TDI Commissioner's Bulletin B-0032-01
2000 Annual Aggregate Closed Claim Report 2000 Closed Claim Reconciliation Form
Texas Department of Insurance
Property & Casualty Program – Data Services, Mail Code 105-5D
333 Guadalupe l P. O. Box 149104, Austin, Texas 78714-9104
512-475-3024 telephone l 512-463-6122 fax l www.tdi.state.tx.us
July 20, 2001
COMMISSIONER’S BULLETIN NO. B-0032-01
TO:
ALL INSURANCE COMPANIES AND OTHER ENTITIES ADMITTED TO DO
BUSINESS AND AUTHORIZED TO WRITE LIABILITY INSURANCE IN THE STATE
OF TEXAS
RE:
2000 Annual Aggregate Closed Claim Report
2000 Closed Claim Reconciliation Form
Purpose and Statutory Authority
Commissioner's Bulletin #B-0032-01 announces the 2001 Closed Claim Data Call for 2000
closed claim information for the period ending December 31, 2000. Pursuant to the authority
of §§38.151 – 38.163 of the Texas Insurance Code (TIC), the Texas Department of Insurance
(TDI) requires each insurance company or other entity admitted to do business and authorized
to write liability insurance in Texas including county mutual insurance companies, Lloyds’ plan
companies, and reciprocal or interinsurance exchanges, but excluding farm mutual insurance
companies and county mutual fire insurance companies writing exclusively industrial fire
insurance as defined by Article 17.02 of the TIC and each pool, joint underwriting association,
or self-insurance mechanism or trust authorized by law to insure its participants, subscribers,
or members against liability.
The Annual Aggregate Closed Claim Report [formerly called the Annual (Summary) Closed
Claim Report] and instructions are adopted by reference in 28 Texas Administrative Code
(TAC), Sec. 5.9202. The Closed Claim Reconciliation Form, affidavit, and instructions are
adopted by reference in 28 TAC Sec. 5.9204.
Internet Availability
This Commissioner's bulletin may be downloaded directly from our Web page located at
www.tdi.state.tx.us. The Acknowledgment of Receipt may also be downloaded as a
separate document.
The Closed Claim Report of Accepted Transactions, the Closed Claim Report of Unaccepted
Transactions, the Closed Claim Report of Unusual Circumstances, and the Closed Claim
Corrections/Suspect Errors Report are not available through our Web page due to the
confidentiality provisions of §§38.151 – 38.163 of the TIC. Copies of these documents are
available by contacting TDI.
Summary of Changes
Changes made to this year's call are as follows:
♦ Updated Closed Claim Error Code Listing has been revised with correct dates and
address information.
Commissioner’s Bulletin #B-0032-01
2000 Annual Aggregate Closed Claim Report/2000 Reconciliation Form
July 20, 2001
Page 2 of 2
Important Dates To Remember
Item
Due Date
Acknowledgment of Receipt
August 10, 2001
2000 Reconciliation Packet
September 10, 2001
The acknowledgment of receipt must be returned to and received by TDI no later than August
10, 2001. A separate acknowledgment form must be submitted for each company.
Completed acknowledgments of receipt may be submitted to TDI by facsimile, e-mail, or
regular mail. Refer to General Instructions for detailed information.
Enforcement/Compliance
Failure to comply with TDI's reporting requirements may result in disciplinary action.
Please contact Vicky Knox at (512) 475-1879, or via e-mail at Vicky.Knox@tdi.state.tx.us, if
you have any questions, or if you need additional information.
Sincerely,
Clare Pramuk
Data Services Director
Property & Casualty Division
CP/vk
Enclosures
Table of Contents
♦ Acknowledgment of Receipt of 2000 Annual Aggregate Closed Claim
Report and 2000 Closed Claim Reconciliation Form
♦ General Information
♦ Instructions for the Texas Annual Aggregate Closed Claim Report of
Bodily Injury Indemnity Payments of $10,000 or Less For Calendar Year
2000
♦ Texas Annual Aggregate Closed Claim Report of Bodily Injury Indemnity
Payments of $10,000 or Less for Calendar Year 2000
♦ Instructions for the Texas Closed Claim Reconciliation Form For
Calendar Year 2000
♦ Texas Closed Claim Reconciliation Form For Calendar Year 2000
♦ Affidavit for Texas Annual Aggregate Closed Claim Report and/or Texas
Closed Claim Reconciliation Form for Calendar Year 2000
♦ 2000 Reconciliation Checklist
♦ Frequently Asked Questions
♦ Texas Closed Claim Reporting Guide Order Form
♦ Enclosures
•
2000 Closed Claim Report of Accepted Transactions (ATL) (green paper)
•
2000 Closed Claim Report of Unaccepted Transactions (pink paper)
•
2000 Closed Claim Report of Unusual Circumstances (blue paper)
•
2000 Closed Claim Corrections/Suspect Errors Report (yellow paper)
•
Closed Claim Error Code Listing
ACKNOWLEDGMENT of RECEIPT
2000 ANNUAL AGGREGATE CLOSED CLAIM REPORT
And
2000 CLOSED CLAIM RECONCILIATION FORM
On behalf of my company, I hereby execute this ACKNOWLEDGMENT OF RECEIPT for the 2000 CLOSED
CLAIM RECONCILIATION FORM AND THE 2000 ANNUAL AGGREGATE CLOSED CLAIM REPORT.
Name:
Position:
Company Name:
NAIC Company Number
Date Ack.:
QUARTERLY CLOSED CLAIM REPORTS POINT OF CONTACT (CLOSED CLAIM COORDINATOR):
This person must have access to your claims information system. This person is responsible for reviewing
individual closed claim reports, correcting closed claim reports, and distributing closed claim rejection summaries
to the appropriate personnel within the company.
Name:
Mailing Address Line 1:
Mailing Address Line 2:
City:
State:
Zip:
Phone Number:
Fax Number:
E-Mail or Internet Address:
RECONCILIATION FORM POINT OF CONTACT:
This person must have access to the Annual Statement information.
Name:
Mailing Address Line 1:
Mailing Address Line 2:
City:
State:
Zip:
Phone Number:
Fax Number:
E-Mail or Internet Address:
Return completed and signed acknowledgement to TDI no later than August 10, 2001.
Mail To:
Fax To:
E-mail:
Vicky Knox
Vicky Knox
Vicky.Knox@tdi.state.tx.us
Data Services (MC 105-5D)
Data Services
P.O. Box 149104
(512) 463-6122
Austin, TX 78714-9104
General Information
for the
2001 Closed Claim Data Call for 2000 Data
Important Dates To Remember
•
Acknowledgment of Receipt
DUE: August 10, 2001
•
2000 Reconciliation Packet
DUE: September 10, 2001
Acknowledgment of Receipt
•
The acknowledgment of receipt must be returned to and received by TDI no later than August
10, 2001.
•
A separate acknowledgment form must be submitted for each company receiving an
accepted transactions listing.
•
Completed acknowledgments of receipt may be submitted to TDI by facsimile, e-mail, or
regular mail. Refer to General Instructions for detailed information.
Internet Availability
•
This Commissioner's bulletin is available for downloading direct from our Web page located at
www.tdi.state.tx.us. The Acknowledgment of Receipt may also be downloaded as a
separate document.
•
The Closed Claim Report of Accepted Transactions, the Closed Claim Report of Unaccepted
Transactions, the Closed Claim Report of Unusual Circumstances, and the Closed Claim
Corrections/Suspect Errors Report are not available through our Web page due to the
confidentiality provisions of §§38.151 – 38.163 of the TIC. Copies of these documents are
available by contacting TDI, Vicky Knox (512) 475-1879.
Summary of Changes
Changes made to this year's call are as follows:
♦ Updated Closed Claim Error Code Listing has been revised with correct dates.
Checklist and Submission Instructions
•
The Reconciliation Packet must be submitted in accordance with the 2000 Reconciliation
Checklist.
•
Submissions not conforming to the above criteria will not be accepted.
•
Incomplete submissions will not be accepted.
Enforcement/Compliance
•
Failure to comply with TDI's reporting requirements may result in disciplinary action.
TDI Point of Contact
•
Vicky Knox (512) 475-1829 or e-mail at Vicky.Knox@tdi.state.tx.us
Delivery Address
The completed 2000 Reconciliation Packet should be addressed and submitted to one of the
following addresses:
U. S. Postal Service Address
Courier Address
Texas Department of Insurance
Texas Department of Insurance
Attn: Data Services (MC 105-5D)
Attn: Data Services (MC 105-5D)
2000 Closed Claim Reconciliation
2000 Closed Claim Reconciliation
P. O. Box 149104
333 Guadalupe
Austin, Texas 78714-9104
Austin, Texas 78701
Instructions for the
Texas Annual Aggregate Closed Claim Report of
Bodily Injury Indemnity Payments of $10,000 or Less
For Calendar Year 2000
A.
General Instructions:
1.
A separate acknowledgment form must be submitted for each company that receives
an accepted transactions listing.
2.
Submit a separate annual aggregate report for each company. Group reporting is
not allowed.
3.
The annual aggregate report may be handwritten in ink or typed. Printed copies are
acceptable if they match the form TDI has provided.
4.
The responses for the company name and NAIC Company code number must be
completed.
5.
All monetary amounts must be rounded to the nearest dollar.
6.
All rows and columns must add exactly.
7.
Keep a copy of your submission on file for at least two years.
8.
The affidavit must be signed by the highest-ranking company official with
management and control authority over the development of the reported information.
The affidavit must be notarized.
Note: Only one notarized affidavit is required if submitting both an Annual
Aggregate Report and a Reconciliation Form.
B.
Line Item Instructions:
•
Column 1: Report the number of files (claimant level) closed in 2000 involving primary
coverage for bodily injury for which the claimant received a payment of $0 or for which
the claim was denied. Do not include claims with negative payment amounts.
•
Column 2: Report the number of files (claimant level) closed in 2000 involving primary
coverage for bodily injury for which the claimant received a cumulative payment of $1 to
$10,000. Do not include claims with negative payment amounts.
•
Column 3: Report the sum of columns 1 and 2.
•
Column 4: Report the aggregate dollar amount paid for the files (claimant level) closed in
2000 involving primary coverage for bodily injury. Round all amounts to the nearest
dollar. Note that payments made prior to 2000 must be included in this total.
Example: A claim had a $5,000 payment in 1999 and a $2,500 payment in 2000 that
closed the file, how do I report this?
Indicate a closed claim count of 1 in column 2 and $7,500 in column 4 as the amount for
which the claim closed in 2000.
Texas Annual Aggregate Closed Claim Report of
Bodily Injury Indemnity Payments of $10,000 or Less
For Calendar Year 2000
Company Name _____________________________________________________________________________
NAIC Group Code # ___________________________ NAIC Company Code # _________________________
(1)
(2)
(3)
(4)
Aggregate
Number of Claims
$0
Indemnity Payments
Aggregate
Number of Claims
$1 to $10,000
Indemnity Payments
Total
Number of
Claims
(1 + 2)
Aggregate
Dollar
Amount
Paid Out
A) General Liability
B) Other Professional
Liability
+
Subtotal for General
Liability and Other
Professional Liability
=
**
C) Commercial Auto
Liability
+
*
D) Liability Portion of
Texas Commercial
Multiperil
+
*
E) Medical
Professional
Liability
+
*
F) TOTAL
(Lines A through E)
=
*
*Transfer Totals to Line 2 of the Reconciliation Form.
**Transfer the combined totals for 4A & 4B to Line 2 of the Reconciliation Form.
Instructions for the
Texas Closed Claim Reconciliation Form
For Calendar Year 2000
A.
General Instructions:
1.
A separate acknowledgment form must be submitted for each company that receives
an accepted transactions listing.
2.
Submit a separate reconciliation form for each company. Group reporting is not
allowed.
3.
The reconciliation form may be handwritten in ink or typed. Printed copies are
acceptable if they match the form TDI has provided.
4.
The responses for the company name, NAIC company code number, NAIC group,
contact person, telephone, and FAX number must be completed.
5.
All monetary amounts must be rounded to the nearest dollar.
6.
All rows and columns must add exactly. Rounding errors and miscellaneous
statistical adjustments must be indicated on line 13. Please attach an explanation of
any adjustments made on line 13.
7.
The Total column is the sum of the amounts entered by line of business.
8.
Keep a copy of your submission on file for at least two years.
9.
The affidavit must be signed by the highest-ranking company official with
management and control authority over the development of the reported information.
The affidavit must be notarized. Note: Only one notarized affidavit is required if
submitting both an Annual Aggregate Report and a Reconciliation Form.
10. Overview on completing the reconciliation form.
•
Transfer the amounts shown on the Closed Claim Report of Accepted
Transactions (green paper) to line 1 of the reconciliation form.
•
Transfer the amounts from the annual aggregate closed claim report to line 2.
•
Show the subtotal of lines 1 and 2 on line 3.
•
Include adjustments on lines 4 through 13 as necessary to balance with the
Texas Statutory Page 14 as per the line item instructions below.
•
Transfer the amounts shown on the Closed Claim Report of Unusual
Circumstances (blue paper) to line 14 of the reconciliation form. See the Texas
closed claim reconciliation form instructions, item B, Line Item Instructions for
detailed information on Unusual Circumstances.
•
Transfer the amounts for claims on the Closed Claim Report of Unaccepted
Transactions (pink paper) that are to be included in the 2000 Texas closed claim
database to line 16 of the reconciliation form. Note that all claims on the Closed
Claim Report of Unaccepted Transactions may not require quarterly closed claim
reports. See the Texas closed claim reconciliation form instructions, item B, Line
Item Instructions for detailed information on Unaccepted Transactions.
•
Research the claims on the Closed Claim Corrections/Suspect Errors Report
(yellow paper) and provide either replies or revised closed claim reports. If
claim(s) is (are) to be excluded from the 2000 Texas closed claim database,
indicate closed claim subtraction(s) on line 17. If the payment on a claim is
revised, then indicate closed claim addition(s) on line 18 of the reconciliation
form.
•
Verify the amounts shown on the Closed Claim Report of Accepted Transactions
(green paper) and note corrections on lines 17 and 18 of the reconciliation form.
Submit revised reports as required (see item A, General Instructions, #11 for help
in determining when revised reports are required).
•
Determine whether any claims for bodily injury involving primary coverage over
$10,000 were not reported by July 2, 2001. Transfer the total payment amounts
to line 19 of the reconciliation form and send late quarterly closed claim reports.
•
Transfer the amount of direct losses on the Texas Statutory Page 14 to lines 20
and 21 of the reconciliation form.
11. Use the following guidelines to determine if revised closed claim reports are
necessary:
Claims on the Closed Claim Report of Accepted Transactions must be revised if the
amount paid on a claim differs from the amount shown on the accepted transactions
listing by more than $100.
•
Exception: If the amount to be changed involves a reallocation of the amounts
between the primary carrier payment and the deductible (questions 12.a.1 and
12.a.2), TDI will make the adjustments between questions 12.a.1 and 12.a.2
provided that the response in question 12a.7 does not change. If the response in
question 12a.7 changes, then a revised closed claim report is necessary.
B.
Line Item Instructions:
1.
Payments Included in Quarterly Closed Claim Reports
Included with the reconciliation form is the Closed Claim Report of Accepted
Transactions, printed on green paper, that lists information from accepted reports
filed for 2000 closed claims (long and short forms) or a report indicating no accepted
transactions. The accepted transactions listing summarizes the payment amounts
reported on question 12.a.1 by the policy type reported on question 7.a in the
quarterly closed claim reports. Please verify the claim number, NAIC company
code, policy type and amounts. The total dollar amounts reported by line of
insurance should be transferred onto line 1 of the reconciliation form. Do not
alter these amounts. Corrections to the Closed Claim Report of Accepted
Transactions should be noted on lines 17-18, as applicable, on the
reconciliation form.
Do not include any payment amounts for claims that are listed on the Closed
Claim Report of Unaccepted Transactions. The payment amounts for these
claims must be included on line 16 of the closed claim reconciliation form.
2.
Payments reported on Annual Aggregate Closed Claim Report
Report the aggregate dollar amounts paid out indicated on the Annual Aggregate
Closed Claim Report, (col. 4). Combine the amounts for general liability and other
professional liability.
3.
Total Closed Claim Payments Reported
Report the sum of lines 1 and 2 of the reconciliation form for each column.
4.
Property damage losses paid
Report the amount of property damage losses paid in 2000 (regardless of whether
the claim was opened or closed) for each column.
5.
Other losses reported on TX Statutory Page 14 that did not entail bodily injury
Report the amount paid in 2000 (regardless of whether the claim was opened or
closed) for claims that did not involve bodily injury. Please include a list of the
various categories of claims with the total amount paid for each category for each
separate line of insurance.
6.
Payments on claims not closed in calendar year
Report the amount paid in 2000 for bodily injury claims that were not closed by
December 31, 2000. Please have claim level detail available to support any amounts
shown on the closed claim reconciliation form.
7.
Payments made prior to January 1 on claims closed during the year
Report the amount paid for bodily injury claims that closed in 2000, but payments
were made prior to January 1, 2000.
8.
Excess coverage payments not reportable on Quarterly Closed Claim Reports
Report the amount paid by excess carriers that do not meet the following provision:
Excess carriers must report closed claims whenever an award or settlement over
$10,000 is large enough to trigger excess coverage by exceeding the per occurrence
retention of a self-insured entity which does not report its claims to TDI.
Do not include "excess" coverage for under-insured motorists’ coverage on this line.
9.
Losses paid on claims not settled under Texas law
Report the amount for claims that were not settled according to Texas civil justice
laws, but with payments reported on Texas Statutory Page 14.
10. Payments on claims reported on policies written in another state
Report the amount for claims settled under Texas civil justice laws, but with losses
not included on Texas Statutory Page 14.
11. Payments of $10,000 or less on Quarterly Closed Claim Reports
Report any claim for $10,000 or less that is not deleted from the Closed Claim Report
of Accepted Transactions (green paper) on this line. The amounts for these claims
are subtracted (from the correct company and line of insurance) to avoid reporting
the same claim on lines 1 and 2 of the reconciliation form.
12. Reimbursements received
Report any recoveries for indemnification, subrogation, or canceled transactions.
Report any deductible recoveries on claims not affecting the Closed Claim Report of
Accepted Transactions. If a deductible is recovered on a claim reported on the
accepted transaction list, then follow the instructions for lines 17 and 18 so that the
individual closed claim report is corrected.
13. Rounding and Statistical Adjustments
Report adjustments for coding errors and miscellaneous adjustments on this line.
Please attach an explanation for statistical adjustments. Please have claim level
detail available to support any amounts shown on the closed claim reconciliation
form.
Rounding adjustment(s) to balance the reconciliation form may also be shown on
Line 13.
14. Unusual Circumstances (including Class Action Suits and Catastrophe Claims)
Transfer the amounts shown on the Closed Claim Report of Unusual Circumstances
(blue paper) to line 14 of the reconciliation form for claims that are to be included in
the 2000 Texas closed claim database.
Note that the Closed Claim Report of Unusual Circumstances summarizes
information on claims involving class action lawsuits and/or catastrophe claims for
incidents with multiple claimants (more than 10) received during calendar year 2000.
If you have an unusual circumstance, which was not included on this list, please
contact TDI for further instructions as to what information will need to be provided.
15. Write-In Adjustments
Report any other adjustments necessary to balance the reconciliation form. Please
attach an explanation. Please have claim level detail available to support any
amounts shown on the closed claim reconciliation form.
16. Payments for claims on the Closed Claim Report of Unaccepted Transactions
A.
Report the total amount for claims on the Closed Claim Report of Unaccepted
Transactions that qualify for inclusion within the 2000 Texas closed claim
database. Included with the reconciliation form is the Closed Claim Report of
Unaccepted Transactions, printed on pink paper, that lists quarterly closed claim
reports not accepted into the TDI database and the error codes associated with
each report. These claim(s) arrived in our office on or before July 2, 2001, but
contain errors that need to be corrected.
Please refer to the Closed Claim Error Code Listing (revised July 2001) included
with the reconciliation form to correct the reports. Revised quarterly closed claim
reports are necessary for each claim that qualifies for inclusion within the 2000
Texas closed claim database. If a claim does not qualify for inclusion within the
2000 Texas closed claim database, please attach an explanation stating why the
claim is withdrawn (e.g., duplicate report, claim not settled under Texas law,
claim not closed in 2000, ineligible company or policy type).
B.
In addition to the corrected closed claim reports, please submit a list that
indicates the claim number, policy type, payment amount and closing date for
each claim from the Closed Claim Report of Unaccepted Transactions that
qualifies for inclusion within the 2000 Texas closed claim database.
17. Closed Claim Subtractions
A.
Report any claim that is incorrectly reported on the Closed Claim Report of
Accepted Transactions (green paper) due to errors in NAIC company code,
policy type (line of business), payment amount, or closing year. The correct
information for the claim is used to correct the TDI database; therefore, only one
closed claim subtraction is possible for any individual claim report. The entire
amount of the claim reported on the accepted transaction list must be subtracted.
B.
Please refer to the Closed Claim Corrections/Suspect Errors Report (yellow
paper) for a list of closed claim reports that were accepted into TDI's database
but appear to still need corrections or clarifications. If your research indicates
that the report does not qualify for inclusion into the 2000 Texas Closed Claim
database, show the payment amount as a closed claim subtraction.
• If there is a claim on the Closed Claim Report of Accepted Transactions that
shows a closing date in your computer system prior to 2000, please research
to see if the closed claim report was accepted by TDI in a prior year. If TDI
accepted the claim prior to 2000, then a closed claim subtraction on line 17 is
necessary to delete the claim report and avoid reporting the same claim twice.
If the claim was not accepted by TDI prior to 2000, then the claim report
should remain in the TDI database. Please subtract the payment amount for
the claim from line 7 of the reconciliation form.
•
If there is a claim on the Closed Claim Report of Accepted Transactions that
was open through 2000, then a closed claim subtraction on line 17 is
necessary to delete the claim report. Please include a revised closed claim
report with a correction to the closing date (question 1g) or include an
explanation that the claim remains open.
C.
To report closed claim subtractions, please provide a list sorted by policy type
and claim number. This list must also indicate the amount to be subtracted and
the reason(s) for the subtraction. The following example indicates the closed
claim subtractions for a company with NAIC company code 10000. The
corresponding adjustments for each claim is indicated in instruction number 18 -
Closed Claim Additions.
Example:
Company - NAIC# 10000:
Policy Type
Claim Number
Amount
Reason(s)
CA
403000502
$50,000
Change company to NAIC# 20000
CA
403000512
$40,000
Delete - private passenger auto
CA
403000523
$15,000
Correct policy type to GL
CA
478000963
$100,000
Change to NAIC# 20000, type-GL
CA
480000333
$20,000
Correct amount is $25,000
GL
301252109
$74,000
Delete - surplus lines claim
GL
313111105
$65,400
Delete - claim closed in 2001
GL
451111009
$35,000
Change to deductible
GL
486777813
$57,000
Change to NAIC# 20000, MP, deductible
MED
485000213
$85,000
Delete - not settled under Texas law
MED
485000301
$0
Changed deductible to a payment ($18,000)
MED
485000315
$65,000
Payment: $40,000 Deductible: $25,000
MP
472555312
$150,000
Change to GL, correct amount is $157,500
MP
472555315
$325,000
Multiple claimant file requiring three reports
The amount of the closed claim subtractions for NAIC company code 10000 is equal
to the sum of the payments for each policy type group.
17. Amounts for Closed Claim Subtractions - NAIC# 10000
General Liability and Other Professional Liability
$157,400
Commercial Auto Liability
$225,000
Texas Commercial Multiperil Liability
$475,000
Medical Professional Liability
$150,000
18. Closed Claim Additions
A.
Report the revised amounts for claim reports on the Closed Claim Report of
Accepted Transactions that were incorrect. Only one closed claim addition is
possible for any individual claim report. The amount of the claim reported on
question 12.a.1 of the individual closed claim report is the amount that is shown
as a closed claim addition.
If there is a change in the NAIC company code or policy type for a claim on a
Closed Claim Report of Accepted Transactions, TDI will make the corrections to
the report forms.
B.
If there is a change to the payment amount, use the following guidelines to
determine if revised closed claim reports are necessary:
Claims on the Closed Claim Report of Accepted Transactions must be revised if
the amount paid on a claim differs from the amount shown on the accepted
transactions listing by more than $100.
•
Exception: If the amount to be changed involves a reallocation of the
amounts between the primary carrier payment and the deductible (questions
12.a.1 and 12.a.2), TDI will make the adjustments between questions 12.a.1
and 12.a.2 provided that the response in question 12a.7 does not change. If
the response in question 12a.7 changes, then a revised closed claim report is
necessary.
C.
To report closed claim additions, please provide a list sorted by policy type and
claim number. This list must also indicate the amount to be added. It is not
necessary to indicate the reason for the addition since this is indicated in the list
for closed claim subtractions.
Example: Using the data from the example for line item 17, these are the
corresponding closed claim additions that would be expected for the companies
with NAIC company codes 10000 and 20000.
Company - NAIC# 10000:
Policy Type
Claim Number
Amount
CA
480000333
$25,000
GL
403000523
$15,000
GL
451111009
$0
GL
472555312
$157,500
MED
485000301
$18,000
MED
485000315
$40,000
MP
472555315A
$50,000
MP
472555315B
$150,000
MP
472555315C
$125,000
The amount of the closed claim additions for NAIC company code 10000 is equal
to the sum of the payments for each policy type group.
18. Amounts for Closed Claim Additions - NAIC# 10000
General Liability and Other Professional Liability
$172,500
Commercial Auto Liability
$25,000
Texas Commercial Multiperil Liability
$325,000
Medical Professional Liability
$58,000
Company - NAIC# 20000:
Policy Type
Claim Number
Amount
CA
403000502
$50,000
GL
478000963
$100,000
MP
486777813
$0
The amount of the closed claim additions for NAIC company code 20000 is equal
to the sum of the payments for each policy type group.
18. Amounts for Closed Claim Additions - NAIC# 20000
General Liability and Other Professional Liability
$100,000
Commercial Auto Liability
$50,000
Texas Commercial Multiperil Liability
$0
Medical Professional Liability
$0
Note that there are no closed claim additions shown for the following claim
numbers since they were deleted.
301252109
313111105
403000512
485000213
19. Late Quarterly Closed Claim Reports
A.
Report eligible claim forms which were not filed with TDI by July 2, 2001 and not
included on the Closed Claim Report of Accepted Transactions or the Closed
Claim Report of Unaccepted Transactions. These reports are delinquent and
should be submitted with the Reconciliation Form by September 10, 2001.
Please contact this office if you believe that a report was submitted and not
included on either the Closed Claim Report of Accepted Transactions or the
Closed Claim Report of Unaccepted Transactions or the Closed Claim Report of
Unusual Circumstances.
B.
Please provide a list of the late quarterly closed claim reports sorted by policy
type and claim number. The list must also indicate the amount paid on question
12.a.1 of the report. Please indicate why the report was submitted late.
Example: The following reports for a company with NAIC company code 10000
were not included on the accepted transaction list and are late.
Policy Type
Claim Number
Amount
Reason(s)
CA
487001503
$40,850
[Your comments here]
CA
488006152
$38,500
CA
488006153
$415,700
GL
378001964
$150,820
GL
378002199
$64,839
GL
383002556
$40,500
The amount of late quarterly closed claim reports for NAIC company code 10000
is the sum of the payments for each policy type group.
19. Late Quarterly Closed Claim Reports - NAIC# 10000
General Liability and Other Professional Liability
$256,159
Commercial Auto Liability
$495,050
Texas Commercial Multiperil Liability
$0
Medical Professional Liability
$0
20. Sum of lines 3 through 19
Report the sum of lines 3 through 19 for each column. This line must equal line 21.
21. Annual Statement Texas Statutory Page 14, DIRECT LOSSES PAID
Report the amounts on the Annual Statement Texas Statutory Page 14, column 6,
(Direct Losses Paid) according to the following instructions:
•
General Liability and Other Professional Liability - sum of amounts reported on
line 17 (Other liability) and line 18 (Product liability). All amounts reported on line
17, column 6, Texas Statutory Page 14 (Including Employers' Liability, Personal
Liability, etc.) should be included on line 21 of the Reconciliation Form.
•
Commercial Auto Liability - sum of amounts reported on line 19.3 (Commercial
auto no-fault) and 19.4 (Other commercial auto liability).
•
Texas Commercial Multiperil Liability - include only the liability portion on line 5.2
(Commercial multiple peril liability portion).
•
Medical Professional Liability - indicate only line 11 (Medical malpractice).
Texas Closed Claim Reconciliation Form for Calendar Year 2000
Company Name _____________________________________________________ NAIC# ___________ NAIC Group ___________
Contact Person _____________________________________ Telephone __________________ FAX ________________________
Note: Round all amounts to dollars.
General Liability and
Other Professional
Liability
Commercial Auto
Liability
Texas Commercial
Multiperil
Liability
Medical
Professional
Liability
TOTAL
Annual Statement Lines of Business
17, 18
19.3, 19.4
5.2
11
1. Payments Included in Quarterly
Closed Claim Reports from the ATL** (green)
2. Payments reported on Annual Aggregate
Closed Claim Report (Col. 4)
3. Total Closed Claim
Payments Reported
A D J U S T M E N T S T O L I N E 3
4. Property damage losses paid
5. Other losses reported on TX Statutory Page
14 that did not entail bodily injury*
6. Payments on claims not closed in
calendar year 2000
7. Payments made prior to Jan. 1 on claims
closed during the year 2000
( )
( )
( )
( )
( )
8. Excess coverage payments not reportable
on Quarterly Closed Claim Reports
9. Losses paid on claims not settled
under Texas law
10. Payments on claims reported on policies
written in another state
( )
( )
( )
( )
( )
11. Payments of $10,000 or less that were
reported on Quarterly reports
( )
( )
( )
( )
( )
12. Reimbursements received
( )
( )
( )
( )
( )
13. Rounding and Statistical Adjustments
Please Attach Explanation
14. Unusual Circumstances (blue)
Please Attach Explanation
15. Write-in Adjustments
Please Attach Explanation
16. Payments for claims on the Closed Claim
Report of Unaccepted Transactions (pink)
17. Closed Claim subtractions* (yellow & green)
( )
( )
( )
( )
( )
18. Closed Claim additions* (yellow & green)
19. Late Quarterly Closed Claim Reports*
(Filed after July 2, 2001)
20. Sum of lines 3 through 19,
(Must equal line 21)
21. Annual Statement Texas Statutory
Page 14, DIRECT LOSSES PAID
* See instructions for further details
**ATL= Accepted Transactions Listing (green form)
A F F I D A V I T
TEXAS ANNUAL AGGREGATE CLOSED CLAIM REPORT
AND/OR
TEXAS CLOSED CLAIM RECONCILIATION FORM
FOR CALENDAR YEAR 2000
THE STATE OF
COUNTY OF
I,_________________________________________ the (position) ______________________
Of ________________________________________________________________________
being duly sworn, deposes and says that on the 31st day of December last, all of the information
of the named Company contained herein, together with any necessary related exhibits, schedules
and explanations contained, annexed or referred to are a full and true statement in accordance
with the instructions provided according the best of my information and knowledge.
______________________________________
Signature
Subscribed and Sworn To Before Me this the _______ day of __________________ 2001.
______________________________________
Notary Public
______________________________________
(Printed name of Notary)
My Commission Expires:
_______________________________________
2000 Reconciliation Checklist
The Reconciliation Packet must be complete and the items must be arranged and submitted in
the order listed below. Partial or incomplete submissions will not be accepted.
REMINDER: All documents must be assembled and submitted in the order as they appear
on this checklist.
q Completed 2000 Closed Claim Reconciliation Form
q Completed 2000 Annual Aggregate Closed Claim Report
q Completed, signed and notarized Affidavit
q Photocopy of 2000 Closed Claim Report of Accepted Transactions (ATL)(Green)
q Photocopy of 2000 Closed Claim Report of Unusual Circumstances (Blue)
q Photocopy of 2000 Closed Claim Report of Unaccepted Transactions (UATL)(Pink)
q Photocopy of 2000 Closed Claim Corrections/Suspect Errors Report (Yellow)
q Detailed/supporting information for individual line items on the reconciliation form sorted by
line item number
q Corrected closed claim reports or explanations why reports are not required for all claims on
the Unaccepted Transaction Listing
q Replies or revised closed claim reports for all inquiries on the Corrections/Suspect Errors
Report
q Revised closed claim reports for claims on the Accepted Transaction Listing with incorrect
payment amounts
q Completed late reports sorted by policy type and claim number
q Written detailed explanation(s) for items not covered above
q Completed and signed Reconciliation Checklist
I have reviewed the reconciliation packet to ensure all items are included and are in the order
described above.
_____________________________________
Reconciliation Coordinator Signature/Date
Frequently Asked Questions
Q.
Who is required to complete the Calendar Year Annual Aggregate Closed Claim
Report and the Reconciliation Form?
A.
Each insurance company or other entity admitted to do business and authorized to write
liability insurance in Texas, including county mutual insurance companies, Lloyds' plan
companies, and reciprocal or interinsurance exchanges, but excluding farm mutual
insurance companies and county mutual fire insurance companies writing exclusively
industrial fire insurance as defined by Article 17.02 of the TIC and each pool, joint
underwriting association, or self-insurance mechanism or trust authorized by law to
insure its participants, subscribers, or members against liability.
•
Companies that had Direct Losses Paid on lines 5.2, 11, 17, 18, 19.3, or 19.4 of the
Annual Statement Texas Statutory Page 14.
•
Companies that had Reported Premiums Written on lines 5.2, 11, 17, 18, 19.3, or
19.4 of the Annual Statement Texas Statutory Page 14, for any of the past three
years (even if no direct losses are paid).
•
Companies that had claims closed during the year that were eligible under §§38.151
– 38.163, TIC.
•
Companies that do not meet any of these criteria may request, in writing, an
exemption from the reporting requirement. Exemptions apply only to the 2001
Closed Claim Data Call for 2000 Data. Exemptions will not be granted for Quarterly
Closed Claim Reports due to statutory mandates.
Q.
What is the purpose of the reconciliation form?
A.
The purpose of the form is to reconcile the amounts reported under the requirements of
§§38.151 – 38.163, TIC, to the direct losses reported on the Annual Statement Texas
Statutory Page 14 and to ensure compliance with those reporting requirements.
Q.
Does the acknowledgment of receipt need to be completed by an officer of the
company?
A.
No; however, the person signing the acknowledgment of receipt must have sufficient
authority to ensure that the 2000 Annual Aggregate Closed Claim Report and 2000
Closed Claim Reconciliation Form is submitted timely and accurately.
Q.
Is one acknowledgment of receipt acceptable for all companies within my group?
A.
No, a separate acknowledgment form must be submitted for each company receiving an
accepted transactions listing.
Q.
What lines of insurance are to be included?
A.
General liability; Professional liability other than medical professional liability;
Commercial automobile liability; the liability portion of commercial multiperil coverage,
including TCPP and TBOP; and Medical professional liability.
Q.
What types of coverage are to be included?
A.
Bodily injury coverage only for primary coverage (Note: Excess coverage claims will
appear on line 8 of the Texas Closed Claim Reconciliation Form).
Q.
What closed claims should be included?
A.
1) Quarterly Closed Claim Reports (Long & Short Forms)
Indemnity payments more than $10,000 for bodily injury involving primary coverage
for each claimant.
2) Annual Aggregate Closed Claim Report
Claims closed during calendar year 2000 involving an indemnity payment of
$10,000 or less (including years prior to 2000) for bodily injury involving primary
coverage for each claimant, including claims for which no indemnity payment is made
on closing.
Q.
There are other companies in my group that are admitted companies, but did not
receive copies of the 2000 Annual Aggregate Closed Claim Report and 2000
Closed Claim Reconciliation Form. Do I need to submit reports for these
companies?
A.
No, only admitted companies with premiums written since 1998 or direct losses paid in
2000 are required to file the 2000 Annual Aggregate Closed Claim Report and 2000
Closed Claim Reconciliation Form.
Q.
How does the reconciliation work?
A.
By balancing the loss amounts reported to TDI on closed claim reports (Long and Short
Forms) for the last year, with the losses reported on the Annual Statement, Texas
Statutory Page 14. Adjustments necessary to balance these figures may include the
following:
•
Payment information from claims $10,000 or less from the Annual Aggregate
Closed Claim Report
•
Excess coverage payments for bodily injury coverage
•
Time differences between payment year and closing year for bodily injury claims
•
Jurisdiction differences for claims either included or excluded on the Annual
Statement, Texas Statutory Page 14
•
Miscellaneous adjustments requiring explanation
Q.
How do I complete the reconciliation form?
A.
Refer to the overview in A. General Instructions, item 10 for additional information.
Q.
My annual statement data indicates loss payments in Texas, however, there are
not any claims listed on the Closed Claim Report of Accepted Transactions or the
Closed Claim Report of Unaccepted Transactions. Is there something wrong?
A.
Possibly. Closed claim reports are required for bodily injury claims* with indemnity
payments over $10,000 settled under Texas law. The reporting requirement applies
only for primary coverage or coverage which is excess to a self-insured retention.
Some reasons why there may not be any reports listed on the Closed Claim Report of
Accepted Transactions or the Closed Claim Report of Unaccepted Transactions are as
follows:
•
Payment amounts on the Annual Statement are not for bodily injury coverage
•
Payment amounts on individual claims are $10,000 or less
•
Payments are being made for claims not settled under Texas law
•
Payments are being made on excess coverage not reportable to TDI
•
Payments over $10,000 in indemnity for bodily injury claim reports were not
received by TDI.
*
Please note that claims for personal injury, mental anguish and civil rights violations
do not qualify as bodily injury claims for this reporting requirement. The payment
amounts for these types of claims must be shown on line 5 of the closed claim
reconciliation form.
Q.
My records indicate that there are bodily injury claims over $10,000 not reported
to TDI. What should I do about this?
A.
Please identify all bodily injury indemnity payments above $10,000 that closed during
2000. A quarterly closed claim report must be submitted for each claim. Please provide
a list sorted by policy type and claim number. This list should also indicate the amount
paid on question 12.a.1 of the report. Please indicate why the report was submitted late.
The closed claim reports must be submitted with the reconciliation form and are due on
September 10, 2001.
Q.
For one of the claims on the 2000 Closed Claim Report of Accepted Transactions,
my computer system shows that the claim was paid and closed during 1999. How
do I balance this claim to the 2000 Annual Statement Data?
A.
Please note that a claim file is defined as “closed” when all the indemnity and all
expenses have been paid. Therefore, it is possible that TDI will not receive a closed
claim report until the following year when the expenses have been paid. Refer to
Instructions for the Texas Closed Claim Reconciliation Form, B. Line Item Instructions,
line 17 for additional information.
Q.
For one of the claims on the 2000 Closed Claim Report of Accepted Transactions,
my computer system shows a portion of the payments was made during 1999.
How do I balance this claim to the 2000 Annual Statement Data?
A.
The portion of the claim paid prior to 2000 must be subtracted from line 7 of the closed
claim reconciliation form. The claim report will remain in the 2000 TDI database.
Q.
For one of the claims on the 2000 Closed Claim Report of Accepted Transactions,
my computer system shows that the claim closed during 2001. How do I balance
this claim to the 2000 Annual Statement Data?
A.
The claim must be deleted from the 2000 TDI database as a Closed Claim Subtraction
on line 17 of the closed claim reconciliation form. A revised closed claim report showing
a 2001 closing date must be submitted. If payments were made on the claim during
2000, then the payment amounts must be included on line 6 of the closed claim
reconciliation form.
Q.
The Closed Claim Report of Accepted Transactions includes claim numbers that
do not appear in the Annual Statement data for Texas, but instead show on the
Annual Statement data for another state. Is something wrong?
A.
No, your company apparently books losses by premium state rather than accident state.
Since the claim settled under Texas law, the report must be included within the 2000
TDI database. To balance with the Annual Statement data, please subtract the payment
amounts for these claims from line 10 of the closed claim reconciliation form.
Q.
When are revised closed claim reports necessary?
A.
Refer to Instructions for the Texas Closed Claim Reconciliation Form, A. General
Instructions, item 11, for additional information.
Q.
One of the claims shown on the Closed Claim Report of Accepted Transactions
showed a payment amount by our company. Further research revealed that the
amount was recovered from the insured as a deductible payment. How do I make
this correction on the reconciliation form?
A.
This claim would remain in the 2000 TDI database. Show the adjustment of the
payment to a deductible as a closed claim subtraction on line 17 of the reconciliation
form. Indicate the reason for the closed claim subtraction so that the closed claim report
is not deleted. Please refer to the line item instruction for line 17 for additional
information and examples.
Q.
Where do I note amounts for medical payments on the closed claim reconciliation
form?
A.
Amounts for medical payments must be shown on line 5 of the closed claim
reconciliation form.
Q.
Where do I note amounts for UM/UIM claims and PIP claims?
A.
Amounts for UM/UIM and PIP payments must be shown on line 5 of the closed claim
reconciliation form.
& & & & & & & & & & & & & &
Texas Closed Claim Reporting Guide
Order Form
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YES, I want to order a copy of the Texas Closed Claim Reporting Guide.
Contact Person:
Company Name:
Mailing Address:
Street Address:
City: State:
Zip Code:
Phone: ( ) Fax: ( )
E-mail Address:
Send order form to:
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P. O. Box 149104
Austin, TX 78714-9104
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