WCIRB Policy Data Quality Program (PDQP) Explanatory Notes for Quarterly Report. About the Program. About the PDQP Report. Section A Insurer Results

Transcription

1 WCIRB Policy Data Quality Program (PDQP) About the Program The WCIRB Policy Data Quality Program (PDQP) is a data quality program approved by the WCIRB Governing Committee to monitor the quality of policy data submitted to the WCIRB and to proactively identify potential data quality deficiencies using a series of key performance indicators, or metrics. Insurers that do not meet specific performance standards pursuant to this program are required to take remedial action and may be assessed fines. Additional information about the PDQP is located on the WCIRB s website at About the PDQP Report PDQP quarterly reports (Reports) allow insurer participants to monitor their results on a quarterly and fourquarter basis. The Report header identifies the quarter and four-quarter periods. The Report includes the following sections: Section A Insurer Results Section B Statewide Results An accompanying Excel report provides detailed information on the specific policy transactions corresponding to the results summarized in Section A for the indicated quarter. All details reflect the attributes of the policy transaction at the point in time that the policy was included in the PDQP metric. Details are included for the identified quarter only not for the entire four-quarter period. These explanatory notes are intended to clarify terms used in the PDQP report. For a complete description of the program metrics and administrative procedures, please refer to the program document available on the WCIRB s website. Section A Insurer Results This section provides a summary of an insurer group s results for the PDQP metrics during the identified quarter and four-quarter period. The quarterly results are displayed first, with the four-quarter results appearing just to the right. For each metric, the tolerance for acceptable performance and the minimum volume of policy transactions that are required to assess the insurer s performance are displayed. Assessments of whether insurers meet performance standards are based on the four-quarter period. If an insurer s results over a four-quarter period exceed the tolerance while meeting the minimum volume of policy transactions, the insurer s results will be subject to further evaluation pursuant to the PDQP provisions. 1

2 Submission Timeliness Policies Tolerance: 5% Minimum: 25 policies received more than 60 days after the policy inception date Measures an insurer s volume of new and renewal policies, annual rating endorsements, and renewal certificates / renewal agreements received by the WCIRB more than 60 days after policy inception. A) Number of policies received more than 60 days after the policy inception date B) Total number of policies received Policy Types Included: Transaction Type WCPOLS Transaction Code Included in This Metric New Policy TC01 Renewal Policy TC02 Annual Rating Endorsement TC04 Renewal Certificate / Renewal Agreement TC18 Policy Replacement Due to Key Field Change Policy Replacement Due to Rating Change Policy Replacement Due to Non-Rating Change Policy Replacement Due to Misc. Change / Non-Key Field Change Policy Replacement Due to Add / Delete State Change Proof of Coverage Notice / Binder Policy Transaction as a Result of Hardcopy Submission TC06 TC08 TC10 TC14 TC15 TC16 N/A Policies are required to be submitted to the WCIRB within 60 days from policy inception date, as specified in the California Workers' Compensation Uniform Statistical Reporting Plan

3 Submission Timeliness Cancellations / Reinstatements Tolerance: 5% Minimum: 25 cancellations and/or reinstatements received more than 60 days after the issuance date Measures an insurer s volume of cancellations and reinstatements received by the WCIRB more than 60 days after issuance. A) Number of cancellations and reinstatements received more than 60 days after issuance B) Total number of cancellations and reinstatements received Policy Types Included: Transaction Type WCPOLS Transaction Code Included in This Metric Cancellations TC05 Reinstatements TC05 Non-Renewals TC05 Policy cancellations and reinstatements are required to be submitted to the WCIRB within 60 days from issuance, as specified in the California Workers' Compensation Uniform Statistical Reporting Plan

4 Responsiveness to Policy Work Items Tolerance: 20% Minimum: 25 policy work items closed more than 60 days from issuance of the inquiry Measures an insurer s volume of policy work items responded to completely and accurately more than 60 days after issuance of the inquiry. A) Number of policy work items closed more than 60 days after issuance B) Total number of policy work items closed The 60-day period to close the policy work items starts when the work item first appears in an insurer s WCIRB Connect work queue; the metric only totals the number of days the work item is in the WCIRB Connect work queue and excludes the days the work item is pending with the WCIRB Only work items created after 12/1/17 are included Issuance means the date the item appears in the insurer s work queue A work item is closed when WCIRB records reflect the work item as closed or approved through: o o A data correction submitted by the insurer, or The closure of the work item by the WCIRB in response to information provided by the insurer that satisfied the inquiry 4

5 Below is a list of the policy audit work items that are included in this metric: Code FM07 FM10 FM12 FM20 FM21 FM22 FM22A FM23 FM23A FM24 FM25 FM26 FM27 FM28 FM29 FM30 FM31 ID01 ID02 PC02 PC03 PC04 PC05 PC07E PC07R PC10E PC10R PC15 PC15A PC16 PC18 PC20 Error Wording Customized L&R- Requirements for Usage Endorsement reported using DG record - review required L&R Endorsement Requiring Alternate Coverage, but not provided. General L&R - variable text wording was not submitted General L&R WC excluded individual's name not provided General L&R WC excluded location not provided General L&R WC excluded operation name not provided General L&R WC excluded location not provided General L&R WC excluded operation name not provided General L&R WC excluded operation name not provided. General L&R WC excluded class code not provided General L&R WC excluded operation name not provided. General L&R WC excluded class code not provided General L&R WC excluded location not provided General L&R WC included operations name not provided. General L&R WC description of included class code not provided General L&R WC included location not provided Name was not on prior coverage for this policyholder Name was added to the policy No record of prior coverage - Large EAP No record of prior coverage - Employee Leasing Policy Cancellation or nonrenewal is outside of policy effective period Cancellation and Reinstatement received - unable to determine applicability Duplicate Coverage Duplicate Coverage Duplicate coverage with policy from same group Duplicate coverage with policy from same group Renewal policy received - prior policy not received Renewal policy received - prior policy cancelled Policy Period exceeds 1 year 16 days - Policy Period Endorsement required No record of prior coverage - mod reported Cancelled flat policy has USR 5

6 Unmatched Policy Transactions Cancellations / Reinstatements Tolerance: 2% Minimum: 25 cancellations or reinstatements not matched to policies within 60 days Measures an insurer s volume of cancellations and reinstatements that are not matched to previously submitted policies within 60 days of receipt of the cancellations or reinstatements by the WCIRB. A) Number of cancellations and reinstatements not matched within 60 days B) Total number of all cancellations and reinstatement received Starting in May 2018, insurers will be notified of unmatched cancellations and reinstatements via the PM05 work items in the WCIRB Connect work queue The 60-day period to resolve the unmatched cancellations and reinstatements starts when the unmatched cancellation or reinstatement is received by the WCIRB The WCIRB will attempt to match the unmatched cancellation / reinstatement to subsequent transactions for 15 days. If we do not receive a subsequent transaction for the unmatched transaction within 15 days, the insurer will be notified via the PM05 work item in WCIRB Connect. Excluded from this metric are: o Flat cancellation notices; and o Unmatched endorsements 6

7 Unmatched Unit Statistical Reports (USRs) Tolerance: 2% Minimum: 25 original first report level USRs not matched to policies within 60 days Measures an insurer s volume of original first report level USRs that are not matched to previously submitted policies within 60 days of receipt of the USRs by the WCIRB. A) Number of original first report level USRs not matched within 60 days B) Total number of original first report level USRs received Starting in May 2018, insurers will be notified of unmatched USRs via the R51 and R34 work items in the WCIRB Connect work queue The 60-day period to resolve the unmatched USR starts when the unmatched USR is received by the WCIRB The WCIRB will attempt to match the unmatched USR to subsequent transactions for 15 days. If we do not receive a subsequent transaction for the unmatched transaction within 15 days, the insurer will be notified via the R34 and R51 work item in WCIRB Connect. R34 work item indicates the policy number reported on the USR does not match to any policy in the WCIRB s system R51 work item indicates the policy number reported on the USR matches to a policy in the WCIRB s system, but the policy effective date does not match that of the corresponding policy 7

8 Experience Modification Reporting Success Policy Transactions Tolerance: 10% Minimum: 25 initial policies reported with missing or incorrect experience modification(s) 60 days after receipt of the initial policy Measures an insurer s volume of initial policies with incorrect or missing experience modifications 60 days after receipt of initial policy. A) Number of initial policies with unresolved experience modification audit errors 60 days after receipt of the initial policy B) Total number of initial policies subject to published experience modifications An initial policy is the first of any of the following WCPOLS transactions received by the WCIRB: New Policy, Renewal Policy, Annual Rerate Endorsement, and Renewal Certificate / Renewal Agreement The 60-day period to resolve the experience modification error starts when the work item first appears in an insurer s WCIRB Connect work queue The following experience modification errors are included in this metric and can be located in the Data Quality Edits Work Queue: Code XM01 XM03 XM04 XM05 XM06 Error Wording X-mod not reported on policy X-mod reported - rating for same effective date pending X-mod reported with incorrect effective date and mod X-mod reported, but effective date incorrect X-mod reported, but mod factor incorrect 8

9 Forms Compliance Tolerance: Advisory Only Minimum: Advisory Only Identifies an insurer s policies reported with unapproved forms and/or policies not endorsed with provisions required by California law using approved forms. Measures: A. Instances of unapproved forms received, with each unique form only counted once per insurer per quarter B. Instances of policies missing language required by California law using approved forms, with each unique missing form only being counted once per insurer per quarter This is an advisory metric with no threshold; however, an insurer may be subject to remedial actions if deficiencies are identified and not resolved timely Policy forms need to be filed and approved for each individual company within an NAIC Group Unapproved forms can be identified in the Data Quality Edits work queue by the FM01 Error. The Unapproved form number is identified as part of the Error. Code FM01 Form XXXXXXXX not approved Error Wording Instances of missing required language can be identified in the Data Quality Edits work queue by the FM03, FM04, FM05, and FM06 Error. The description of the form with the missing required language is provided as part of the error wording. Code FM03 FM04 FM05 FM06 Error Wording Required policy conditions form not on policy Required information page not on policy Required California policy amendatory endorsement not on policy Required California cancellation endorsement not on policy 9

10 Section B Statewide Results This section contains a summary of the statewide results for six of the seven metrics during the identified quarter and four-quarter period, based on the policy transaction reporting of all insurers including both PDQP participants and non-participants. (Statewide results are not provided for the Forms Compliance metric.) 10