West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-23 - Medical Malpractice Loss Experience And Loss Expense Annual Reporting Requirements › Section 114-23-7 - Severability

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Severability. If
				any provision of this legislative rule is held invalid, the remainder of the rule
				shall not be affected thereby.
Exhibit A
Annual Loss Experience and Loss Expense Reporting Form
(Note: Attach Additional Sheets For Answers When Necessary)
1. Company
				Name:________________________________________________
If part of a group, specify group name:
__________________
2. Coverage
				Classification::__________________________________________
3. Provide, on a West Virginia basis and on a
				countrywide basis, the following information by twelve-month accident year for the
				preceding ninety-six months:
a. paid
				losses;
b. accumulated paid
				losses;
c. paid loss adjustment
				expenses; and,
d. incurred but not
				reported losses.
4. Provide,
				on a West Virginia basis and on a countrywide basis, the calculation of loss
				development factors by twelve-month accident year for the preceding ninety-six
				months for the following:
a. paid losses;
b. accumulated paid losses;
c. paid loss adjustment expenses; and,
d. incurred but not reported losses.
5. Provide, on a West Virginia basis
				and a countrywide basis, the ratio of accumulated paid losses to earned premiums by
				twelve-month accident year for the preceding ninety-six months.
6. Provide, on a West Virginia basis and a
				countrywide basis, the number of policies in force and the paid losses per policy by
				twelve-month accident year for the preceding ninety-six months.
7. Provide a comparison of allocated West Virginia
				operating expenses and actual West Virginia operating expenses by twelve-month
				accident year for the preceding ninety-six months.
8. Provide, on a West Virginia basis and on a
				countrywide basis, a linear trend analysis which shows the indicated projected
				trended development factors for paid losses, accumulated paid loss, paid loss
				adjustment expenses and incurred but not reported losses. Provide the R squared
				results of the linear models.
9. Provide
				the methodology by which the credibility of West Virginia data in relationship to
				countrywide data is weighted in calculating an indicated percentage of premium rate
				increase by twelve-month accident year for the preceding ninety-six months. Provide
				formulas used in the methodology and a narrative explanation and justification of
				use of the particular methodology.
10.
				Provide the following information with regard to actual expenses:
a. Actual paid claims by policy type by year
				(please separate underlying tort payments from bad faith, unfair claims practices
				and other extra contractual payments).
b. Actual legal fees by policy type by
				year.
c. Actual administrative costs
				paid by policy type by year.
11. Provide audited financial statements inclusive
				of income statements and balance sheets, statements of cash flow and footnotes to
				financials.
The above information is correct to the best of my knowledge and
				  belief.
________
Name (type or print)
________
Title
____________________________
Address
________
Telephone Number
________
Signature