Current through Register Vol. 38, No. 18, March 15, 2024
For those filings made in accordance with
11 NCAC 10
.1102(15), supporting information shall be presented as
follows:
(1) Reference Filing Adoption Form:
(a) Insurer's name.
(b) Contact
person for filing.
(c) Title of contact person.
(d) Phone number.
(e) Insurer's
FEIN.
(f) Insurer's file number.
(g) Department file number.
(h)
NCRB reference filing number.
(i) Effective date.
(j) Insurer's proposed effective date (if different from NCRB effective
date).
(k) Insurer's approximate market share of North Carolina
written premium.
(l) Whether the multiplier is applicable to this
filing only or to subsequent reference filings.
(m) Statement of
accuracy of information.
(n) Signature of company
official.
(o) Date signed.
(2) Summary of Supporting Data Form:
(a)
Statement of whether the filing applies uniformly to all workers' compensation classes.
(b) Loss costs modification:
(i) Without
modification (factor equals 1.000).
(ii) With modification
(supporting documentation required).
(c) Loss costs
modification factor.
(d) Selected expenses (attach Expense
Provision Exhibit):
(i) Commission and brokerage.
(ii) Other acquisition.
(iii)
General expenses.
(iv) Taxes, licenses, fees, loss based
assessments.
(v) Profit, contingencies, credit for investment
income.
(vi) Other.
(vii) Total (i+ii+iii+iv+v+vi).
(e) Development of Expected Loss and Loss Adjustment Expense (Target Cost)
Ratio: Expressed in decimal form: 1.000-(d)(vii).
(f) Overall
effect of expense constant and minimum premiums: Expressed in decimal form, i.e., 1.2% overall effect would
be 0.988.
(g) Overall effect of size-of-risk discounts plus
expense gradation recognition in retrospective rating: Expressed in decimal form, i.e., 8.6% average discount
would be 0.914.
(h) Provision for loss based assessments: See
NCRB Reference Filing, Exhibit II.
(i) Company formula loss costs
multiplier (b)(ii) x (1.000 - h)/ [(g) - (d)(vii)] x (f).
(j)
Company selected loss costs multiplier. Explain any differences between (i) and (j).
(k) Rate level changes for the coverages to which this page
applies.
(l) Statement of whether the insurer is amending the
minimum premium formula.
(m) Statement of whether the insurer is
amending the expense constant(s).
(n) Statement of whether the
insurer is changing the premium discount schedules.
(o) If the
answer to (l), (m), or (n) is yes, documentation is required.
(3) Expense Provisions Exhibit: For the following items, the insurer shall
provide the three most recent years, the average, industry average, and the selected:
(a) Commissions and brokerage.
(b) Other acquisition.
(c)
General expenses.
(d) Taxes, licenses, fees, and loss based
assessments.
(e) Profit, contingencies, and investment income:
(i) Profit and contingencies.
(ii) Credit for investment income.
(f) Other.
(g) Total
(a+b+c+d+e+f).
The insurer shall indicate if the insurer's actual expense ratios are
North Carolina, countrywide, or other (explain); and if the insurer's actual expense ratios are a percent of
standard premium, percent of net premium, or other (explain). The insurer shall explain if the selected
provisions differ from the average for reasons other than rounding.
Authority
G.S.
58-2-40;
58-36-15;
58-36-100;
Eff. February 1, 1996;
Temporary Amendment Eff. December 1, 1999;
Amended Eff. July 1, 2000;
Pursuant to
G.S.
150B-21.3A, rule is necessary without substantive public interest Eff.
January 3, 2017.