SERFF Tracking #: SMPJ-129807620 State Tracking #: Company Tracking #: 14-IR-WC-9018R



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Product Name: Employers Liability WC Filing at a Glance Company: Product Name: State: TOI: Sub-TOI: Filing Type: Sompo Japan Insurance Company of America Employers Liability WC District of Columbia 16.0 Workers Compensation 16.0002 Employers Liability WC Rate/Rule Date Submitted: 11/14/2014 SERFF Tr Num: SERFF Status: State Tr Num: State Status: Co Tr Num: Effective Date Requested (New): Effective Date Requested (Renewal): Author(s): Reviewer(s): SMPJ-129807620 Closed-APPROVED 14-IR-WC-9018R 03/01/2015 03/01/2015 Mary Alado Disposition Date: 12/10/2014 Disposition Status: Effective Date (New): Effective Date (Renewal): APPROVED

Product Name: Employers Liability WC General Information Project Name: Employers Liability (Stop Gap) Project Number: 14-IR-WC-9018R Reference Organization: N/A Reference Title: N/A Filing Status Changed: 12/10/2014 State Status Changed: Created By: Mary Alado Corresponding Filing Tracking Number: N/A Status of Filing in Domicile: Not Filed Domicile Status Comments: Reference Number: N/A Advisory Org. Circular: N/A Deemer Date: Submitted By: Mary Alado Filing Description: We are revising our Employers Liability (Stop Gap) Coverage rating rules. Our proposed rates for this coverage are significantly lower than our current rates and are based on competitor s filings. Historically, we have provided only a very incidental amount of this coverage on a countrywide basis and therefore do not have credible experience on which to base our premium charges. As a result, we believe there is no meaningful rate impact for this revision. Please refer to our filing memorandum for additional information. Manual pages SDC-WC-MR-3 and 4 will replace Page 1 showing our revised rating rules for this coverage. The endorsement which provides this coverage, NCCI Endorsement WC 00 03 03C, was filed on our behalf by the appropriate WC Bureau/Advisory Organization and approved by your department. Company and Contact Filing Contact Information Mary Alado, State Filings Analyst II 11405 North Community House Rd. Suite 600 Charlotte, NC 28277 Filing Company Information Sompo Japan Insurance Company of America 777 Third Avenue 24th Floor New York, NY 10017-1307 (212) 416-1200 ext. [Phone] malado@sompo-us.com 704-759-2534 [Phone] CoCode: 11126 Group Code: 3219 Group Name: FEIN Number: 13-2554270 State of Domicile: New York Company Type: State ID Number: Filing Fees Fee Required? Retaliatory? No No

Product Name: Employers Liability WC Fee Explanation:

Product Name: Employers Liability WC Correspondence Summary Dispositions Status Created By Created On Date Submitted APPROVED Robert Nkojo 12/10/2014 12/10/2014

Product Name: Employers Liability WC Disposition Disposition Date: 12/10/2014 Effective Date (New): Effective Date (Renewal): Status: APPROVED Comment: Rate data does NOT apply to filing. Schedule Schedule Item Schedule Item Status Public Access Supporting Document Consulting Authorization Yes Supporting Document Actuarial Certification (P&C) Yes Supporting Document District of Columbia and Countrywide Experience for the Yes Last 5 Years (P&C) Supporting Document District of Columbia and Countrywide Loss Ratio Analysis Yes (P&C) Supporting Document Memorandum Yes Rate Rule Page Yes Rate Rule Page Yes Rate Rule Page Yes

Product Name: Employers Liability WC Rate Information Rate data does NOT apply to filing.

Product Name: Employers Liability WC Rate/Rule Schedule Item Schedule Item Previous State No. Status Exhibit Name Rule # or Page # Rate Action Filing Number Attachments 1 Rule Page SDC-WC-MR-3 New SDC-WC-MR-3.pdf 2 Rule Page SDC-WC-MR-4 New SDC-WC-MR-4.pdf 3 Rule Page Page 1 Withdrawn 01-WC-158; 17798 Rule Page Withdrawn.pdf

DISTRICT OF COLUMBIA (08) WORKERS COMPENSATION AND EMPLOYERS LIABILITY MISCELLANEOUS RULE PAGE Sompo Japan Insurance Company of America The following is added to Part One, Rule 3.A.14 Limits of Liability Employers Liability Coverage Endorsement (Stop Gap Coverage) WC 00 03 03C Employers Liability Coverage Endorsement Rules: - This form is most commonly requested when an insured has operations in a monopolistic workers compensation jurisdiction. Monopolistic workers compensation coverage does not include Employers Liability Coverage. This form can be used to provide Employers Liability Coverage for operations in monopolistic jurisdictions. - For operations in a monopolistic jurisdiction, an employer must purchase Workers Compensation insurance from the appropriate state fund. - This form is appropriate for use in non-monopolistic jurisdictions only in isolated circumstances. These are if 1) all employees are excluded from the workers compensation law or all employees have elected not to be subject the law, and 2) there is no state law or regulation making the use of this form illegal. - This is an optional endorsement that will be attached to NCCI's Workers Compensation and Employers Liability Policy. - Premium charged for this coverage will be non-auditable. Rates: (1) If Known / Ongoing Exposure in a Monopolistic State Basic Limits and Rates: Bodily Injury by Accident $100,000 each accident Bodily Injury by Disease $500,000 policy limit Bodily Injury by Disease $100,000 each employee Rate: 0.037 per $100 in estimated monopolistic state payroll Rates for Increased Limits: $500,000 / $500,000 / $500,000 0.055 $1,000,000 / $1,000,000 / $1,000,000 0.068 $2,000,000 / $2,000,000 / $2,000,000 0.080 Minimum Premium: $150 Edition 03-2015 SDC-WC-MR-3 Includes copyrighted material of National Council on Compensation Insurance, Inc. with its permission.

DISTRICT OF COLUMBIA (08) WORKERS COMPENSATION AND EMPLOYERS LIABILITY MISCELLANEOUS RULE PAGE Sompo Japan Insurance Company of America Employers Liability Coverage Endorsement (Stop Gap Coverage) cont'd (2) If No Known / Incidental Exposure In A Monopolistic State Employers Liability can be provided on an "if any" basis if the insured currently has no exposure in a monopolistic state or jurisdiction. A premium charge of $150 applies. If exposure develops in a monopolistic state or jurisdiction, the rates shown in (1) above apply. (3) If Provided in a Non-Monopolistic State (per Rules above). Use the same rates as shown in (1) above per $100 payroll for the non-monopolistic state for which coverage is needed. Edition 03-2015 SDC-WC-MR-4 Includes copyrighted material of National Council on Compensation Insurance, Inc. with its permission.

Product Name: Employers Liability WC Supporting Document Schedules Bypassed - Item: Bypass Reason: Attachment(s): Item Status: Status Date: Bypassed - Item: Bypass Reason: Attachment(s): Item Status: Status Date: Bypassed - Item: Bypass Reason: Attachment(s): Item Status: Status Date: Bypassed - Item: Bypass Reason: Attachment(s): Item Status: Status Date: Satisfied - Item: Comments: Attachment(s): Item Status: Status Date: Consulting Authorization N/A Actuarial Certification (P&C) N/A District of Columbia and Countrywide Experience for the Last 5 Years (P&C) N/A District of Columbia and Countrywide Loss Ratio Analysis (P&C) N/A Memorandum WC Stop Gap Filing Memo.pdf

Sompo Japan Nipponkoa America Workers Compensation Employers Liability (Stop Gap) Coverage Rate Memorandum Sompo Japan Insurance Company of America and Sompo Japan Fire & Marine Insurance Company of America (if applicable in your state) is/are submitting this rate filing memorandum in support of the proposed rates for Employers Liability (Stop Gap) coverage. We propose an effective date of March 1, 2015. This revised rating rule would be used with endorsement WC 00 03 03C Employers Liability Coverage Endorsement, which was previously filed on our behalf by the appropriate WC Bureau/Advisory Organization or previously adopted by us in your state. This filing is an update to our previous submission for Employers Liability (Stop Gap) coverage in your state. Our previous rates are significantly higher than those available in the current market. This, combined with the rare need to provide this coverage in non-monopolistic states, means we currently provide only a very incidental amount of this coverage on a countrywide basis. The rates proposed represent a significant decrease from our previously approved rates, but with minimal current writings, we believe there is no meaningful rate impact tied to this update. Also, you may notice that our previous rule contained rates by classification; however, for simplicity, we have eliminated the distinction by classification in our revised rules. Since we have a very limited volume of Employers Liability (Stop Gap) coverage on a countrywide basis and no claims, we do not have credible experience that would allow us to develop revised rates for this coverage on its own. As a result, we have based our proposed rates on a review of competitors rates. Proposed rates apply to payroll per $100. We are proposing rates that are in line with the average of the Berkley, Berkshire-Hathaway and Accident Fund rates that have been filed in monopolistic states since 2010. These are recapped below along with our proposed rates. Employers Liability (Stop Gap) is a coverage that is typically requested by clients with operations in monopolistic states, but there are a few situations under which stand-alone Employers Liability coverage might be needed in a non-monopolistic state. For these rare situations, we have included a provision in our updated rule. The minimum premium charge would be $150 and simply reflects a reasonable minimum charge to provide this coverage. Competitor Stop Gap Rate Information and Rate Selection Limits of Liability Berkley Berkshire- Hathaway Accident Fund Average Sompo Selected 100/500/100 0.040 0.030 0.040 0.037 0.037 500/500/500 0.058 0.050 0.058 0.055 0.055 1000/1000/1000 0.072 0.060 0.072 0.068 0.068 2000/2000/2000 0.080 0.080 0.080 0.080 0.080 Minimum Premium $150 $350 $250 $250 $150