure Amount Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims NUM Right Zero Description Amount of Exposure as measures in term of the value applicable Exposure Base unit Not applicable START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
49 Chapter 5 Field s 49 Exposure Base Unit Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A Description Amounts ( $000s) 1 Amounts ( $000,000s) 2 Number of Square feet (00s) 1 Number of Acres 2 Number of Square meters (00s) 5 Number of Hectares 6 Unit measure (Imperial) 1 Unit measure (Metric) 2 Unit measure (Other) 3 Unit measure (Unspecified) 9 No exposure 0 START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
50 50 Chapter 5 Field s Exposure Type Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A Description Annual Payroll 1 Annual Revenue (Gross Receipts/ Sales) 2 Area 3 Per Unit 4 Flat Rated 5 Tenants Legal Liability 6 START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
51 Chapter 5 Field s 51 Industry Classification Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A Blank Description Applicable Industry Classification code from Appendix A1, A2 and A3 value START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
52 52 Chapter 5 Field s Kind of Loss Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A 2 N/A Description Premises/ Operations Bodily Injury 11 Property Damage 12 START date Personal Injury 13 Jan. 1, 1990 Product/ Completed Operations Bodily Injury 21 Property Damage 22 Personal Injury 23 Jan. 1, 1990 Professional (Malpractice, Errors & Omissions, Officers & Directors) Bodily Injury 31 Property Damage 32 Personal Injury 33 Jan. 1, 1990 Financial Loss 34 Jan. 1, 1990 Tenant s Legal Liability Property Damage 42 Employers Liability Bodily Injury 51 Pollution Liability Bodily Injury 61 Jan. 1, 1990 Property Damage 62 Jan. 1, 1990 Other 69 Jan. 1, 1990 Automobile Liability All Losses 70 Jan. 1, 1994 STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
53 Chapter 5 Field s 53 Line Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR N/A N/A Description Liability 3 START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
54 54 Chapter 5 Field s Loss Amount Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims NUM Right Zero 10 N/A Description Loss Amount (Whole dollars) Value START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
55 Chapter 5 Field s 55 Notice of Claim Date Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims Date N/A N/A 8 N/A Description Enter the Notice of Claim Date START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT CCYYMM Jan. 1, 2012 O DD Jan. 1, 2012
56 56 Chapter 5 Field s Notice of Occurrence Date Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims Date N/A N/A 8 N/A Description Enter the Notice of Occurrence Date START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT CCYYMM DD Jan. 1, 2012 O Jan. 1, 2012
57 Chapter 5 Field s 57 Percent Participation Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims NUM Right Zero Description Percent participation in the policy to the nearest integer (e.g. for 7 1/2%, enter 008) Value START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
58 58 Chapter 5 Field s Policy Control ID Reporting Format Field Field Fill Field Size Field Positions Format Alignment Character Premiums Claims CHAR Left Blank Description Any standard characters START date STOP date Applicable Premium Location All AB BC MB NB NL NS NT NU ON PE QU SK YU US OT
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