PROPOSED RULES
INSURANCE COMMISSIONER
Original Notice.
Preproposal statement of inquiry was filed as WSR 05-17-163.
Title of Rule and Other Identifying Information: Property and casualty statistical plans.
Hearing Location(s): John L. O'Brien Building, Hearing Room C, 504 15th Avenue S.W., Olympia, WA 98504, on April 5, 2006, at 10:00 a.m.
Date of Intended Adoption: June 15, 2006.
Submit Written Comments to: Kacy Scott, P.O. Box 40255, Olympia, WA 98504-0258, e-mail Kacys@oic.wa.gov, fax (360) 586-3109, by April 4, 2006.
Assistance for Persons with Disabilities: Contact Lorie Villaflores by March 31, 2006, TTY (360) 586-0241 or (360) 725-7087.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: RCW 48.19.370 requires the commissioner to adopt rules and statistical plans for property and casualty insurance. WAC 284-24-015 has not been amended since 1998, and includes information that is no longer accurate. WAC 284-24-015 is repealed and replaced with chapter 284-24B WAC that sets forth a process for insurers to report insurance statistical data and for qualifying entities to be designated as statistical agents. In addition, a new chapter 284-24C WAC prescribes specific data elements that medical malpractice insurers must report to statistical agents. These data elements will assist the commissioner to determine if rating elements comply with RCW 48.19.020 and 48.19.030, and will provide information the commissioner needs to monitor the condition of this market.
Reasons Supporting Proposal: Statistical reporting has been required under RCW 48.19.370 since 1947. These rules update processes and procedures under which insurers report data. These rules are consistent with processes and procedures adopted by the National Association of Insurance Commissioners.
Statutory Authority for Adoption: RCW 48.02.060, 48.19.370.
Statute Being Implemented: RCW 48.19.370.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Mike Kreidler, Insurance Commissioner, governmental.
Name of Agency Personnel Responsible for Drafting: Lisa Smego, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7134; Implementation: Beth Berendt, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7117; and Enforcement: Carol Sureau, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7050.
No small business economic impact statement has been prepared under chapter 19.85 RCW. There is no impact on small business as defined under RCW 19.85.020(1).
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kacy Scott, Insurance Building, 302 14th Avenue S.W., P.O. Box 40254, Olympia, WA 98504-0258, phone (360) 725-7041, fax (360) 586-3109, e-mail KacyS@oic.wa.gov.
December 1, 2005
Mike Kreidler
Insurance Commissioner
OTS-8447.2
RULES THAT REQUIRE PROPERTY AND CASUALTY INSURERS
TO REPORT STATISTICAL DATA
(a) Property, as defined in RCW 48.11.040;
(b) Marine and transportation, as defined in RCW 48.11.050, if not exempt from statistical reporting under RCW 48.19.010 (1)(e);
(c) Vehicle, as defined in RCW 48.11.060;
(d) General casualty, as defined in RCW 48.11.070; and
(e) Surety, as defined in RCW 48.11.080.
(2) "NAIC Statistical Handbook" is a publication of the National Association of Insurance Commissioners (NAIC) that explains insurance statistical data and provides reporting requirements and report formats for data that statistical agents must submit to the commissioner.
(3) "Statistical agent" means an entity that the commissioner has designated under RCW 48.19.370(4) to collect insurance statistical data from insurers and report these data to the commissioner on behalf of those insurers.
(4) "Statistical plan" means a system for collecting information from insurers.
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(a) Incorporate the provisions of the NAIC Statistical Handbook into this chapter;
(b) Prescribe the manner of reporting statistical and the types of statistical data insurers must submit to statistical agents under RCW 48.19.370; and
(c) Establish a procedure for the commissioner to designate statistical agents under RCW 48.19.370.
(2) This chapter does not limit the powers granted to the commissioner by any law of this state.
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(a) Medical Professional Liability Reports: Statistical Plan Reporting Requirements; and
(b) Medical Professional Liability Reports: Model Medical Professional Liability Statistical Plan.
(2) The commissioner will issue a technical assistance advisory to notify insurers and statistical agents of the effective date of any revisions to the NAIC Statistical Handbook.
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(2) RCW 48.19.370 says each insurer must report loss and expense experience to the commissioner. As a condition of transacting the business of insurance under RCW 48.05.040, each insurer must:
(a) Report its insurance statistical data to a statistical agent designated by the commissioner in accordance with the statistical plans filed with the commissioner by the statistical agent in WAC 284-24B-060;
(b) Comply with the reporting requirements and data quality procedures in the NAIC Statistical Handbook; and
(c) Adopt edit and audit procedures to screen and check data for reasonableness and accuracy.
(3) So the commissioner may assure compliance with this chapter, each insurer filing rates under chapter 48.19 RCW must include the name of its statistical agent for that line of insurance.
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(1) Identifies the line(s) of business for which the entity will collect and report statistical experience;
(2) States the entity's qualifications to act as a statistical agent; and
(3) Agrees to:
(a) Comply with the reporting requirements and data quality procedures in the NAIC Statistical Handbook, and all rules, technical advisories and directives issued by the commissioner;
(b) Report statistical data to the commissioner in a timely manner; and
(c) Submit to an examination in accordance with procedures described in RCW 48.03.010.
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(1) Their statistical plans, including standard report formats; and
(2) All changes in their statistical plans or reporting formats.
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(2) If data submitted to the commissioner by a statistical agent appear likely to identify individual insurers, claimants or insureds, or the statistical agent or an insurer asserts that data are exempt from public disclosure under RCW 48.02.120(3), such data may not be publicly disclosed until the commissioner:
(a) Notifies the statistical agent and any insurer that has asserted the data to be exempt from public disclosure of the disclosure request;
(b) Provides a thirty-day period from the date of notice for any insurer that reported data to the statistical agent to assert that its data are trade secrets or are otherwise protected from disclosure; and
(c) Provides aggrieved insurers with the opportunity to request a hearing under RCW 48.04.010 and chapter 34.05 RCW.
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OTS-8450.4
SPECIFIC RULES THAT APPLY TO STATISTICAL PLANS FOR MEDICAL PROFESSIONAL LIABILITY REPORTS
(2) "Medical professional liability insurance" or "medical malpractice insurance" provides coverage for tort claims brought against various medical-related institutions and medical professionals, such as:
(a) Institutions, including hospitals, infirmaries, nursing homes, mental institutions, blood banks, sanitariums, and clinics; and
(b) Individual medical professionals including physicians, surgeons, dentists, nurses, pharmacists, opticians, optometrists, physiotherapists, chiropractors, laboratory technicians, and various specialists.
(3) "Medical malpractice statistical agent" means an organization designated by the commissioner under RCW 48.19.370(4) to gather, compile and report medical malpractice statistical data.
(4) "NAIC Statistical Handbook" is a publication of the National Association of Insurance Commissioners (NAIC) that explains insurance statistical data and provides reporting requirements and report formats for data that statistical agents must submit to the commissioner.
(5) "Statistical plan" means a system for collecting information from insurers.
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(a) Incorporate the provisions of chapter 284-24B WAC into this chapter;
(b) Prescribe the manner of reporting statistical data and the types of statistical data medical malpractice insurers must submit to statistical agents under RCW 48.19.370; and
(c) Establish a medical professional liability statistical plan.
(2) This chapter does not limit the powers granted to the commissioner by any law of this state.
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(1) Comply with the provisions of RCW 48.19.370 and chapter 284-24B WAC; and
(2) Report its insurance statistical data to a statistical agent designated by the commissioner in accordance with the statistical plans filed by the statistical agent under WAC 284-24B-060 and all additional detail required by this chapter.
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(1) Company number: Experience must be reported by the company number assigned by the medical malpractice statistical agent. Medical malpractice statistical agents must convert each company number to NAIC group and company code numbers.
(2) Accounting/calendar date:
(a) Accounting quarter (where applicable).
(b) Accounting year.
(3) Transaction identifier and amounts. Identify the following items and their respective amounts:
(a) Written premium.
(b) Paid losses.
(c) Paid allocated loss adjustment expenses.
(d) Outstanding losses.
(e) Outstanding allocated loss adjustment expense.
(4) Subline identifier:
(a) Hospital professional and other health care facilities liability.
(b) Physicians, surgeons, and dentists professional liability.
(c) Other health care professional liability.
(d) All composite rated risks.
(e) Indivisible premium policy experience.
(5) Classification codes. Individual industry classification codes describing specific coverage. In Washington, the current Insurance Services Office (ISO) five digit common statistical base classifications must be used.
(6) State indicator.
(7) Policy effective year:
(a) The effective date of the policy, defined as the beginning date of the declarations page or renewal certificate.
(b) For claims-made tail coverage, the date on which tail coverage began is required.
(8) Type of program indicator:
(a) Monoline; or
(b) Package.
(9) Date of entry into the claims-made program:
(a) The date of entry into the claims-made program is the retroactive date employed in claims-made coverage in order to exclude coverage for occurrences that took place prior to that date even though claims resulting from such occurrences are made within the policy period.
(b) Claims-made tail coverage records must include, in the date of entry into the claims-made program field, the date applicable to the basic and excess coverage.
(10) Type of policy contract identifier:
(a) Claims-made coverage - basic and excess.
(b) Claims-made coverage - tail.
(c) Occurrence coverage.
(11) Exposures. The applicable exposure is required for each of the subdivisions of experience for which separate classification codes and exposure bases exist. The current Insurance Services Office (ISO) exposure reporting basis included with the common statistical base classifications must be used.
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(1) Claim dates:
(a) Incident month/year; and
(b) Report month/year.
(c) Closed month/year (closed claims only).
(2) Additional transaction identifiers and details. Identify the following items and their respective amounts:
(a) Paid losses segmented by amounts paid or incurred for past and future:
(i) Wage loss;
(ii) Medical expenses; and
(iii) All other losses.
(b) Paid allocated loss adjustment expenses segmented by amounts paid for:
(i) Defense counsel;
(ii) Expert witness; and
(iii) All other allocated loss adjustment expenses.
(c) Outstanding losses segmented by amounts paid or incurred for past and future:
(i) Wage loss;
(ii) Medical expenses; and
(iii) All other losses.
(d) Outstanding allocated loss adjustment expense segmented by amounts paid or incurred for:
(i) Defense counsel;
(ii) Expert witness; and
(iii) All other allocated loss adjustment expenses.
(3) Policy limit per incident.
(4) Deductible or retention.
(5) Medical outcome classifications (use only one code):
(a) Emotional only: Fright, no physical damage.
(b) Temporary: Slight - lacerations, contusions, minor scars, rash. No delay.
(c) Temporary: Minor - infections, mis-set fracture, fall in hospital. Recovery delayed.
(d) Temporary: Major - burns, surgical material left, drug side effect, brain damage. Recovery delayed.
(e) Permanent: Minor - loss of fingers, loss or damage to organs. Includes nondisabling injuries.
(f) Permanent: Significant - deafness, loss of limb, loss of eye, loss of one kidney or lung.
(g) Permanent: Major - paraplegia, blindness, loss of two limbs, brain damage.
(h) Permanent: Grave - quadriplegia, severe brain damage, lifelong care or fatal prognosis.
(i) Permanent: Death.
(6) Act or omission classification, as follows:
(a) Diagnosis related;
(b) Anesthesia related;
(c) Surgery related;
(d) Medication related;
(e) Intravenous and/or blood products related;
(f) Obstetrics related;
(g) Treatment related;
(h) Monitoring related;
(i) Biomedical equipment and/or product related;
(j) Behavioral health related; or
(k) All other.
(7) Injury location codes:
(a) Type of facility (use only one code):
(i) Blood bank.
(ii) Clinic (multiservice facility, including ambulatory surgical centers).
(iii) Hospital inpatient facility.
(iv) Hospital outpatient facility.
(v) Medical test site.
(vi) Nursing home.
(vii) Physician's office.
(viii) Patient's home.
(ix) Other outpatient facility.
(x) Other hospital/institutional location.
(xi) Other.
(b) Location of institutional injury (paid and closed claims only, use only one code):
(i) Critical care unit.
(ii) Emergency room.
(iii) Labor/delivery room.
(iv) Laboratory services.
(v) Nursery.
(vi) Operating room.
(vii) Patient room.
(viii) Physical therapy department.
(ix) Radiology.
(x) Special procedure room.
(xi) Other.
(8) Claim disposition (paid and closed claims only):
(a) Settled by parties (use only one code):
(i) Before filing suit or demanding hearing.
(ii) Before trial or hearing.
(iii) During trial or hearing.
(iv) After trial or hearing but before judgment or decision (award).
(v) After judgment or decision, but before appeal.
(vi) During appeal.
(vii) After appeal.
(viii) Claim or suit abandoned.
(ix) During review panel or nonbinding arbitration.
(b) Disposed of by a court (use only one code):
(i) No court proceedings.
(ii) Directed verdict for plaintiff.
(iii) Directed verdict for defendant.
(iv) Judgment notwithstanding the verdict (plaintiff).
(v) Judgment notwithstanding the verdict (defendant).
(vi) Judgment for the plaintiff.
(vii) Judgment for the defendant.
(viii) Decision for plaintiff on appeal.
(ix) Decision for defendant on appeal.
(x) All other.
(c) Disposed of by binding arbitration (use only one code).
(i) Claim not subject to arbitration.
(ii) Claim subject to arbitration, but previously coded disposition reached in lieu of award.
(iii) Award for plaintiff.
(iv) Award for defendant.
(d) Mediation.
(e) Private trial:
(i) Award for plaintiff.
(ii) Award for defendant.
(9) Territory indicator for principal location in which the incident of alleged medical malpractice occurred, including:
(a) County indicator; and
(b) City indicator.
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OTS-8446.1
REPEALER
The following section of the Washington Administrative Code is repealed:
| WAC 284-24-015 | Statistical plans and designation of statistical agents. |