reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 116 - DISCOUNTING OF WORKER'S COMPENSATION LOSS RESERVES › Section 116.5 - Actuarial statement of opinion

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				The actuarial statement of opinion required to be submitted with the annual
				statement shall include the opinion of an actuary with respect to the
				following:
(1) The adequacy of workers
				compensation loss reserves on an undiscounted basis.
(2) The sufficiency of the investment yield
				on invested assets to fund the discount.
(3) The reasonableness of the matching of the
				invested assets and loss reserves attributable to the workers' compensation
				business to provide an adequate income stream to fund the discount.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 116 - DISCOUNTING OF WORKER'S COMPENSATION LOSS RESERVES › Section 116.6 - Reserves for loss adjustment expenses

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Loss adjustment expense reserves shall be
				calculated with the following standards:
(1)
				Insurance companies are not permitted to discount loss adjustment expense
				reserves which are not applicable to specific claims.
(2) Insurance companies are permitted to
				discount loss adjustment expense reserves which are allocable to specific
				claims if they can demonstrate, to the satisfaction of the Commissioner, the
				validity of their assumptions underlying the calculation of the reserves. The
				insurance company shall provide an actuarial statement of opinion which
				includes the opinion of the actuary with respect to the criteria in §
										116.5 (relating to actuarial
				statement of opinion).
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 116 - DISCOUNTING OF WORKER'S COMPENSATION LOSS RESERVES › Section 116.8 - Increased loss reserves and loss adjustment expense reserves

Current through Register Vol. 54, No. 28, July 13, 2024
The Commissioner may require an insurance company to maintain
				  loss reserves at a greater level than those which result from the application
				  of this chapter, and allocated loss adjustment expense reserves at a level
				  greater than those calculated under §
									116.6 (relating to reserves for
				  loss adjustment expenses) when the Commissioner determines it is necessary to
				  insure that reserves are established at an adequate level.
The provisions of this §
											116.8 amended under The Insurance
					 Company Law of 1921 (40 P. S. §§
												341-999); The Insurance Department Act of
					 1921 (40 P. S. §§
												1-321);
					 and sections 206, 506, 1501 and 1502 of The Administrative Code of 1929
					 (71
					 P. S. §§
												66,
					 186,
					 411 and
					 412).
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118 - DISCOUNTING OF MEDICAL MALPRACTICE LOSS RESERVES › Section 118.1 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The definitions
				utilized in Chapter 116 (relating to discounting of worker's compensation loss
				reserves) are incorporated for use in this chapter except that language
				utilizing the term "worker's compensation" shall be amended for use in this
				chapter utilizing the term "medical malpractice."
(b) For purposes of this chapter, the
				definition of "insurance company" in §
									116.1 (relating to definitions)
				also includes the Pennsylvania Professional Liability Joint Underwriting
				Association, an insurance entity created under section 801 of the Health Care
				Services Malpractice Act (40 P. S. §
										1301.801).
(c) The term "independent actuary" as used in
				§
									118.4(a)
				(relating to actuarial certification) means a fellow or associate of the
				Casualty Actuarial Society with appropriate experience in responsible actuarial
				work, including medical malpractice, who is not an officer, director or
				employee of the insurer whose reserves he is certifying.
(d) Other definitions:
Act
-The Insurance Department Act of 1921
				  (40
				  P. S. §§
											1-297-4).
Commissioner
-The Insurance Commissioner of
				  the Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118 - DISCOUNTING OF MEDICAL MALPRACTICE LOSS RESERVES › Section 118.2 - Reporting and data collection requirements

Current through Register Vol. 54, No. 28, July 13, 2024
For loss reserves established by insurance companies under
				  sections 312-316 of the act (40 P. S. §§
										111-115), a company is permitted to discount
				  the medical malpractice reserves to their present value if the company complies
				  with the following requirements. The insurance company shall:
(1) File an annual actuarial certification of
				its medical malpractice loss reserves and loss adjustment expense reserves with
				the Department simultaneously with the filing of the company's annual
				statement.
(2) Provide a written
				notice to the Department stating its intent to maintain separate data regarding
				the company's loss payment patterns for allocated loss adjustment expenses and
				losses. This data shall be regularly compiled and submitted to the Department
				upon request.
(3) Comply with
				existing annual statement instructions for reporting loss and loss adjustment
				expense reserves including completion of supplemental Schedule P, Part 4C of
				the annual statement.
(4) File with
				its annual statement a description of the underlying assumptions for the
				calculation of the discount to present value of its loss reserves and allocated
				loss adjustment expense reserves.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118 - DISCOUNTING OF MEDICAL MALPRACTICE LOSS RESERVES › Section 118.3 - Restrictions on discounting loss reserves

Current through Register Vol. 54, No. 28, July 13, 2024
The discounting of loss reserves is subject to the following
				  limitations:
(1) The loss reserves
				discounted to present value in accordance with this chapter may not be less
				than those required in accordance with section 313(b) of the act (40 P. S. §
										112(b)).
(2) The maximum rate of interest which an
				insurer may assume for purposes of discounting is 6%.
(3) An insurer may request an exception to
				the maximum interest rate in paragraph (2) if the insurer can demonstrate to
				the satisfaction of the Commissioner that its investment yield justifies a
				higher interest rate assumption. The Commissioner may require the insurer to
				submit additional documentation to support its request for approval of a higher
				interest rate assumption. The Commissioner will act upon requests for
				exceptions made under this paragraph within 90 days of the date the request is
				received by the Insurance Department.
(4) An insurer may not discount loss reserves
				or loss adjustment expense reserves for policies with an effective date on or
				after June 16, 2001.
(5) An insurer
				may not discount loss reserves or loss adjustment expense reserves after
				December 31, 2010.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118 - DISCOUNTING OF MEDICAL MALPRACTICE LOSS RESERVES › Section 118.4 - Actuarial certification

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The
				actuarial certification required in accordance with this chapter shall be
				prepared by an independent actuary and filed by the insurer with its annual
				statement.
(b) The actuarial
				certification shall be filed each year in which the insurer discounts its loss
				reserves.
(c) The actuarial
				certification shall include the opinion of an independent actuary with respect
				to the following:
(1) The adequacy of medical
				malpractice loss reserves on an undiscounted basis.
(2) The sufficiency of the investment yield
				on invested assets to fund the discount.
(3) The reasonableness of the matching of the
				invested assets and loss reserves attributable to the medical malpractice
				business to provide an adequate income stream to fund the discount.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118 - DISCOUNTING OF MEDICAL MALPRACTICE LOSS RESERVES › Section 118.5 - Reserves for loss adjustment expenses

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Loss adjustment expense reserves shall be
				calculated in accordance with the following standards:
(1) Insurance companies are not permitted to
				discount loss adjustment expense reserves which are not allocable to specific
				claims.
(2) Insurance companies are
				permitted to discount loss adjustment expense reserves which are allocable to
				specific claims if:
(i) The company
				demonstrates, to the satisfaction of the Commissioner, the validity of the
				assumptions underlying the calculation of the reserves.
(ii) The actuarial certification which
				includes the opinion of an independent actuary with respect to the criteria in
				§
											118.4 (relating to actuarial
				certification) is applicable to the loss adjustment expense reserves as well as
				the loss reserves.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118 - DISCOUNTING OF MEDICAL MALPRACTICE LOSS RESERVES › Section 118.6 - Increased loss reserves and loss adjustment expense reserves

Current through Register Vol. 54, No. 28, July 13, 2024
Under section 316 of the act (40 P. S. §
										115), the Commissioner may require an
				  insurance company to restate its loss reserves or its allocated loss adjustment
				  expense reserves by reducing or eliminating the discount if the Commissioner
				  determines it is necessary to insure that reserves are established at an
				  adequate level.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118a - PROPERTY AND CASUALTY ACTUARIAL OPINION › Section 118a.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This chapter sets forth requirements relating to statements
				  of actuarial opinion and related documents filed under section 320 of The
				  Insurance Company Law of 1921 (40 P. S. §
										443) with the Commissioner by insurers
				  licensed to transact property or casualty insurance, or both, in this
				  Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118a - PROPERTY AND CASUALTY ACTUARIAL OPINION › Section 118a.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
				  have the following meanings, unless the context clearly indicates otherwise:
Appointed actuary
-A qualified actuary
				  appointed by an insurer in accordance with the property and casualty annual
				  statement instructions relating to actuarial opinions prescribed by the NAIC.
Commissioner
-The Insurance Commissioner of
				  the Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
Domestic insurer
-An insurer incorporated or
				  organized under the laws of the Commonwealth.
Insurer
-The term includes the following
				  entities licensed to transact property or casualty insurance, or both, in this
				  Commonwealth:
(i) An insurance
				company, association or exchange.
(ii) A reciprocal or interinsurance
				exchange.
(iii) An employers'
				mutual liability insurance association.
(iv) The Industry Placement Facility under
				The Pennsylvania Fair Plan Act (40 P. S. §§
										1600.101-1600.502).
(v) The Pennsylvania Professional Liability
				Joint Underwriting Association under section 731 of the Medical Care
				Availability and Reduction of Error (MCARE) Act (40 P. S. §
										1303.731).
Foreign insurer
-An insurer not incorporated
				  or organized under the laws of the Commonwealth.
NAIC
-The National Association of Insurance
				  Commissioners, or successor organization.
Qualified actuary
-An individual who meets
				  the following requirements:
(i) Is one
				or more of the following:
(A) A member in good
				standing of the Casualty Actuarial Society.
(B) A member in good standing of the American
				Academy of Actuaries who has been approved as qualified for signing casualty
				loss reserve opinions by the Casualty Practice Council of the American Academy
				of Actuaries.
(C) Approved by the
				Commissioner as otherwise having demonstrated competency in loss reserve
				evaluation for property or casualty insurance, or both, to the Commissioner's
				satisfaction under §
										118a.4(a)
				(relating to general requirements for domestic insurers).
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118a - PROPERTY AND CASUALTY ACTUARIAL OPINION › Section 118a.3 - Statement of actuarial opinion and supporting documentation

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Statement of actuarial opinion.
Unless exempted under §
									118a.6 (relating to exemptions),
				an insurer shall annually file with the Department an opinion of an appointed
				actuary entitled "Statement of Actuarial Opinion." Under section 320 of The
				Insurance Company Law of 1921 (40 P. S. §
										443), the statement of actuarial opinion
				shall be prepared in accordance with the property and casualty annual statement
				instructions prescribed by the NAIC and filed as instructed by the Department
				on or before the first day of March.
(b)
Actuarial opinion summary.
A domestic insurer required to file a statement of actuarial opinion
				under subsection (a) shall annually file with the Department a document
				entitled "Actuarial Opinion Summary" written by the insurer's appointed actuary
				and supporting the statement of actuarial opinion. The actuarial opinion
				summary shall be prepared in accordance with the property and casualty annual
				statement instructions prescribed by the NAIC and filed as instructed by the
				Department on or before the 15th day of March. The Department may require a
				foreign insurer to file an actuarial opinion summary by providing 60 days'
				advance notice to the insurer.
(c)
Actuarial report and workpapers.
An actuarial report and
				underlying workpapers shall be prepared and maintained to support a statement
				of actuarial opinion as required by the property and casualty annual statement
				instructions prescribed by the NAIC and provided to the Department upon
				request.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118a - PROPERTY AND CASUALTY ACTUARIAL OPINION › Section 118a.4 - General requirements for domestic insurers

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The following requirements apply to a
				request by a domestic insurer for the Commissioner's approval of an individual
				under subparagraph (i)(C) of the definition of "qualified actuary" in §
									118a.2 (relating to definitions):
(1) The domestic insurer shall file the
				request with the Department at least 90 days prior to the filing of the
				domestic insurer's annual financial statement.
(2) Requests filed under paragraph (1) must
				contain the following:
(i) A properly
				completed biographical affidavit in the form adopted by the NAIC. The NAIC
				biographical affidavit form is available on the Department's web site at
www.insurance.pa.gov
or upon request
				from the Department.
(ii) A list of
				the loss reserve opinions for property or casualty insurance, or both, issued
				by the individual in the past 3 years.
(iii) Other information that the Commissioner
				in the Commissioner's discretion may require to determine the individual's
				qualifications. The Department will provide the domestic insurer with a written
				request for the information, describing the type of information required and
				why the information is needed.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118a - PROPERTY AND CASUALTY ACTUARIAL OPINION › Section 118a.5 - Confidentiality

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The statement
				of actuarial opinion shall be filed with an insurer's annual statement in
				accordance with the property and casualty annual statement instructions
				prescribed by the NAIC and shall be treated as a public document.
(b) The documents, materials or other
				information prepared or provided by an insurance company, association or
				exchange solely in support of the statement of actuarial opinion filed under
				this chapter, including actuarial reports, workpapers or actuarial opinion
				summaries and other material solely prepared by the insurance company,
				association or exchange for the purpose of providing it to the Department in
				connection with actuarial reports, workpapers or actuarial opinion summaries
				are treated as confidential and privileged as provided under section 320 of The
				Insurance Company Law of 1921 (40 P. S. §
										443).
(c) The Commissioner may share confidential
				information received under this chapter with regulatory or law enforcement
				officials of this Commonwealth or other jurisdictions and the NAIC under
				sections 201-A and 202-A of The Insurance Department Act of 1921 (40 P. S.
				§§
										65.1-A and 65.2-A) and section
				320 of The Insurance Company Law of 1921 (40 P. S. §
										443), including the release of documents to
				the Actuarial Board for Counseling and Discipline (ABCD) if the material is
				required for the purpose of professional disciplinary proceedings and the ABCD
				establishes procedures satisfactory to the Commissioner for preserving the
				confidentiality of the documents. A waiver of any applicable privilege or claim
				of confidentiality in the documents, materials or information will not occur as
				a result of sharing information under this subsection.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118a - PROPERTY AND CASUALTY ACTUARIAL OPINION › Section 118a.6 - Exemptions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A domestic
				insurer may annually submit a written request to the Commissioner for approval
				of an exemption from the requirement to file a statement of actuarial opinion
				in the manner set forth by the property and casualty annual statement
				instructions prescribed by the NAIC.
(b) A foreign insurer exempted from filing a
				statement of actuarial opinion by the chief insurance regulatory official in
				its domiciliary jurisdiction is exempt from filing a statement of actuarial
				opinion under this chapter if the foreign insurer files a copy of the approved
				exemption with the Commissioner in accordance with the property and casualty
				annual statement instructions prescribed by the NAIC.
This section cited in 31 Pa. Code §
											118a.3 (relating to statement of
					 actuarial opinion and supporting
					 documentation).
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 118a - PROPERTY AND CASUALTY ACTUARIAL OPINION › Section 118a.7 - Penalties

Current through Register Vol. 54, No. 28, July 13, 2024
Failure to file the statement of actuarial opinion, actuarial
				  opinion summary and additional statements, letters, workpapers or reports
				  required under this chapter will subject the insurer to the penalties provided
				  by law.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 119 - ANTI-FRAUD-STATEMENT OF POLICY › GENERAL › Section 119.1 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise:
Act
-The Workers' Compensation Act
					 (77
					 P. S. §§
											1-1041.4).
Department
-The Insurance Department of
					 the Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 119 - ANTI-FRAUD-STATEMENT OF POLICY › INSURANCE FRAUD REPORTING › Section 119.11 - Insurance claims fraud reporting, investigation and prosecution

Current through Register Vol. 54, No. 28, July 13, 2024
Insurers, as defined in section 1101 of the act
					 (77
					 P. S. §
											1039.1) should report an
					 incidence of workers' compensation insurance fraud to State and local criminal
					 law enforcement agencies.
(1) Sections
				  1106 and 1107 of the act (77 P. S. §§
											1039.6 and
				  1039.7) provide incentives
				  for active reporting of fraud by an express grant of civil and criminal
				  immunity to insurers and their representatives and the opportunity to pursue
				  restitution through judicial proceedings.
(2) Section 1109 of the act (77 P. S. §
											1039.9) expressly authorizes district
				  attorneys or the Attorney General, or both, to investigate and prosecute
				  instances of fraud as identified in Article XI of the act (77 P. S.
				  §§
											1039.1-1039.12).
(3) The Department will look to insurers to
				  report an incidence of fraud directly to district attorneys or the Attorney
				  General, or both, and, when practical, seek court ordered restitution to
				  compensate for fraud-related losses.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 119 - ANTI-FRAUD-STATEMENT OF POLICY › ANTI-FRAUD PLANS › Section 119.21 - Department referrals to criminal law enforcement authorities

Current through Register Vol. 54, No. 28, July 13, 2024
Section 1202 of the act (77 P. S. §
											1040.2) authorizes the Department to report
					 to and cooperate with criminal law enforcement agencies with respect to Article
					 XI of the act (77 P. S. §§
											1039.1-1039.12). Department actions under
					 this section will be limited to cases in which the incidence of fraud involves
					 the specific acts of insurers, agents, brokers or other entities required to be
					 licensed to engage in the business of insurance in this Commonwealth. The
					 Department's actions under this section may be in addition to or in lieu of its
					 exercise of its civil jurisdiction over entities engaged in the business of
					 insurance in this Commonwealth. In addition, when an insurer makes a direct
					 case referral involving an agent or broker to a criminal law enforcement
					 authority, the insurer shall also refer the matter to the Department for
					 possible civil action under the insurance laws and regulations of the
					 Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 119 - ANTI-FRAUD-STATEMENT OF POLICY › ANTI-FRAUD PLANS › Section 119.22 - Institution and maintenance of anti-fraud plans

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Section 1203 of the act (77 P. S. §
											1040.3) requires insurers, as defined in
				  section 1101 of the act (77 P. S. §
											1039.1), to institute and maintain an
				  insurance anti-fraud plan. This requirement applies to a workers' compensation
				  insurer with workers' compensation premium volume as of August 31, 1993.
				  Workers' compensation insurers which become licensed or commence a writing
				  premium volume, or both, after August 31, 1993, should institute and maintain
				  an anti-fraud plan within 4 months of commencing to write business. Maintenance
				  of the anti-fraud plan includes its ongoing implementation and operation by
				  insurers. Since a substantial number of workers' compensation insurers also
				  actively write motor vehicle insurance, the Department encourages insurers to
				  merge their workers' compensation anti-fraud initiatives into their established
				  motor vehicle insurance anti-fraud plans established under 75 Pa.C.S. Chapter
				  18 (relating to motor vehicle insurance fraud). The content of each insurers'
				  workers' compensation anti-fraud plan should reflect the following minimum
				  requirements:
(1) Policies and procedures
				  established by the insurer to prevent workers' compensation insurance fraud.
				  The policies and procedures should cover all aspects of the insurer's operation
				  and recognize the wide variety of potential fraudulent activity. Procedures
				  should address internal fraud, fraud involving the integrity and security of
				  company data including electronic data processed information, fraud involving
				  employes or company representatives, and fraud resulting from misrepresentation
				  on applications and renewals for insurance coverage and claims fraud. Detailed
				  information should be provided describing existing procedure manuals, internal
				  policies, guidelines and employe training programs implemented by the insurer
				  to prevent fraud. It is recommended that specific policies and procedures be
				  either included in the anti-fraud plan or, if the policies and procedures are
				  voluminous, appropriately summarized.
(2) Policies and procedures established by
				  the workers' compensation insurer to detect and investigate possible insurance
				  fraud in the claims process. Reference should be made to specific procedure
				  manuals, internal policies, guidelines and training initiatives designed to
				  detect fraud in the claims process.
(3) Policies and procedures established by
				  the insurer to report workers' compensation insurance fraud to appropriate
				  criminal law enforcement agencies, including procedures to cooperate with and
				  monitor progress of the agencies in their fraud cases.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 119 - ANTI-FRAUD-STATEMENT OF POLICY › ANTI-FRAUD PLANS › Section 119.23 - Anti-fraud plan certification

Current through Register Vol. 54, No. 28, July 13, 2024
Each insurer writing workers' compensation insurance as of
					 August 31, 1993, shall certify in writing to the Department by December 31,
					 1993, that it has instituted and is maintaining an anti-fraud plan that
					 satisfies the requirements of the act as explained by this chapter. An insurer
					 newly licensed and writing coverage on and after August 31, 1993, shall certify
					 within 4 months of commencement of writing coverage that it has instituted and
					 maintains an anti-fraud plan. Letters of certification should be filed with
					 Dennis C. Shoop, Director, Bureau of Enforcement, Insurance Department, 1321
					 Strawberry Square, Harrisburg, Pennsylvania, 17120.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 119 - ANTI-FRAUD-STATEMENT OF POLICY › ANTI-FRAUD PLANS › Section 119.24 - Anti-fraud plan annual reports

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  Section 1204 of the act (77 P. S. §
											1040.4) requires insurers to report annually
				  to the Department a summary of actions taken under their anti-fraud plans to
				  prevent and combat fraud. Annual reports under this section should cover
				  anti-fraud activities for each calendar year. The first annual report should
				  cover the period August 31, 1993, through December 31, 1994, and shall be filed
				  with the Department by March 31, 1995. Thereafter, reports are to be filed by
				  March 31 of each year and cover the previous calendar year's anti-fraud
				  activities. The annual report should provide detailed information on the
				  following:
(1) Specific actions taken by the
				  insurer during the year to prevent and combat insurance fraud. The actions
				  should be thoroughly described in the annual report and should contain
				  statistical information relating to the number of cases of detected fraud,
				  including the status of disposition of those cases, the number of personnel and
				  other resources committed to detecting and combating fraud, the total dollar
				  cost of fraud and the savings attributed to detected fraud or otherwise
				  recovered by the insurer.
(2)
				  Measures implemented throughout the year to provide for the integrity and
				  security of fraud related data and information collected and maintained. The
				  measures apply to data collected and maintained in a manual or automated
				  environment.
(3) Originating
				  sources of the information on the fraudulent activity-for example, an agent,
				  adjuster, employe, policyholder or citizen.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 119 - ANTI-FRAUD-STATEMENT OF POLICY › ANTI-FRAUD PLANS › Section 119.25 - Reporting of fraud to criminal law enforcement authorities

Current through Register Vol. 54, No. 28, July 13, 2024
Consistent with section 1109 of the act (77 P. S. §
											1039.9), section 1205 of the act
					 (77
					 P. S. §
											1040.5) authorizes insurers to
					 refer an incidence of fraud to criminal law enforcement agencies. Workers'
					 compensation insurers should refer cases directly to criminal law enforcement
					 authorities and cooperate with and assist those authorities when
					 requested.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 119 - ANTI-FRAUD-STATEMENT OF POLICY › ANTI-FRAUD PLANS › Section 119.26 - Monitoring of insurer compliance with anti-fraud requirements

Current through Register Vol. 54, No. 28, July 13, 2024
The Department will audit insurers to determine compliance
					 with the anti-fraud provisions of the act as part of financial and market
					 conduct examinations performed under sections 213, 214 and 216 of The Insurance
					 Department Act of 1921 (40 P. S. §§
											51,
					 53 and
					 54).
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 120 - LOSS COSTS ADJUSTMENT FILINGS-STATEMENT OF POLICY › Section 120.1 - Workers' compensation loss costs and loss costs adjustment filings

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Under the
				conditions of the act, rating organizations will no longer develop or file
				final rates, but instead will develop and file for approval prospective loss
				costs and supporting actuarial and statistical data. Each insurer shall
				individually determine and file the rates it will use as a result of its own
				independent company decision making process. Rating organizations will continue
				to develop and file rules, relativities and supplementary rating information as
				identified in this chapter on behalf of their members, subscribers or service
				purchasers. Rating organization filings should be limited to loss costs and
				should not contain provisions for expenses.
(b) After the initial required filing
				specified in the act, a participating insurer of a rating organization is
				authorized to continue to use the rates and deviations filed and approved for
				its use until disapproved, or until the insurer makes its own filing to change
				its rates, either by making an independent filing or by filing a nonadoption
				letter of the rating organization filing. Nonresponse by a company to the
				Department to a rating organization filing will be considered adoption of that
				filing.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 120 - LOSS COSTS ADJUSTMENT FILINGS-STATEMENT OF POLICY › Section 120.2 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following terms, when used in this chapter, have the
				  following meanings, unless the context clearly indicates otherwise:
Act
-The Workers' Compensation Act ( ___P. S
				  ___ ).
Commissioner
-The Insurance Commissioner of
				  the Department.
Department
-The Insurance Department of the
				  Commonwealth.
Developed losses
-Losses adjusted, using
				  standard actuarial techniques, to recognize the effect of differences between
				  current payment or reserve estimates, or both, and those estimated to be needed
				  to provide actual ultimate loss.
Expenses
-The portion of a rate attributable
				  to acquisition, field supervision, collection expenses, general expenses,
				  taxes, licenses, fees, loss adjustment expenses, other operating expenses and
				  assessments.
Loss trending
-A procedure for projecting
				  developed losses to the average date of loss for the period during which the
				  policies are to be effective.
Profit and contingency
-The amounts that when
				  considered with net investment and other income, provide an appropriate total
				  after-tax return.
Prospective loss costs
-That portion of a
				  rate that does not include provisions for expenses or profit and are based on
				  historical aggregate losses adjusted through development to their ultimate
				  value and projected through trending to a future point in time.
Rate
-The rate of premium, policy and
				  membership fee, or other charge made by an insurer for or in connection with a
				  contract or policy of insurance of the kind to which the act applies.
Supplementary rating information
-The term
				  includes a manual or plan of rates, classification system, rating schedule,
				  minimum premium policy fee, rating rule, rate-related underwriting rule,
				  experience rating plan, statistical plan and other information needed to
				  determine the applicable rate in effect or to be in effect.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 120 - LOSS COSTS ADJUSTMENT FILINGS-STATEMENT OF POLICY › Section 120.3 - Rates/loss costs

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Rating
				organizations will no longer develop or file advisory final rates that contain
				provisions for expenses and profit, including investment income or
				consideration of the time value of money, or both. Instead, for workers
				compensation insurance, rating organizations will develop and file for approval
				with the Commissioner in accordance with Article VII of the act (___P.___S.___)
				a reference filing containing advisory prospective loss costs and supporting
				actuarial and statistical data, including a discussion of those considerations
				enumerated in the Statement of Principles of the Casualty Actuarial Society
				regarding property and casualty loss reserving.
(b) Loss costs filings will contain the
				advisory prospective loss costs and the underlying loss data and other
				supporting actuarial information for calculations or assumptions underlying
				those loss costs. It is anticipated that loss based assessments will be
				included in prospective loss costs.
(c) After a loss costs filing has been filed
				with the Department and approved, the rating organization will provide its
				participating insurers with a copy of the approved reference filing.
(d) The rating organization may print and
				distribute manuals of prospective loss costs as well as rules and other
				supplementary rating information described in section 2 A of the Calculation of
				Company Loss Cost Multiplier Form which appears in Appendix A.
(e) With the initial prospective loss costs
				reference filing, rating organizations will no longer develop or file minimum
				premiums, minimum premium formulas, loss constants, premium discounts or
				expense constants.
Pennsylvania Code › Title 31 - INSURANCE › Part VII - Property, Fire and Casualty Insurance › Chapter 120 - LOSS COSTS ADJUSTMENT FILINGS-STATEMENT OF POLICY › Section 120.5 - Supplementary rate information: rating organization action

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Rating organization
				filings.
The rating organization files with the Department, for
				approval, filings containing a revision of rules and supplementary rating
				information. This includes policy-writing rules, rating plans, classification
				codes and descriptions and rules which include factors or relativities such as
				employers liability increased limits factors, classification relativities or
				similar factors but excludes minimum premiums. A rating organization filing
				should be limited to loss costs and not contain provisions for expenses.
(1) These filings are made by the rating
				organization on behalf of insurers that have authorized the rating organization
				to file rules, relativities and supplementary rating information on their
				behalf.
(2) Rating organizations
				may print and distribute manuals of rules and supplementary rating information
				excluding minimum premiums.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.1 - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The following
				words and terms, when used in this chapter, have the following meanings, unless
				the context clearly indicates otherwise:
Act
-Article XVI of The Insurance Company Law
				  of 1921 (40 P. S. §§
											991.1601-991.1625).
Alien insurer
-An insurer incorporated or
				  organized under the laws of a foreign nation or of a province or territory
				  other than a state or a territory of the United States or the District of
				  Columbia.
Binding authority
-The authority delegated to
				  a surplus lines licensee by an eligible surplus lines insurer to obligate the
				  eligible surplus lines insurer to accept a particular risk.
Commissioner
-The Insurance Commissioner of
				  the Commonwealth.
Department
-The Insurance Department of the
				  Commonwealth.
Eligible surplus lines insurer list
-The most
				  recent list of eligible surplus lines insurers published by the Department
				  under section 1605(b) of the act (40 P. S. §
											991.1605(b)).
Foreign insurer
-
(i) An insurer, other than an alien insurer,
				not incorporated or organized under the laws of the Commonwealth.
(ii) For purposes of this chapter, the term
				also includes a United States branch of an alien insurer which branch is not
				entered through and licensed to transact insurance or reinsurance in this
				Commonwealth.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.2 - Notice to insured

Current through Register Vol. 54, No. 28, July 13, 2024
The written notice required to be given to the insured under
				  section 1608 of the act (40 P. S. §
										991.1608) shall be:
(1) Substantially similar in content to that
				set forth in section 1608(1) and (2) of the act.
(2) Prominently printed on the first page of
				the quotation.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.3 - Conditions of binding authority

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				A surplus lines licensee may not exercise binding authority in this
				Commonwealth on behalf of an eligible surplus lines insurer unless there is in
				force a written contract executed by all parties to the contract setting forth
				the terms, conditions and limitations governing the exercise of binding
				authority by the surplus lines licensee. The written contract must, at a
				minimum, contain the following:
(1) A
				description of the classes of insurance for which the surplus lines licensee
				holds binding authority.
(2) The
				geographical limits of the binding authority.
(3) The maximum dollar limitations on the
				binding authority for any one risk for each class of insurance.
(4) The maximum policy period for which the
				surplus lines licensee may bind a risk.
(5) A prohibition against delegation of
				binding authority by the surplus lines licensee or, if the binding authority is
				delegable by the surplus lines licensee, a prohibition against delegation of
				binding authority by the surplus lines licensee without the prior written
				approval of the eligible surplus lines insurer.
(6) A provision in the following or
				substantially similar language:
It is understood and agreed that all insurance placed
				  pursuant to this agreement on risks resident, located, or to be performed in
				  this Commonwealth, shall be effected and written in accordance with Article XVI
				  of the act of May 17, 1921 (P. L. 682, No. 284) (40 P. S. §§
												991.1601-991.1625).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.4 - Evidence of insurance

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Section
				1612 of the act (40 P. S. §
										991.1612)
				requires the surplus lines licensee, upon placing surplus lines insurance, to
				deliver the contract of insurance to the insured or to the writing producer. A
				cover note, binder or other evidence of insurance shall be delivered by the
				surplus lines licensee if the contract of insurance is not immediately
				available.
(b) Delivery of the
				contract or other evidence of insurance by the surplus lines licensee shall
				occur within 15 calendar days after:
(1)
				Coverage has been bound by the surplus lines licensee, if the surplus lines
				licensee holds binding authority on behalf of the eligible surplus lines
				insurer.
(2) The surplus lines
				licensee has received written notification from the eligible surplus lines
				insurer or other nonadmitted insurer that it has assumed the risk, if the
				surplus lines licensee does not hold binding authority on behalf of the
				eligible surplus lines insurer.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.5 - Diligent search of admitted insurers

Current through Register Vol. 54, No. 28, July 13, 2024
Under section 1604(2)(i) of the act (40 P. S. §
										991.1604(2)(i)), surplus
				  lines insurance may be procured through a surplus lines licensee from
				  nonadmitted insurers if a diligent search is made among the admitted insurers
				  who are writing, in this Commonwealth, coverage comparable to the coverage
				  being sought. The following minimum requirements and conditions apply to the
				  conduct of a diligent search among admitted insurers under section 1604(2)(i)
				  of the act.
(1) Under section
				1609(a)(1)(i) of the act (40 P. S. §
										991.1609(a)(1)(i)), the
				writing producer shall execute and forward to the surplus lines licensee a
				written statement, in a form prescribed by the Department, declaring that a
				diligent effort to procure the desired coverage from admitted insurers was
				made. A diligent effort will be deemed to have been made if the writing
				producer has documented a declination of coverage from at least three admitted
				insurers which are writing, in this Commonwealth, coverage comparable to the
				coverage being sought. A declination may be documented by any of the following:
(i) A written declination from the admitted
				insurer.
(ii) A written record of
				an oral declination made by the person who initially received the declination
				or by another person working for the business from information transmitted by
				the person who received the declination. The written record must include:
(A) The name, office location and phone
				number of the admitted insurer or firm acting in the capacity of underwriting
				manager for the admitted insurer.
(B) The name and position of the person
				contacted.
(C) The date of
				contact.
(D) An explanation of the
				declination.
(iii) A
				written record that the writing producer contacted an admitted insurer who
				failed to respond within 5 business days, which includes the manner in which
				the contact was made and the information required under subparagraph
				(ii)(A)-(C).
(iv) A written record
				that the risk does not meet the underwriting guidelines of the admitted
				insurer. The written record must include:
(A)
				The name of the admitted insurer.
(B) Reference to the underwriting guidelines
				upon which the declination is based.
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.6 - Export list coverages

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Under
				section 1604(2)(ii) of the act (40 P. S. §
										991.1604(2)(ii)), the
				Commissioner may create and maintain an export list of insurance coverages for
				which the full amount or kind of insurance cannot be obtained from admitted
				insurers.
(b) The diligent search
				requirement of section 1604(2)(i) of the act and the reporting requirements of
				section 1609(a) of the act (40 P. S. §
										991.1609(a)) do not apply to
				the placement of an insurance coverage which appears on the export
				list.
(c) Within 45 calendar days
				after the placement of an insurance coverage which appears on the most recent
				export list published by the Commissioner, the surplus lines licensee shall
				file with the Department or its designee a written declaration reporting the
				transaction on a form prescribed by the Department.
The provisions of this §
											124.6 amended under sections 206,
					 506 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and Article XVI of The
					 Insurance Company Law of 1921 (40 P. S. §§
												991.1601-991.1626).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.7 - Unique forms of coverages

Current through Register Vol. 54, No. 28, July 13, 2024
Under section 1604(2)(iii) of the act (40 P. S. §
										991.1604(2)(iii)), surplus
				  lines insurance may be procured through a surplus lines licensee from
				  nonadmitted insurers if the kind of insurance sought to be obtained from
				  admitted insurers requires a unique form of coverage not available in the
				  admitted market. Within 45 calendar days after a unique form of coverage has
				  been placed, the surplus lines licensee shall file with the Department or its
				  designee, a written declaration reporting the transaction on a form prescribed
				  by the Department.
The provisions of this §
											124.7 amended under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and Article XVI of The
					 Insurance Company Law of 1921 (40 P. S. §§
												991.1601-991.1626).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.8 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
											124.8 reserved under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and Article XVI of The
					 Insurance Company Law of 1921 (40 P. S. §§
												991.1601-991.1626).
Pennsylvania Code › Title 31 - INSURANCE › Part VIII - Miscellaneous Provisions › Chapter 124 - SURPLUS LINES INSURANCE › Section 124.9 - Reserved

Current through Register Vol. 54, No. 28, July 13, 2024
The provisions of this §
											124.9 reserved under sections 206,
					 506, 1501 and 1502 of The Administrative Code of 1929 (71 P. S.
					 §§
												66,
					 186,
					 411 and
					 412); and Article XVI of The
					 Insurance Company Law of 1921 (40 P. S. §§
												991.1601-991.1626).