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NAIC BLANKS (E) WORKING GROUP Blanks Agenda Item Submission Form CONTACT PERSON: TELEPHONE: EMAIL ADDRESS: ON BEHALF OF: NAME: Dale Bruggeman DATE: 03/13/2017 FOR NAIC USE ONLY Agenda Item # 2017-15BWG Year 2017 Changes to Existing Reporting [ X ] New Reporting Requirement [ ] REVIEWED FOR ACCOUNTING PRACTICES AND PROCEDURES IMPACT No Impact [ X ] Modifies Required Disclosure [ ] DISPOSITION TITLE: Chair SAPWG AFFILIATION: Ohio Department of Insurance ADDRESS: 50W. Town St., 3 rd Fl., Ste. 300 Columbus, OH 43215 [ ] Rejected For Public Comment [ ] Referred To Another NAIC Group [ X ] Received For Public Comment [ ] Adopted Date [ ] Rejected Date [ ] Deferred Date [ ] Other (Specify) BLANK(S) TO WHICH PROPOSAL APPLIES [ X ] ANNUAL STATEMENT [ X ] QUARTERLY STATEMENT [ X ] INSTRUCTIONS [ ] CROSSCHECKS [ ] BLANK [ X ] Life and Accident & Health [ X ] Property/Casualty [ X ] Health [ ] Separate Accounts [ X ] Fraternal [ X ] Title [ ] Other Specify Anticipated Effective Date: Annual 2017 IDENTIFICATION OF ITEM(S) TO CHANGE Add additional disclosure item to Note 25, Change in Incurred Losses and Loss Adjustment Expenses (life, health, property, fraternal and title) and Note 32 Discounting of Liabilities for Unpaid Losses or Unpaid Loss Adjustment Expenses (property). REASON, JUSTIFICATION FOR AND/OR BENEFIT OF CHANGE** The purpose of this proposal is to add additional disclosure to in SSAP No. 55 Unpaid Claims, Losses and Loss Adjustment Expenses and SSAP No. 32 Propertyy and Casualty Contracts from Statutory Accounting Principles Working Group related to changes in methodology about unpaid losses and loss adjusting expenses which were based on ASU 2015-09, Financial Services Insurance Disclosures about Short-Duration Contracts. Comment on Effective Reporting Date: Other Comments: NAIC STAFF COMMENTS ** This section must be completed on all forms. Revised 6/13/2009 2017 National Association of Insurance Commissioners 255

ANNUAL AND QUARTERLY STATEMENT INSTRUCTIONS LIFE, HEALTH AND FRATERNAL 25. Change in Incurred Losses and Loss Adjustment Expenses A. Describe the reasons for changes in the provision for incurred loss and loss adjustment expenses attributable to insured events of prior years. The disclosure should indicate whether additional premiums or return premiums have been accrued as a result of the prior-year effects (if applicable). B. Information about significant changes in methodologies and assumptions used in calculating the liability for unpaid losses and loss adjustment expenses, including reasons for the change and the effects on the financial statements for the most recent reporting period presented. A. Reserves as of December 31, 2 were $ million. As of, 2, $ million has been paid for incurred losses and loss adjustment expenses attributable to insured events of prior years. Reserves remaining for prior years are now $ million as a result of re-estimation of unpaid claims and claim adjustment expenses principally on yyy and zzz lines of insurance. Therefore, there has been a $ million unfavorable (favorable) prior-year development since December 31, 2 to, 2. The increase (decrease) is generally the result of ongoing analysis of recent loss development trends. Original estimates are increased or decreased, as additional information becomes known regarding individual claims. Included in this increase (decrease), the Company experienced $ million of unfavorable (favorable) prior year loss development on retrospectively rated policies. However, the business to which it relates is subject to premium adjustments. 2017 National Association of Insurance Commissioners 256

ANNUAL AND QUARTERLY STATEMENT INSTRUCTIONS PROPERTY 25. Changes in Incurred Losses and Loss Adjustment Expenses A. Describe the reasons for changes in the provision for incurred loss and loss adjustment expenses attributable to insured events of prior years. The disclosure should indicate whether additional premiums or return premiums have been accrued as a result of the prior-year effects (if applicable). B. Information about significant changes in methodologies and assumptions used in calculating the liability for unpaid losses and loss adjustment expenses, including reasons for the change and the effects on the financial statements for the most recent reporting period presented. A. Reserves as of December 31, 2 were $ million. As of, 2, $ million has been paid for incurred losses and loss adjustment expenses attributable to insured events of prior years. Reserves remaining for prior years are now $ million as a result of re-estimation of unpaid claims and claim adjustment expenses principally on yyy and zzz lines of insurance. Therefore, there has been a $ million unfavorable (favorable) prior-year development since December 31, 2 to, 2. The increase (decrease) is generally the result of ongoing analysis of recent loss development trends. Original estimates are increased or decreased, as additional information becomes known regarding individual claims. Included in this increase (decrease), the Company experienced $ million of unfavorable (favorable) prior year loss development on retrospectively rated policies. However, the business to which it relates is subject to premium adjustments. 2017 National Association of Insurance Commissioners 257

ANNUAL AND QUARTERLY STATEMENT INSTRUCTIONS TITLE 25. Change in Incurred Losses and Loss Adjustment Expenses A. Describe the reasons for changes in the provision for incurred claim and claim adjustment expenses attributable to insured events of prior years. The disclosure should indicate whether additional premiums or return premiums have been accrued as a result of the prior-year effects (if applicable). For Title reporting entities, provision refers to the known claims reserve included in Line 1 of the Liabilities page and prior years refers to prior report years. B. Information about significant changes in methodologies and assumptions used in calculating the liability for unpaid claims and claim adjustment expenses, including reasons for the change and the effects on the financial statements for the most recent reporting period presented. A. Reserves as of December 31, 2 were $ million. As of, 2, $ million has been paid for incurred losses and loss adjustment expenses attributable to insured events of prior years. Reserves remaining for prior years are now $ million as a result of re-estimation of unpaid claims and claim adjustment expenses principally on yyy and zzz lines of insurance. Therefore, there has been a $ million unfavorable (favorable) prior-year development since December 31, 2 to, 2. The increase (decrease) is generally the result of ongoing analysis of recent loss development trends. Original estimates are increased or decreased, as additional information becomes known regarding individual claims. Included in this increase (decrease), the Company experienced $ million of unfavorable (favorable) prior year loss development on retrospectively rated policies. However, the business to which it relates is subject to premium adjustments. 2017 National Association of Insurance Commissioners 258

ANNUAL STATEMENT INSTRUCTIONS PROPERTY 32. Discounting of Liabilities for Unpaid Losses or Unpaid Loss Adjustment Expenses State whether or not any of the liabilities for unpaid losses or unpaid loss adjustment expenses are discounted, including liabilities for Workers Compensation. If the company is required to respond to this note in the affirmative for non-tabular discounting, it must also respond in the affirmative to Schedule P Interrogatory 4, and complete Columns 32 and 33 of Part 1, Part 1A, etc., of Schedule P. If the answer is in the affirmative, furnish the following information for each line of business affected: A. If a tabular basis is used: Identify table used. Rate(s) used to discount. The amount of discounted liability reported in the financial statements. The amount of tabular discount, disclosed by line of business and reserve category (i.e., case and IBNR). The amount of interest accretion recognized in the Statement of Income. The line item(s) in the Statement of Income in which the interest accretion is classified. Definition of Tabular Reserves: Tabular reserves by accident year are indemnity reserves that are calculated using discounts determined with reference to actuarial tables that incorporate interest and contingencies such as mortality, remarriage, inflation, or recovery from disability applied to a reasonably determinable payment stream. This definition shall not include medical loss reserves or any loss adjustment expense reserves. The Company discounts the liabilities for unpaid losses for Workers Compensation and Medical Professional Liability claims. The Company does not discount unpaid loss adjustment expenses. Reserves for Workers Compensation claims have been discounted on a tabular basis using the Table at %. The December 31, 20 and December 31, 20 liabilities include $ and $ of such discounted reserves, respectively. The Company recognized $ amount of interest accretion in the Statement of Income for the current year related to tabular discount on Lines. The amount of discount for case and IBNR reserves at December 31, 20 is as follows: 2017 National Association of Insurance Commissioners 259

THIS EXACT FORMAT MUST BE USED IN THE PREPARATION OF THIS NOTE FOR THE TABLE BELOW. REPORTING ENTITIES ARE NOT PRECLUDED FROM PROVIDING CLARIFYING DISCLOSURE BEFORE OR AFTER THIS ILLUSTRATION. (NOTE: THIS DOES NOT INCLUDE THE ENDING NARRATIVE.) A. Tabular Discount Tabular Discount Included in Schedule P Lines of Business Schedule P, Part 1* 1 2 Case IBNR 1. Homeowners/Farmowners 2. Private Passenger Auto Liability/Medical 3. Commercial Auto/Truck Liability/Medical 4. Workers Compensation 5. Commercial Multiple Peril 6. Medical Professional Liability occurrence 7. Medical Professional Liability claims-made 8. Special Liability 9. Other Liability occurrence 10. Other Liability claims-made 11. Special Property 12. Auto Physical Damage 13. Fidelity, Surety 14. Other (including Credit, Accident & Health) 15. International 16. Reinsurance Nonproportional Assumed Property 17. Reinsurance Nonproportional Assumed Liability 18. Reinsurance Nonproportional Assumed Financial Lines 19. Products Liability occurrence 20. Products Liability claims-made 21. Financial Guaranty/Mortgage Guaranty 22. Warranty 23. Total * Must exclude medical loss reserves and all loss adjustment expense reserves. Medical Professional Liability unpaid losses have been discounted on a nontabular basis using rates of from % to %. The discount rates used are based upon. The amount of the discount as of December 31, 20 and December 31, 20 respectively is $ and $ for losses and $ and $ for loss adjustment expense. The amount of discount at December 31, 20 for case, IBNR, Defense & Cost Containment expense and Adjusting & Other expense is as follows: W:\QA\BlanksProposals\2017-15BWG.doc 2017 National Association of Insurance Commissioners 260