West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-23 - Medical Malpractice Loss Experience And Loss Expense Annual Reporting Requirements
Section 114-23-7 - Severability
Universal Citation: 114 WV Code of State Rules 114-23-7
Current through Register Vol. XLI, No. 38, September 20, 2024
7.1. Severability. If any provision of this legislative rule is held invalid, the remainder of the rule shall not be affected thereby.
Exhibit A
Annual Loss Experience and Loss Expense Reporting Form
(Note: Attach Additional Sheets For Answers When Necessary)
1. Company
Name:________________________________________________
If part of a group, specify group name:
__________________
2. Coverage
Classification::__________________________________________
3. Provide, on a West Virginia basis and on a
countrywide basis, the following information by twelve-month accident year for the
preceding ninety-six months:
a. paid
losses;
b. accumulated paid
losses;
c. paid loss adjustment
expenses; and,
d. incurred but not
reported losses.
4. Provide,
on a West Virginia basis and on a countrywide basis, the calculation of loss
development factors by twelve-month accident year for the preceding ninety-six
months for the following:
a. paid losses;
b. accumulated paid losses;
c. paid loss adjustment expenses; and,
d. incurred but not reported losses.
5. Provide, on a West Virginia basis
and a countrywide basis, the ratio of accumulated paid losses to earned premiums by
twelve-month accident year for the preceding ninety-six months.
6. Provide, on a West Virginia basis and a
countrywide basis, the number of policies in force and the paid losses per policy by
twelve-month accident year for the preceding ninety-six months.
7. Provide a comparison of allocated West Virginia
operating expenses and actual West Virginia operating expenses by twelve-month
accident year for the preceding ninety-six months.
8. Provide, on a West Virginia basis and on a
countrywide basis, a linear trend analysis which shows the indicated projected
trended development factors for paid losses, accumulated paid loss, paid loss
adjustment expenses and incurred but not reported losses. Provide the R squared
results of the linear models.
9. Provide
the methodology by which the credibility of West Virginia data in relationship to
countrywide data is weighted in calculating an indicated percentage of premium rate
increase by twelve-month accident year for the preceding ninety-six months. Provide
formulas used in the methodology and a narrative explanation and justification of
use of the particular methodology.
10.
Provide the following information with regard to actual expenses:
a. Actual paid claims by policy type by year
(please separate underlying tort payments from bad faith, unfair claims practices
and other extra contractual payments).
b. Actual legal fees by policy type by
year.
c. Actual administrative costs
paid by policy type by year.
11. Provide audited financial statements inclusive
of income statements and balance sheets, statements of cash flow and footnotes to
financials.
The above information is correct to the best of my knowledge and belief.
________
Name (type or print)
________
Title
____________________________
Address
________
Telephone Number
________
Signature
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