Use of appropriate forms for data reporting filing requirements pursuant to 11 NYCRR 162 (Regulation 131).

July 17, 1987 SUBJECT: INSURANCE Circular Letter No. 13 (1987) WITHDRAWN TO: ALL INSURERS LICENSED TO WRITE IN NEW YORK STATE PERSONAL INJURY & PROPERTY DAMAGE LIABILITY DURANCE RE: USE OF APPROPRIATE FORMS FOR DATA REPORTING FILING REQUIREMENTS PURSUANT TO 11 NYCRR 162 (REGULATION 131) Pursuant to Section 334 of the Insurance Law, as specified in Regulation 131, 11 NYCRR 162, promulgated on July 13, 1987, dealing with data reporting filing requirements, all commercial property/casualty insurers must submit to the Department the data necessary to compile the Annual Commercial Property/Casualty Insurance Report. Please note that the forms attached to Regulation 131, as promulgated and distributed, were reduced in size. In order to expedite processing, the prescribed forms, in the size annexed to this Circular Letter, should be utilized by every insurer for all data submissions pursuant to Regulation 131. Please duplicate sufficient quantities of these annexed forms for continued use. Very truly yours, [SIGNATURE] JAMES P. CORCORAN SUPERINTENDENT OF INSURANCE Insurer NAIC Group Code   NAIC Company Code(s)   Federal Employer ID # New York 19   Direct Written Premiums For Selected Markets Market 19   Direct Written Premium Municipal Liability Public School Liability Child Care Liability Public Official Liability Non-Profit IRC 5501(c)(3) Directors & Officers Liability Other Directors & Officers Liability Medical Malpractice Liability Attorneys Malpractice Liability Accountants Malpractice Liability Architects and Engineers Malpractice Liability Other Professional Liability Other Errors & Omissions Liability Recreational Liability Other Owners, Landlords and Tenants Liability Other Manufacturers & Contractors Liability Products Liability Completed Operations Liability Liquor Law Liability Public Officials Liability Pollution Environmental Impairment Liability Police Professional Liability Commercial Automobile Liability (ex. PIP) All Other Commercial Liability All Other Liability (Not Commercial) (A) Total Liability (B) Total Non-Liability Premium in CMP on Page -14 of the Annual Statement. (C)=(A)+(B) (D) CKP as shown on page 14 (E) Medical Malpractice as shown on page 14 (F) Other Liability as shown on page 14 (C) Commercial Automobile liability (ex. PIP) as shown on page 14 (H)=(D)+(E)+(F)+(G) Calendar Year 19 1. Direct Premium Written* 2. Direct Premium Earned * 3. Direct Incurred Loss* $ %(E) 4. Allocated LAE $ %(E) 5. Unallocated LAE $ %(E) 6. Total LAE (3+6) $ %(E) 7. Losses LAE Incurred (3+6) $ %(E) 8. Commissions $ %(W) 9. Other Acquisition Costs $ %(W) 10. General Expenses $ %(E) 11. Taxes, Licenses & Fees $ %(W) 12. Total Expenses (8+9+10+11) $ 13. Total Losses & Expenses (7+12) $ 14. Underwriting Profit (Loss) (2-13) $ 15. Investment Income** $ 16. Operating Profit (Loss) (14+15) $ 17. Combined Trade Ratio ((7) + (10) / (2)) + ((8) + (9) + (11) / (1)) $ 18. Dividends to Policy holders $ E = Percent of Earned Premium W = Percent of Written Premium =This is to be completed for direct business(before reinsurance assumed or ceded) * Reconcile with page 14 of annual Statement ** Note the instruction in subdivision 162.4(b)(A) of Regulation 131 (1) (2) (3) (4) Unallocated Policy Total Limits Total Limits Total Limits Loss Adjust- Year Written Premium Paid Losses (a) Unpaid Losses (b) Expenses (c) 19 19 19 19 19 19 Total 19 -19 (5) (6) (7) (8) Ultimate Reported Ultimate Ultimate Loss Policy Incurred Incurred Incurred & LAE Ratio Year Losses Claim Claim [(5) / (1) ] Including Counts Counts (d) all LAE(d) 19 19 19 19 19 19 Total 19 -19 (a) Including ALLOCATED Loss Adjustment Expense (LAE) (b) Reserves on known Claims (c) Estimated as a percentage of Total Limits Paid and unpaid losses (d) Developed to an ultimate Settlement Basis, Attach Loss and Claim Development Exhibits (5)) = [(2)+(3)+(4)] x [Appropriate Loss Development Factors] (7)=(6) x appropriate Claim Development factor. Commercial Claim Report State of New York Market Accident Date Resolution Claim Number Past Non- Economic Economic Uninsurable (a) (b) (c) 1) Total Amount of Award 2) Insureds Equitable Share ($ amount) amount Paid on Behalf of Insured: 3)   By Insured 4)   By Insurer 5)   By Other Insurers Future Non- Total* Economic Economic Uninsurable (a) (b) (c) (g) 1) Total Amount of Award 2) Insureds Equitable Share ($ amount) amount Paid on Behalf of Insured: 3)   By Insured 4)   By Insurer 5)   By Other Insurers Form 101-D shall be completed for every claim with a resolution date, as defined in regulation 131 (11 NYCRR 162), on or after January 1, 1987, including such claims that result in no payments. - This is to be completed on a per claimant basis - All amounts shown must be in whole dollars. Percentage must be converted to dollars using appropriate calculations (e.g. if the total award is $ 100,000 and the insureds equitable share is 15% the amount line (2) is 15,000) - Complete lines (3) and (5) with best available estimates - Complete for Direct Incurred Losses (not including reinsurance ceded or assumed) *(g)=[(a)+(b)+(c)+(d)+(e)+(f)] [] Check here if report date of claim is prior to 8-1-86 Insurer NAIC Group Code   NAIC Company Code   Federal Employers ID # Commercial Claim Report-Annual Summary State of New York Market Resolution year ending 19 Separate forms are required for each claim size category by report date category Check if report is for [] Total Awards equal to zero [] Total Awards greater than zero, and less than or equal to $ 50,000 [] Total Awards greater than $ 50,000, and less than or equal to $ 250,000 [] Total Awards greater than $ 250,000, and less than or equal to $ 1,000,000 [] Total Awards greater than $ 1,000,000 report is for [] Claims having report dates prior to 8-1-86 [] Claims having report dates on or after 8-1-86 Past Non- Economic Economic Uninsurable (a) (b) (c) 1) Total Amount of Award 2) Insureds Equitable Share (] amount Paid on Behalf of Insured: 3)   By Insured 4)   By Insurer 5)   By Other Insurers 6) Total Number of Claimants Future Non- Total* Economic Economic Uninsurable (a) (b) (c) (g) 1) Total Amount of Award 2) Insureds Equitable Share (] amount Paid on Behalf of Insured: 3)   By Insured 4)   By Insurer 5)   By Other Insurers 6) Total Number of Claimants The resolution year is the year that final judgment is rendered after all appeals have been exhausted. - This is to be completed separately by market and by size of resolution as defined above - All amounts shown must be In whole dollars - These reports shall reconcile with the Commercial Claim Reports on individual claims