Federal Act Coverages and Reporting

Transcription

1 Federal Act Coverages and Reporting January 30 February 2, 2018 Palm Beach County Convention Center West Palm Beach, FL The Path to Data Excellence

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3 Federal Act Coverages and Reporting Presented by: Julie Gonzalez and Carol Brusca Objectives To provide an overview of Federal Act Coverage programs and discuss data reporting requirements across multiple data types. 2 1

4 Agenda Overview United States Longshore and Harbor Workers Compensation Act (USL&HW) and Extensions Federal Employers Liability Act (FELA) and Admiralty Law Federal Mine Safety and Health Act (Black Lung Disease) Federal Coverage Service Catastrophe Provisions Other Federal Coverages 3 Overview 2

5 Data Types Policy Data Proof of Coverage Unit Report Control (URC) Program Premium Trends Exposure Trends Unit Statistical Data Experience Rating Class Rates/Loss Costs Legislative Analysis Financial Call Data Statewide Premium Level Indications Industry Results Detailed Claim Information Legislative Analysis Research Medical Call Data Legislative Analysis Research 5 State vs. Federal Workers compensation (WC) 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 6 3

6 Federal Coverage Considerations Coverage Determination Basic Manual Underwriting rules Forms Manual Endorsements Determination of Benefits Administration of claims Statistical Plan and Reporting Guidebooks Rules and requirements Reporting coverage, exposure, and claims 7 United States Longshore and Harbor Workers Compensation Act (USL&HW) and Extensions 4

7 USL&HW Act Federal WC law that applies to workers in maritime employments E.g.: longshore and harbor workers, shipbuilders, ship breakers, and ship repairers It does not apply to masters or crews of vessels 9 USL&HW Act Navigable waters Determined by the federal government, these are waters that provide a channel for commerce and transportation of people and goods Compensation benefits provided to workers for an employment related injury or disease occurring on the navigable waters of the United States 10 5

8 USL&HW Act Status and Situs Status C O V E R E D Situs Status determines if the work performed or duty is considered maritime employment Situs determines if the place of injury is considered an area used by an employer for maritime work 11 Underwriting Rule and Endorsement Coverage added to a Standard Policy by attaching the Longshore and Harbor Workers Compensation Act Coverage Endorsement (WC A) Basic Manual User s Guide F-7 Additional Coverages Summary Table 12 6

9 USL&HW Act Extensions Defense Base Act (DBA) (WC A) Covers workers engaged in employment on overseas defense bases or under contract with the US government (NOT military personnel) Nonappropriated Funds (WC A) Covers morale, welfare, and recreation workers on US military installations in the continental US and overseas Outer Continental Shelf Lands Act (WC C) 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 13 USL&HW Act Classifications Classifications, loss costs, or rates that are subject to the USL&HW Act Basic Manual Rule 3-A

10 USL&HW Act Classifications F Classification Codes Most F classification codes have corresponding state act classification codes Example: Freight Handling NOC Class Code 7360 provides coverage under the individual state acts Class Code 7350F provides coverage under the US Longshore and Harbor Workers Compensation Act (USL&HW Act) 15 USL&HW Act Classifications Non F Classification Codes F Loaded Industrial classification codes where loss cost/rate is increased for USL&HW Act benefits Florida example advisory loss cost and/or rate pages effective 01/01/2018 Classification Payroll Rate LHWCA Factor AdjustedRate Premium 6872F $75, n/a $9, $75, $17,

11 USL&HW Act Reporting Policy Endorsement Identification Record Report applicable endorsement numbers Longshore and Harbor Workers Compensation Act Coverage Endorsement (WC A) State Code 00 Endorsement Number WC Bureau Version Identifier A Exposure Record Exposure Act Code 02 USL&HW F Classes USL&HW Coverage on Non F Classes 17 Texas Classes for Oil, Gas or Other Mineral Operations on or Over Water Basic Manual Texas exception Classifications for oil, gas or other minerals on or over water Exposure Act Code Code 08 Coverage Under USL&HW Act for Oil, Gas or Other Mineral Operations on or Over Water 18 9

12 USL&HW Act Reporting Unit Statistical Data Exposure Record Exposure Act Code 02 USL&HW F Classes USL&HW Coverage on Non F Classes Edit Specific Maritime and F Classification Codes must be reported with Exposure Act Code 02 Classification Code 9077F United States Armed Service Risks must be reported with Exposure Act Code USL&HW Act and State Act Jurisdictional Benefits Exclusive State or Federal Only B E N E F I T S Concurrent State and Federal 20 10

13 USL&HW Act Reporting Unit Statistical Data Loss Record Loss Condition Act Report 01 (State Act) or 02 (USL&HW Act) depending on benefits and jurisdiction Texas Oil, Gas or Other Mineral Operations Report 05 (State Act) or 08 (USL&HW Act) Classification Code 9077F United States Armed Service Risks Claims must be reported with Loss Conditions Act Code 02. Jurisdiction state report 00 for federal benefits or appropriate state code for state benefits 21 USL&HW Act Reporting Financial Calls Financial Call Reporting Guidebook lists all F class codes Exclude F class data from ratemaking calls, but report as a line item on Call #8 Include Industrial Codes F loaded Include in Supplemental Calls (#1, #1A #1D, #14, #19, #26 addendum to Call #19 section) 22 11

14 USL&HW Act Reporting DCI Exclude claims where benefits are payable under the USL&HW Act Subsequent Reporting of a Claim Reclassified as Federal Act Jurisdiction State Code 59 Federal Act Medical Call Data Claims are subject to medical transactions 23 Federal Employers Liability Act (FELA) and Admiralty Law 12

15 Federal Employers Liability Act (FELA) Protects and compensates railroad workers injured on the job Railroads engaged in interstate commerce are liable for injuries to employees if the railroads have been negligent Railroad worker must prove that the railroad was legally negligent in causing the injury 25 Underwriting Rule and Endorsement Basic Manual Rule 3 A 4 FELA Endorsement (WC A) FELA coverage is not available in the Assigned Risk market Program I, Program II, and Program II USL&HW Act Basic Manual User's Guide F-7 Additional Coverages Summary Table 26 13

16 FELA Coverage FELA Program I Standard Workers Compensation and Employers Liability Policy WC C Federal Employers Liability Act Coverage Endorsement WC A 27 FELA Coverage With Voluntary Compensation and State Act Federal Employers Liability Act Coverage Endorsement WC A FELA Program II Standard Workers Compensation and Employers Liability Policy WC C Voluntary Compensation and Employers Liability Coverage Endorsement WC A 28 14

17 FELA Coverage With Voluntary Compensation and USL&HW Act Federal Employers Liability Act Coverage Endorsement WC A FELA Program II USL&HW Act Standard Workers Compensation and Employers Liability Policy WC C Voluntary Compensation and Employers Liability Coverage Endorsement WC A Longshore and Harbor Workers Compensation Act Coverage Endorsement WC A 29 FELA Classification Groups Basic Manual User s Guide FL Rate Pages Effective 01/01/2018 Class Code Rate Minimum Premium 6702M M M M Risks are subject to Federal Employers Liability Act (FELA). A provision for the USL&HW Assessment is included for those classifications under Program II USL Act

18 Admiralty Law Also known as the Jones Act, Merchant Marine Act, and Maritime Law For masters and members of the crews of vessels Operation or welfare of the vessel while in navigable waters Provides seamen with the same protection from employer negligence as FELA provides to railroad workers Employees can bring action against their employer for negligence 31 Admiralty Law Basic Manual Rule 3 A 4 Maritime Endorsement (WC B) Program I, Program II, and Program II USL&HW Act Basic Manual User s Guide F 7 Additional Coverages Summary Table 32 16

19 Admiralty Law Transportation, Wages, Maintenance, and Cure (TWMC) Transportation returning an injured worker back to shore Wage salary Maintenance living expenses Cure medical expenses To provide coverage for TWMC, premium charge is entered in the maritime endorsement or in Item 2 of the policy 33 Admiralty Law Maritime Program I Standard Workers Compensation and Employers Liability Policy WC C Maritime Coverage Endorsement WC B 34 17

20 Admiralty Law With Voluntary Compensation and State Act Maritime Program II Standard Workers Compensation and Employers Liability Policy WC C Maritime Coverage Endorsement WC B Voluntary Compensation Maritime Coverage Endorsement WC Admiralty Law With Voluntary Compensation and USL&HW Act Maritime Coverage Endorsement WC B Maritime Program II USL&HW Act Standard Workers Compensation and Employers Liability Policy WC C Voluntary Compensation Maritime Coverage Endorsement WC Longshore and Harbor Workers Compensation Act Coverage Endorsement WC A 36 18

21 Admiralty Law Classification Groups Basic Manual User s Guide FL Rate Pages Effective 01/01/2018 Class Code Rate Minimum Premium 7038M M M M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA). A provision for the USL&HW Assessment is included for those classifications under Program II USL Act. 37 Minimum Premium for Admiralty or FELA Basic Manual Rule 3 A 16 Separate minimum premium for Admiralty Law or FELA Applies in addition to the minimum premium or premium for other operations 38 19

22 Increased Limits for Admiralty or FELA Basic Manual Rule 3 A 14 Additional premium for increased limits Determined by applying the factor in the Table for Increased Limits Separate minimum premium for increased limits Not available in Assigned Risk Market 39 Statistical Codes Statistical Code 9849 Admiralty/FELA Balance to Minimum Premium Statistical code for Admiralty/FELA increased limits premium Corresponds to limits of liability Example: Statistical Code 9819 for $200,000 increased limit per accident Statistical Code 9840 for increased limits for Admiralty or FELA risks over $500,

23 FELA/Admiralty Law Reporting Policy Endorsement Identification Record Program Type FELA Endorsements Admiralty Law Endorsements Program I WC000104A WC000201A Program II WC000104A & WC000311A WC000201A & WC Program II (USL&HW) Exposure Record Exposure Act Code WC000104A, WC000311A, WC000106A WC000201A, WC000203, WC000106A Program I and Program II (State), report 01 Program II (USL&HW), report 02 Statistical codes for any minimum premium balance or increased limits premium 41 FELA/Admiralty Law Reporting Unit Statistical Data Exposure Act Code Program I and Program II (State), report 01 Program II (USL&HW), report 02 Statistical codes for any minimum premium balance or increased limits premium Loss Conditions Act Code Program I and Program II (State), report 01 Program II (USL&HW Act), report 01 or 02 for Loss Conditions Act Code, depending on benefits For jurisdiction state, report 00 for federal benefits or appropriate state code for state benefits 42 21

24 FELA/Admiralty Law Reporting Transportation, Wages, Maintenance, and Cure (TWMC) Any applicable premium charge is not reportable No designated statistical code Losses and expenses related to TWMC are included in incurred/paid medical and indemnity loss amounts 43 FELA/Admiralty Law Reporting Financial Calls Financial Call Reporting Guidebook lists all maritime and FELA class codes Exclude FELA/Maritime data (including TWMC) from ratemaking calls For differences, show additional premium and losses in Call 8, Row 3 reconciliation (Maritime and FELA) Exclude Admiralty/FELA Balance to Minimum Premium Include in supplemental calls (#1, #1A #1D, #14, #19, #26 addendum to Call #19 section) 44 22

25 FELA/Admiralty Law Reporting DCI Exclude claims where benefits are payable under a federal act (FELA and Admiralty Law) Subsequent Reporting of a Claim Reclassified as Federal Act Jurisdiction State Code 59 Federal Act Medical Call Data Claims are subject to medical transactions 45 Federal Mine Safety and Health Act (Black Lung Disease) 23

26 Federal Mine Safety and Health Act (Black Lung Disease) Disease coverage provided for risks subject to the Act. 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 the US Department of Labor (USDOL) for the complete black lung definition. 47 Federal Mine Safety and Health Act (Black Lung Disease) Basic Manual Rule 3 A

27 Federal Mine Safety and Health Act (Black Lung Disease) State advisory loss costs or rates for disease (federal act and state law coverage) are shown separately in the state pages State advisory loss costs or rates for disease not described by a coal mine classification and for former coal mine operators are determined by the carrier and are not shown separately in the state pages Standard Premium excludes any disease charge WC B Federal Mine Safety and Health Act Coverage Endorsement 49 Coal Mine Code Miscellaneous Values Kentucky rate pages, effective 10/01/2017 Class Code Rate 1005* X* X Refers to special classification phraseology in these pages which is applicable in this state. *Class codes with specific footnotes 1005 Advisory loss cost includes a non ratable disease element of $5.45. (For coverage written separately for federal benefits only, $4.87; for coverage written separately for state benefits only, $0.58.) 1016 Advisory loss cost includes a non ratable disease element of $ (For coverage written separately for federal benefits only, $20.29; for coverage written separately for state benefits only, $2.41.) 50 25

28 Statistical Plan Rules Part 1 L Coal Mine and Black Lung Disease Experience Exposure and losses for traumatic and occupational disease (other than Black Lung) are reported separately from exposure and losses for Black Lung Disease Reporting of experience for Black Lung Disease Corresponding Statistical Codes Specific Exposure Act and Loss Condition Act Codes, based on State and/or Federal Act coverage and benefits 51 Statistical Codes Classification Code 1016 Coal Mining NOC 1005 Coal Mining Surface and Drivers Any non coal mining classification code Statistical Code 0158 Black Lung Disease Experience in Connection With Code Black Lung Disease Experience in Connection With Code Black Lung Disease Experience in Connection With Any Classification Other Than Coal Mine Code State Exceptions Texas Classification Code 1165 and corresponding Statistical Code 0156; 1016 and 0158 are not applicable Virginia Statistical Codes 0161 (Substantial Exposure) and 0162 (Non Substantial Exposure); 0164 is not applicable 52 26

29 Black Lung Disease Exposure/Loss Reporting Exposure Coverage/Loss Condition Act 01 State Act Description Federal Mine Safety and Health Act Federal Mine Safety and Health Act and the State Act 53 Exposure Experience Code Underground Coal Mine Surface Coal Mine Coal Mine Class and Statistical Codes Traumatic or Occupational Disease Black Lung Disease Traumatic or Occupational Disease Black Lung Disease Exposure Act (Coverage) Loss Condition Act (Benefits Paid/Payable) State 01 State 01 TX N/A TX N/A 1005 TX State 01 State 01 Federal 03 Federal 03 State/Federal 04 State 01 Federal 03 State/Federal 04 State 01 State 01 State 01 State 01 Federal 03 Federal 03 State/Federal 04 State 01 Federal 03 State/Federal

30 Non Coal Mine Class and Statistical Codes Exposure Experience Code Non Coal Mine Operations Traumatic or Occupational Disease Black Lung Disease 7219 (e.g., Trucking) 0164 VA 0161 or 0162 Exposure Act (Coverage) Loss Condition Act (Benefits Paid) State 01 State 01 State 01 State 01 Federal 03 Federal 03 State/Federal 04 State 01 Federal 03 State/Federal Black Lung Disease Reporting Loss Fields Loss Condition Act Jurisdiction State 00 Loss Condition Type of Loss 02 Occupational Disease Part of Body 60 Lungs (Example) Nature of Injury 60 Dust Disease, NOC 62 Black Lung 64 Silicosis 56 28

31 Financial Call Reporting Chart 57 Federal Mine Safety and Health Act Reporting Financial Calls Ratemaking Calls Underground Coal Mine For all states except Virginia, do not report any underground coal mine experience (traumatic, OD, and black lung) except as a reconciliation item on Call #8 Surface Coal Mine For all states except Virginia, report any surface coal mine experience for traumatic and OD other than black lung. Do not report any surface coal mine experience for OD black lung except as a reconciliation item on Call #8 Virginia experience for all coal mine risks is reported on Virginia state specific coal mine calls (#32A, #32V, #33) 58 29

32 Federal Mine Safety and Health Act Reporting DCI Exclude claims where benefits are payable under a federal act (Coal Mine Acts) Medical Call Data Claims are subject to medical transactions 59 Federal Coverage Service 30

33 Federal Coverage Service USL&HW Act Coverage State Premium Record Record Type 04 One or more NCCI states on policy Exposure Record Record Type 05 F Class Codes ( F suffix e.g., 6803F) refer to Policy and Proof of Coverage Reporting Guidebook for listing or Exposure Act Code 02 (F class and Non F class loaded) Endorsement Identification Record Record Type 07 Must include one or more of the federal USL&HW endorsement numbers Send daily electronic file to the US Department of Labor (USDOL) 61 Defense Base Act (DBA) Can be written as monoline coverage not part of a standard WC policy Specialized foreign workers compensation coverage for employees working outside of the United States Federal Coverage Service Reported data is sent to NCCI in a special, federally approved format Data file is sent to the US DOL Division of Longshore and Harbor Workers Compensation 62 31

34 Federal Coverage Service Federal Mine Safety and Health Act Coverage 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 Send daily electronic file to the US Department of Labor (USDOL) 63 Catastrophe Provisions 32

35 Catastrophe Provisions Types Catastrophe (Other Than Certified Acts of Terrorism) Terrorism Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) of 2015 Premium surcharge for catastrophe or terrorismrelated programs NCCI evaluates premium surcharges as part of its ratemaking process Circular FYI CW Basic Manual Rule 3 A Catastrophe Provisions Reporting Policy Report on Record Type 07 (Endorsement Identification Record) Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC B) Florida Terrorism Risk Insurance Program Reauthorization Act Endorsement (WC B) Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement (WC D) Statistical Codes: Code 9740 Catastrophe Provisions for Terrorism Rating (TRIPRA) Code 9741 Catastrophe Provisions for Catastrophe (Other Than Certified Acts of Terrorism) Code 9752 Terrorism (discontinued) Report exposure, rate, and/or premium 66 33

36 Catastrophe Provisions Reporting Unit Statistical Include appropriate statistical code Report exposure, rate, and/or premium Financial Calls Exclude from DSR Level, Company Standard, and Net Premiums from ratemaking calls Report as a line item on Call #8 Include on Calls #1, #1A, #1B, #1C, #1D, and #14 DCI and Medical Data Call Premium not applicable 67 Terrorism Data Reporting Federal Insurance Office (FIO) Section 111 of TRIPRA 2015 Data Request National Association of Insurance Commissioners (NAIC) Data Call related to Terrorism Risk Insurance Coverage 68 34

37 Other Coverages Foreign Voluntary Compensation Voluntary Compensation Insurance Provides coverage for workers where WC coverage is NOT required by state law (WC A/ WC A) Foreign Voluntary Comp Coverage for employees who are hired in 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 Additional expenses needed to return injured or deceased worker back to the United States Basic Manual Rule 2 I (CT and FL Exceptions and Endorsements) 70 35

38 Foreign Voluntary Compensation Reporting Policy Endorsement Identification Record: WC A WC A Florida A Connecticut WC Applicable for Foreign Voluntary Compensation Carrier Independently Filed Endorsement for Foreign Voluntary Compensation (appropriate endorsement #) Type of Nonstandard ID Code 09: Voluntary and/or Foreign Voluntary Coverage 71 Foreign Voluntary Compensation Reporting Unit Statistical Type of Nonstandard ID Code 09: Voluntary Coverage Not Mandated by State Act Exposure/Premium Classification code Do not report additional repatriation coverage charge (no statistical code) Paid/Incurred Losses Report the entire claim amount, including repatriation losses and expenses 72 36

39 Foreign Voluntary Compensation Reporting Financial Calls Premium Report audited premium for both Voluntary Compensation and Foreign Voluntary Compensation insurance in DSR Level, Company Standard, and Net Premiums Premium for additional (optional) repatriation coverage is included in Net Premium only, excluded from DSR Level and Company Standard Premiums Call #8 Reconciliation Item Paid Losses and Case Reserves Report the entire claim amount, including repatriation losses and expenses DCI and Medical Data Call No unique reporting exceptions or values 73 National Defense Projects Rating Plan (NDPRP) Retrospective Rating Plan run by the 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 a specific location Estimated annual premium for insurance is at least $10,000 Previously the Comprehensive Rating Plan; not to be confused with the Defense Base Act 74 37

40 Atomic Energy Work performed for, or under the direction of, the Nuclear Regulatory Commission (NRC) or other government agency Projects that involve the operations of, or experimental work on, nuclear reactors Rates agreed upon between Carrier, Contractor, and NRC Class Code 9984 (Atomic Energy Project Work) Work not performed for, or under the direction of, the NRC or other government agency Work that involves research, manufacturing, transportation, or exposure to radioactive materials Rates are based on general rates for job classifications that normally describe operation Class Code 9985 (Atomic Energy: Radiation Exposure NOC) 75 Reporting Rules Statistical Plan Part 1 M. National Defense Projects N. Radiation Exposure Nuclear Regulatory Commission Projects O. Radiation Exposure Other Than Nuclear Regulatory Commission Projects 76 38

41 National Defense Project Rating Plan Coverage Type Policy/ POC Unit Statistical Financial Calls DCI Medical Data Call National Defense Projects Rating Plan (Comprehensive Rating Plan) Only if POC is a requirement* Not Reportable Report on: Call #8 Not Reportable Not Reportable Other National Defense Projects (Guaranteed Cost or Other Retro Plan) Reportable Reportable Reportable in All Calls Subject to Claim Sampling Subject to Medical Transactions *Remember: Reporting NDPRP policies requires you to deactivate the URC Record. 77 Atomic Energy Exposure Reporting Coverage Type Policy/POC Unit Statistical Financial Calls DCI Medical Data Call NRC/Gov t Involvement Only if POC is a requirement* Not Reportable Not Reportable Not Reportable Not Reportable Class Code 9984 No NRC/ Gov t Involvement Class Code 9985 Class Code 9985 Premium, Losses Report on Calls #8, #1, #1A, #19, #26 (Call #19 addendum) Claim Subject to Sampling Claim Subject to Medical Transactions *Remember: Reporting atomic policies WITH NRC/government involvement requires you to deactivate the URC Record

42 79 Thank You for Participating! 40

43 Supplemental Information

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45 Presenter Biographies Carol Brusca is currently a regulatory consultant in the Regulatory Division. She is responsible for monitoring workers compensation industry trends across states. Prior to this role, she was a regulatory services manager, where she was responsible for preparing national and state item filings and providing technical support to regulators, carriers, employers, and agents with NCCI s manual rules. Carol has more than 18 years of insurance industry experience, including 15 years with NCCI. She has earned Associate in Insurance Services (AIS) and Accredited Advisor in Insurance (AAI) designations from The Institutes. Carol has a bachelor s in history from the University of Florida. Julie Gonzalez, AU, AIDM, has worked at NCCI since As a senior 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 reporting rules and data requirements, and enhancing NCCI s external training programs and data reporting tools. In addition, Julie actively participates on industry committees and association forums to forge industry relationships and provide subject-matter expertise. She is a member of the Insurance Data Management Association s Educational Committee, which is responsible for developing the formal certification program for insurance data management. Prior to joining Data Services, Julie was a senior underwriting analyst, responsible for filing workers compensation rules and programs, maintaining the classification system, 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.