RE: Data Call for Direct California Workers Compensation Experience (Abridged)

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1 January 16, 2012 Voice Senior Vice President and Chief Actuary To: Primary Contacts for WCIRB Aggregate Financial Data Calls RE: Data Call for Direct California Workers Compensation Experience (Abridged) Calendar Year 2011 (CA-NC-2011) Due Date: March 20, 2012 This Data Call, issued in compliance with the directive of the Governing Committee, provides the WCIRB with the statistics necessary to fulfill its ratemaking function. Insurers are encouraged to submit this data call via the WCIRB s escad application. You must submit a completed call to the WCIRB even if there is no direct experience to report. This Data Call must be received by the WCIRB on or prior to March 20, The attached Call, which is due on March 20, 2012, will be subject to the SCAD program. A processing fee of $100 will be incurred for each non-escad submission of WCIRB aggregate data call types that can be submitted directly via the escad application. Enclosed is a copy of the transmittal letter which must accompany any non-escad submission or resubmission of aggregate data calls subject to the SCAD program. Please address all non-escad data call submissions to: Workers' Compensation Insurance Rating Bureau of California Attention: Actuarial Department Fax Number: escad@wcirbonline.org Any questions regarding the SCAD program or this Call should be directed to the WCIRB's Actuarial Department by sending an to escad@wcirbonline.org. Senior Vice President and Chief Actuary Enclosures: Abridged Calendar Year 2011 Form Transmittal Letter for Data Call Submissions

2 Data Call for Direct California Workers Compensation Experience (Abridged) Calendar Year 2011 (CA-NC-2011) Due Date: March 20, 2012 Exhibits I. Premium Exhibit a. Direct Written Premium Calendar period 1/1/ /31/2011 b. Direct Earned Premium Calendar period 1/1/ /31/2011 II. Loss Exhibit (1) Indemnity Part A: Paid Losses a. From 1/1/2011 to 12/31/2011 Part B: Total Loss Reserves (including Incurred But Not Reported) a. As of 12/31/2011 b. As of 12/31/2010* c. Change in outstanding reserves: (a) - (b) Part C: Total Losses Incurred a. Sum of Part A, Line (a) and Part B, Line (c) (2) Medical (3) = (1) + (2) Total *To agree with unpaid amounts reported on Part B, line a: Total Loss Reserves as of 12/31/2010 of the Data Call for Direct California Workers Compensation Experience (Abridged) Calendar Year 2010 (CA-NC-2010) issued January 17, Name (Please print or type) Title Company (List all companies included in report) Date Filed Mailing Address Telephone No. Fax No.

3 Transmittal Letter for Data Call Submissions Please indicate all Data Calls included in this submission. WCIRBCalifornia Voice Senior Vice President and Chief Actuary Data Call for Direct California Workers Compensation Experience (Abridged) Calendar Year 2011 (CA-NC-2011) Due March 20, 2012 Other (please specify): Please indicate the type of submission (one per transmittal letter). Original Submission Correction/Response due to Query Voluntary Re-Submission Ref. #: Please complete the following. Name (Please print or type) Title Company (List all companies included in report) Date Filed Mailing Address Telephone No. Fax No. For WCIRB Use Receipt Date Indicated Items Complete Indicated Items Incomplete Method of Submission Number of business days delinquent* *Appeals on delinquencies must be made within 30 days of the initial WCIRB notice that the data call submission is delinquent. Items missing from this submission or comments.

4 Call for Direct California Workers' Compensation Experience Annual Call for Direct California Workers Compensation Experience Abridged (CA-NC-20xx) The information reported shall be in accordance with the following: (a) All data reported on this call should be on a calendar year basis, which means that premiums and losses from all transactions that occurred during year xx should be included, regardless of the effective year of policies or year of accident of claims involved. (b) Include experience (premium and losses) from: Large deductible policies on a gross (first dollar) basis Standard workers compensation policies Employers liability increased limits Minimum premiums Salvage and subrogation (c) Exclude experience (premium and losses) from: Ceded reinsurance Reinsurance assumed Excess insurance USL&H insurance Private residence employee insurance National Defense Project insurance (d) Exclude the impact of the following items from all reported premiums: Application of any deductible credits Application of any retrospective rating plan adjustments California Insurance Guarantee Association (CIGA) assessments California Workers Compensation Revolving Fund assessments California Workers Compensation fraud surcharges Uninsured Employers Trust Fund Assessment Subsequent Injuries Benefits Trust Fund Assessment Occupational Safety & Health Fund assessments Labor Enforcement & Compliance Fund assessments Any charge for terrorism coverage pursuant to the Terrorism Risk Insurance Act of 2002 as amended by the Terrorism Risk Insurance Extension Act of 2005, or the Terrorism Risk Insurance Program Reauthorization Act of (e) Premiums shall be reported in accordance with the definition of Final Premium in Part 4, Section II of the California Workers Compensation Uniform Statistical Reporting Plan 1995 (USRP), available on the WCIRB website at (f) Indemnity and medical losses shall be reported in accordance with the definitions of Indemnity Losses and Medical Losses in Part 4, Section II of the California Workers Compensation Uniform Statistical Reporting Plan 1995 (USRP), available on the WCIRB website at (g) Paid Indemnity Losses shall include indemnity payments made during calendar year 20xx on all indemnity claims. Paid Medical Losses shall include medical payments made during calendar year 20xx on all claims (indemnity and medical-only). 1

5 Call for Direct California Workers' Compensation Experience Annual Call for Direct California Workers Compensation Experience Abridged (CA-NC-20xx) (h) Total Loss Reserves shall include indemnity and medical case reserves, the reserve for incurred but not reported cases, the reserve for reopened cases, and any other reserves to meet specific contingencies. Other voluntary reserves shall be excluded. (i) Insurers who are members of an affiliated group are encouraged to file on a combined group ( consolidated ) basis. However, all members of the group must be individually listed. All data calls for the same evaluation period submitted to the WCIRB must be made under the same grouping structure. Any changes to the reporting group must be communicated to and approved by WCIRB prior to reporting data under the new grouping. (j) Use of the escad web-based application to submit data is highly encouraged. Insurers with access to the escad web-based application should submit this data call online via escad. Non-eSCAD submissions using only WCIRB forms and/or templates are permitted for insurers who do not yet have access to escad, subject to a $100 processing fee for each submission of this Abridged Calendar Year Call. For all non-escad submissions: (i) reported amounts shall be rounded to whole dollars; (ii) Negative amounts shall be displayed enclosed within parentheses; (iii) the totals shall equal their corresponding sum of rounded details shown on the forms, not the rounded sum of actual details. A transmittal letter must accompany any non-escad submission of data calls to the WCIRB. (k) Abridged calls are subject to the SCAD Program (program for Submission of California Aggregate Data). Refer to the SCAD Program effective July 1, 2010 for details. Please contact the WCIRB s Actuarial Department for a comprehensive listing of the edits used to check accuracy of submitted data. This listing of edits is also available by clicking on the Help link in escad. 2