reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-025 - Filings by insurance scoring model vendors

Current through Register Vol. 24-14, July 15, 2024
(1) The commissioner will allow vendors to
			 file insurance scoring models. The vendor must file the scoring model in SERFF
			 in accordance with the
Washington State SERFF Personal Insurance
			 Scoring Model Filing General Instructions
posted on the commissioner's
			 web site (
www.insurance.wa.gov
).
(2) Insurers may use models filed by vendors
			 after the commissioner determines the model complies with Washington state
			 laws.
(3) An insurer may use a
			 model that has been filed by a vendor and accepted by the commissioner if the
			 insurer submits a filing in SERFF that:
(a)
			 References the vendor that filed the model;
(b) References the filing number and model
			 name used by the vendor;
(c) States
			 whether the insurance scoring model will be used for underwriting, rating, or
			 both; and
(d) Proposes an effective
			 date for the insurer's use of the model.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-030 - Confidentiality of insurance scoring models

Current through Register Vol. 24-14, July 15, 2024
(1) The law says insurance scoring models
			 will remain confidential unless the commissioner is taking an enforcement
			 action. An insurer or vendor may request that its insurance scoring model be
			 available for public inspection.
(2) To restrict public access to an insurance
			 scoring model filing, the insurer or vendor must follow the procedures in the
Washington State SERFF Personal Insurance Scoring Model Filing General
			 Instructions
posted on the commissioner's web site (
www.insurance.wa.gov
).
Statutory Authority:
				  RCW
				  48.02.060,
				  48.18.545,
				  48.19.035,
				  48.110.150,
				  48.18.100, and
				  48.19.040. 13-12-038 (Matter No. R
				  2013-06), §
										284-24A-030, filed 5/30/13,
				  effective 7/1/13. Statutory Authority:
				  RCW
				   48.02.060,
				  48.18.100,
				  48.18.120,
				  48.19.080,
				  48.19.370,
				  48.30.010,
				  49.60.178,
				  48.18.545(7), 48.19.035(5).
				  02-19-013 (Matter No. R 2001-11), §
										284-24A-030, filed 9/6/02,
				  effective 10/7/02.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-032 - Under RCW 48.19.035 (2)(b) what does "eligibility rules or guidelines" mean?

Current through Register Vol. 24-14, July 15, 2024
"Eligibility rules or guidelines" mean rules that determine
				whether a consumer is eligible for insurance from a single insurer or a group
				of affiliated companies. Eligibility rules or guidelines do not include rules
				that determine which company within an affiliated group of companies a consumer
				will be placed based on their insurance score or other underwriting
				criteria.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.18.545,
				  48.19.035, and
				  48.30.010. 05-02-026 (Matter No. R
				  2004-01), §
										284-24A-032, filed 12/29/04,
				  effective 7/1/05.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-033 - How will an insurer or a group of affiliated insurers know its eligibility rules or guidelines will be withheld from public inspection?

Current through Register Vol. 24-14, July 15, 2024
Eligibility guidelines will be kept as confidential records if
				they:
(1) Conform to the definition in
			 WAC 284-24A-032; and
(2) Are clearly identified.
To ensure confidentiality, insurers should submit eligibility
				guidelines in a separate and distinct part of the related rate filing so they
				may be separated from other documents in the filing that are public records
				under RCW
				 48.19.040(5).
Statutory Authority:
				  RCW
				  48.02.060,
				  48.18.545,
				  48.19.035, and
				  48.30.010. 05-02-026 (Matter No. R
				  2004-01), §
										284-24A-033, filed 12/29/04,
				  effective 7/1/05.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-035 - What will the commissioner do with the insurance scoring model after he or she receives it?

Current through Register Vol. 24-14, July 15, 2024
Actuarial analysts will review the model to determine whether
				it complies with
				Title
				48 RCW. The scope of the review
				will include whether the model includes:
(1) Any prohibited factors; and
(2) Attributes that may result in unfair
			 discrimination.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.18.100,
				  48.18.120,
				  48.19.080,
				  48.19.370,
				  48.30.010,
				  49.60.178,
				  48.18.545(7), 48.19.035(5).
				  02-19-013 (Matter No. R 2001-11), §
										284-24A-035, filed 9/6/02,
				  effective 10/7/02.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-040 - What action will the commissioner take if a model does not comply with Washington law?

Current through Register Vol. 24-14, July 15, 2024
The commissioner will:
(1) Notify the insurer or vendor that the
			 model does not comply with Washington law;
(2) State the reasons why the model does not
			 comply with Washington law;
(3)
			 Offer the insurer or vendor sixty days to revise the model to resolve the
			 issue(s) outlined in subsection (2) of this section; and
(4) Provide a specific date when the model
			 may no longer be used in Washington if the model has not been revised to
			 resolve the issue(s).
Statutory Authority:
				  RCW
				  48.02.060,
				  48.18.100,
				  48.18.120,
				  48.19.080,
				  48.19.370,
				  48.30.010,
				  49.60.178,
				  48.18.545(7), 48.19.035(5).
				  02-19-013 (Matter No. R 2001-11), §
										284-24A-040, filed 9/6/02,
				  effective 10/7/02.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-045 - If an insurer uses credit history or insurance scores to segment personal insurance business for rating purposes, how can the insurer show that its rating plan results in premium rates that are not excessive, inadequate, or unfairly discriminatory?

Current through Register Vol. 24-14, July 15, 2024
If an insurer uses credit history or insurance scores to
				segment personal insurance business for rating purposes, the insurer
				must:
(1) Submit a multi variate
			 analysis with the first rate and rule filing the insurer makes to comply with
			 this law.
(2) Submit a multivariate
			 analysis any time the insurer uses credit history or an insurance score to
			 revise a risk classification plan, rating factor, rating plan, rating tier, or
			 base rates.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.18.545,
				  48.19.035, and
				  48.30.010. 05-02-026 (Matter No. R
				  2004-01), §
										284-24A-045, filed 12/29/04,
				  effective 7/1/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.18.100,
				  48.18.120,
				  48.19.080,
				  48.19.370,
				  48.30.010,
				  49.60.178,
				  48.18.545(7),
				  48.19.035(5).
				  02-19-013 (Matter No. R 2001-11), §
										284-24A-045, filed 9/6/02,
				  effective 10/7/02.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-050 - What types of information must an insurer include in a multivariate analysis?

Current through Register Vol. 24-14, July 15, 2024
(1) A
			 multivariate statistical analysis must evaluate the rating factors listed below
			 (if applicable to the rating plan, and to the extent that data are credible):
(a) For homeowners, dwelling property,
			 earthquake, and personal inland marine insurance:
(i) Insurance score;
(ii) Territory and/or geographic
			 area;
(iii) Protection
			 class;
(iv) Amount of
			 insurance;
(v) Surcharges or
			 discounts based on loss history;
(vi) Number of family units; and
(vii) Policy form relativity.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24A - Rules that apply to insurers that use credit history for personal insurance underwriting or rating › Section 284-24A-055 - Should an insurer submit actuarial data based on demographic factors with an insurance scoring model or with a rate filing?

Current through Register Vol. 24-14, July 15, 2024
(1) Insurers should not submit actuarial data
			 based on demographic factors with their insurance scoring model.
(2) Insurers must submit actuarial data based
			 on demographic factorsto support any difference in rates or premiums based on:
(a)
"No hit,"
which means the
			 absence of credit history; or
(b)
"No score,"
which means the inability to determine the consumer's
			 credit history.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-010 - Definitions that apply to this chapter

Current through Register Vol. 24-14, July 15, 2024
(1)
"Insurer"
means an
			 authorized insurer that has premium, loss or loss adjustment expense data in
			 Washington state for one or more of these lines of insurance:
(a) Property, as defined in
			 RCW
			  48.11.040;
(b) Marine and transportation, as defined in
			 RCW
			  48.11.050, if not exempt from statistical
			 reporting under
			 RCW
			  48.19.010(1)(e);
(c) Vehicle, as defined in
			 RCW
			  48.11.060;
(d) General casualty, as defined in
			 RCW
			  48.11.070; and
(e) Surety, as defined in
			 RCW
			  48.11.080.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-020 - Purpose

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
			 this chapter is to:
(a) Incorporate the
			 provisions of the
NAIC Statistical Handbook
into this
			 chapter;
(b) Prescribe the manner
			 of reporting statistical data and the types of statistical data insurers must
			 submit to statistical agents under
			 RCW
			  48.19.370; and
(c) Establish a procedure for the
			 commissioner to designate statistical agents under
			 RCW
			  48.19.370.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-030 - The commissioner adopts certain statistical plans

Current through Register Vol. 24-14, July 15, 2024
(1) By reference, the commissioner
			 incorporates all provisions of the
NAIC Statistical Handbook
into this rule, except:
(a) Medical
			 Professional Liability Reports: Statistical Plan Reporting Requirements;
			 and
(b) Medical Professional
			 Liability Reports: Model Medical Professional Liability Statistical
			 Plan.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-040 - Insurers must report statistical experience

Current through Register Vol. 24-14, July 15, 2024
(1) Under
			 RCW
			  48.19.370(4), the
			 commissioner may designate certain rating organizations or other entities as
			 statistical agents to gather, compile, and report insurance statistical
			 data.
(2)RCW
			  48.19.370 says each insurer must report loss
			 and expense experience to the commissioner. As a condition of transacting the
			 business of insurance under
			 RCW
			  48.05.040, each insurer must:
(a) Report its insurance statistical data to
			 a statistical agent designated by the commissioner in accordance with the
			 statistical plans filed with the commissioner by the statistical agent under
			 WAC 284-24B-060;
(b) Comply with the reporting requirements
			 and data quality procedures in the
NAIC Statistical Handbook
;
			 and
(c) Adopt edit and audit
			 procedures to screen and check data for reasonableness and accuracy.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-050 - Process for an entity to be designated a statistical agent

Current through Register Vol. 24-14, July 15, 2024
The commissioner may designate an entity as a statistical agent
				if the entity makes a written request to the commissioner that:
(1) Identifies the line(s) of business for
			 which the entity will collect and report statistical experience;
(2) States the entity's qualifications to act
			 as a statistical agent; and
(3)
			 Agrees to:
(a) Comply with the reporting
			 requirements and data quality procedures in the
NAIC Statistical
			 Handbook
, and all rules, technical advisories and directives issued by
			 the commissioner;
(b) Report
			 statistical data to the commissioner in a timely manner; and
(c) Submit to an examination in accordance
			 with procedures described in
			 RCW
			  48.03.010.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-060 - Statistical agents must file their statistical plans with the commissioner

Current through Register Vol. 24-14, July 15, 2024
Entities that are designated as statistical agents under WAC
				284-24B-050 must promptly file
				with the commissioner:
(1) Their
			 statistical plans, including standard report formats; and
(2) All changes in their statistical plans or
			 reporting formats.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.19.370. 06-13-035 (Matter No. R
				  2005-02), §
										284-24B-060, filed 6/15/06,
				  effective 7/16/06.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-070 - Statistical agents must comply with the NAIC Statistical Handbook

Current through Register Vol. 24-14, July 15, 2024
Statistical agents must collect statistical data in a form and
				detail as required by the
NAIC Statistical Handbook
and any
				additional detail required by rules adopted by the
				commissioner.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.19.370. 06-13-035 (Matter No. R
				  2005-02), §
										284-24B-070, filed 6/15/06,
				  effective 7/16/06.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-080 - Multiple statistical agents for the same line of insurance

Current through Register Vol. 24-14, July 15, 2024
If the commissioner designates more than one statistical agent
				to collect statistical data for a particular line of insurance, those
				statistical agents must arrange to file reports that combine all data collected
				by the statistical agents for that line(s) of insurance. The statistical agents
				may arrange among themselves for the equitable sharing of the costs to produce
				combined reports.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.19.370. 06-13-035 (Matter No. R
				  2005-02), §
										284-24B-080, filed 6/15/06,
				  effective 7/16/06.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-090 - Access to data

Current through Register Vol. 24-14, July 15, 2024
The commissioner shall have access to all statistical data that
				statistical agents collect to comply with this chapter. If requested by the
				commissioner, statistical agents must promptly provide a copy of any report
				produced from data that the statistical agent is required to collect under this
				chapter.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.19.370. 06-13-035 (Matter No. R
				  2005-02), §
										284-24B-090, filed 6/15/06,
				  effective 7/16/06.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-100 - Disclosure of data

Current through Register Vol. 24-14, July 15, 2024
(1) Aggregate
			 data reported to the commissioner by statistical agents are available for
			 public inspection.
(2) If data
			 submitted to the commissioner by a statistical agent appear likely to identify
			 individual insurers, claimants or insureds, or the statistical agent or an
			 insurer asserts that data are exempt from public disclosure under
			 RCW
			  48.02.120(3), such data may
			 not be publicly disclosed until the commissioner:
(a) Notifies the statistical agent and any
			 insurer that has asserted the data to be exempt from public disclosure of the
			 disclosure request;
(b) Provides a
			 thirty-day period from the date of notice for any insurer that reported data to
			 the statistical agent to assert that its data are trade secrets or are
			 otherwise protected from disclosure; and
(c) Provides aggrieved insurers with the
			 opportunity to request a hearing under
			 RCW
			  48.04.010 and
			 chapter
			 34.05 RCW.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24B - Rules that require property and casualty insurers to report statistical data › Section 284-24B-110 - Effective date

Current through Register Vol. 24-14, July 15, 2024
Insurers must affiliate with a designated statistical agent by
				January 1, 2007, and report data in accordance with the requirements included
				in the
NAIC Statistical Handbook
and the designated
				statistical agent's filed statistical plan.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.19.370. 06-13-035 (Matter No. R
				  2005-02), §
										284-24B-110, filed 6/15/06,
				  effective 7/16/06.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24C - Specific rules that apply to statistical plans for medical professional liability reports › Section 284-24C-010 - Definitions that apply to these rules

Current through Register Vol. 24-14, July 15, 2024
(1)
"Medical malpractice
			 insurer"
means an authorized general casualty insurer that has premium,
			 loss or loss adjustment expense data for medical malpractice
			 insurance.
(2)
"Medical
			 professional liability insurance"
or
"medical malpractice
			 insurance"
provides coverage for tort claims brought against various
			 medical-related institutions and medical professionals, such as:
(a) Institutions, including hospitals,
			 infirmaries, nursing homes, mental institutions, blood banks, sanitariums, and
			 clinics; and
(b) Individual medical
			 professionals including physicians, surgeons, dentists, nurses, pharmacists,
			 opticians, optometrists, physiotherapists, chiropractors, laboratory
			 technicians, and various specialists.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24C - Specific rules that apply to statistical plans for medical professional liability reports › Section 284-24C-020 - Purpose

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
			 this chapter is to:
(a) Incorporate the
			 provisions of chapter 284-24B WAC into this chapter;
(b) Prescribe the manner of reporting
			 statistical data and the types of statistical data medical malpractice insurers
			 must submit to statistical agents under
			 RCW
			  48.19.370; and
(c) Establish a medical professional
			 liability statistical plan.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24C - Specific rules that apply to statistical plans for medical professional liability reports › Section 284-24C-030 - Statistical reporting for medical professional liability insurance

Current through Register Vol. 24-14, July 15, 2024
Each medical malpractice insurer must:
(1) Comply with the provisions of
			 RCW
			  48.19.370 and chapter 284-24B WAC;
			 and
(2) Report its insurance
			 statistical data to a statistical agent designated by the commissioner in
			 accordance with the statistical plans filed by the statistical agent under WAC
			 284-24B-060 and all additional
			 detail required by this chapter.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.19.370. 06-13-035 (Matter No. R
				  2005-02), §
										284-24C-030, filed 6/15/06,
				  effective 7/16/06.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24C - Specific rules that apply to statistical plans for medical professional liability reports › Section 284-24C-040 - NAIC Statistical Handbook - Medical professional liability statistical plan reporting requirements

Current through Register Vol. 24-14, July 15, 2024
These data items, as specified by the
NAIC Statistical
				Handbook
, must be reported by each medical malpractice insurer to a
				medical malpractice statistical agent:
(1) Company number: Experience must be
			 reported by the company number assigned by the medical malpractice statistical
			 agent. Medical malpractice statistical agents must convert each company number
			 to NAIC group and company code numbers.
(2) Accounting/calendar date:
(a) Accounting quarter (where
			 applicable).
(b) Accounting
			 year.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24C - Specific rules that apply to statistical plans for medical professional liability reports › Section 284-24C-050 - Additional medical professional liability statistical plan reporting requirements required by the commissioner

Current through Register Vol. 24-14, July 15, 2024
In addition to the data items specified by the
NAIC
				Statistical Handbook
, these data items, specific to this medical
				malpractice statistical plan rule, must be reported by each medical malpractice
				insurer to a medical malpractice statistical agent:
(1) Claim dates:
(a) Incident month/year; and
(b) Report month/year.
(c) Closed month/year (closed claims
			 only).
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24C - Specific rules that apply to statistical plans for medical professional liability reports › Section 284-24C-060 - Effective dates

Current through Register Vol. 24-14, July 15, 2024
(1) Medical
			 malpractice insurers must:
(a) Comply with
			 chapter 284-24B WAC, affiliate with a designated medical malpractice
			 statistical agent by January 1, 2007, and promptly begin reporting data
			 required under WAC
			 284-24C-040; and
(b) Begin reporting statistical data
			 specified under WAC
			 284-24C-050 for claims opened on
			 or after January 1, 2007, to a designated medical malpractice statistical agent
			 in calendar year 2009 in accordance with the medical malpractice statistical
			 agent's filed statistical plan.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-010 - Purpose

Current through Register Vol. 24-14, July 15, 2024
This chapter contains procedural rules to implement chapter
				48.140 RCW. This chapter describes the rules, practices and procedures that
				insuring entities, self-insurers, health care facilities and providers must use
				to report data to the commissioner as required by chapter 48.140
				RCW.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-010, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-020 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The definitions in this section apply throughout this
				chapter.
(1) "Allocated loss
			 adjustment expense" or "ALAE" means defense and cost containment expenses paid
			 or incurred for defense, litigation and medical cost containment expenses and
			 services. Either internal staff, such as in-house counsel or professional
			 medical staff, or external staff, such as defense counsel or expert witnesses,
			 may provide defense and cost containment services.
(a) Defense and cost containment expenses and
			 services include:
(i) Defense services
			 provided by:
(A) Attorneys or expert
			 witnesses; and
(B) Private
			 investigators, hearing representatives or fraud investigators.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-030 - How will the commissioner ensure data confidentiality under RCW 48.140.060(2)?

Current through Register Vol. 24-14, July 15, 2024
RCW  42.56.400(11) protects data filed under chapter 48.140 RCW
				from public disclosure. To ensure data confidentiality, the commissioner
				will:
(1) Develop a secure web-based
			 data reporting application;
(2)
			 Train OIC staff on applicable laws and agency practices related to protecting
			 confidential and privileged information;
(3) Limit access to the claim data base to
			 OIC staff responsible for preparing the statistical summaries and annual
			 report;
(4) Develop and implement
			 confidentiality procedures to be used by staff that has access to the closed
			 claim data base;
(5) Develop
			 procedures to use if data are accidentally released; and
(6) Use aggregate data in summaries and
			 reports so that individual claim data cannot be identified.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-030, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-040 - How are closed claims reported to the commissioner?

Current through Register Vol. 24-14, July 15, 2024
(1) Except as provided in subsection (2) of
			 this section, reporting entities must use the reporting site maintained by the
			 OIC to report closed claims. To help reporting entities collect data, the
			 commissioner will post reporting forms on the OIC internet site so that
			 reporting entities can organize data before entering data into the reporting
			 site.
(2) The commissioner may
			 permit a reporting entity to transmit data electronically in an alternative
			 format if the reporting entity develops, at its own expense, an interface that
			 is compatible with the OIC closed claim data base.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-040, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-050 - How will the OIC assign user ID codes to reporting entities?

Current through Register Vol. 24-14, July 15, 2024
The reporting site will assign a permanent user ID to each
				reporting entity the first time it enters a closed claim into the reporting
				site.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-050, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-060 - What types of claims must be reported to the commissioner?

Current through Register Vol. 24-14, July 15, 2024
The types of closed medical malpractice claims that must be
				reported to the OIC include:
(1)
			 Claims closed with an indemnity payment;
(2) Claims closed with paid allocated loss
			 adjustment expenses; and
(3) Claims
			 closed with both indemnity payments and allocated loss adjustment
			 expenses.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-060, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-070 - Are write-offs or other small sums of money provided as customer service gestures considered claims?

Current through Register Vol. 24-14, July 15, 2024
If a self-insurer, facility or provider waives copayments,
				forgives bills or deductibles, or makes other similar accommodations to a
				client, it is not a claim under
				RCW
				 48.140.010(1). Reporting
				entities are not required to report these types of accommodations to the
				commissioner.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-070, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-080 - When is a claim considered closed?

Current through Register Vol. 24-14, July 15, 2024
A claim is closed on the date the reporting entity takes final
				administrative action to close the claim. Final administrative action occurs
				after the reporting entity:
(1) Issues
			 the final payment to the claimant in the form of a check or draft;
(2) Pays all outstanding bills for allocated
			 loss adjustment expenses; and
(3)
			 If applicable, receives all indemnity and allocated loss adjustment expense
			 claim payment data needed for reporting under this chapter from a facility,
			 provider or excess insuring entity.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-080, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-090 - When are closed claim reports due?

Current through Register Vol. 24-14, July 15, 2024
Under
				RCW
				 48.140.020, reporting entities must report
				all claims closed in the preceding calendar year to the commissioner.
(1) Beginning in 2009, closed claim reports
			 for the prior calendar year are due by March 1.
(2) A reporting entity may report a closed
			 claim any time after the claim is closed, but no later than March 1.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-090, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-100 - Can a reporting entity reopen a claim or make changes to previously reported data?

Current through Register Vol. 24-14, July 15, 2024
The reporting site will allow the reporting entity to change
				previously reported closed claim data, subject to these rules:
(1) OIC will freeze data contained in the
			 reporting site from March 15 through June 30 each year so the OIC can prepare
			 reports and statistical summaries as required by
			 RCW
			  48.140.040 and
			 48.140.050. The commissioner may
			 accept changes to previously reported data if a correction or omission will
			 significantly affect the conclusions stated in the annual report.
(2) After June 30, the reporting site will
			 allow a reporting entity to change previously reported data.
(a) The reporting entity can reopen a claim
			 report using their permanent user ID and the record identifier and make changes
			 or corrections to data.
(b) Changes
			 and corrections submitted by reporting entities after June 30 of each year will
			 appear in future reports and statistical summaries.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-110 - How should reporting entities assign claim and incident identifiers?

Current through Register Vol. 24-14, July 15, 2024
(1) Consistent with
			 requirements of
			 RCW
			  48.140.030(1), the reporting
			 entity must assign a different claim identification number to each closed claim
			 report.
(a) The claim identifier must consist
			 solely of numbers. When the reporting entity enters a claim into the reporting
			 site, the site will automatically combine the reporting entity's user ID with
			 the claim identifier to create a unique record identifier for each
			 claim.
(b) The OIC will use the
			 record identifier to trace the claim for auditing purposes.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-120 - When is the primary insuring entity responsible for reporting closed claims to the commissioner?

Current through Register Vol. 24-14, July 15, 2024
Primary insuring entities are principally responsible for
				reporting closed claim data required under chapter 48.140 RCW and this chapter
				to the commissioner.
(1) The primary
			 insuring entity must report the total amounts paid to settle the claim,
			 including any claim payments or ALAE payments made by:
(a) A facility or provider;
(b) An excess insuring entity; or
(c) Any other person or entity on behalf of
			 the provider.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-130 - When is an excess insuring entity responsible for reporting closed claims to the commissioner?

Current through Register Vol. 24-14, July 15, 2024
(1) If
			 an excess insuring entity insures a self-insurer and makes indemnity payments
			 or incurs allocated loss adjustment expenses, the excess insuring entity is
			 principally responsible to report closed claim data required under chapter
			 48.140 RCW and this chapter.
(a)
			 Self-insurers must report all claim payments and allocated loss adjustment
			 expenses to the excess insuring entity for reporting purposes; and
(b) The excess insuring entity must report
			 data on behalf of itself and the self-insurer.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-140 - When is a self-insurer responsible for reporting closed claims to the commissioner?

Current through Register Vol. 24-14, July 15, 2024
If a closed claim payment falls within its self-insured
				retention, the self-insurer must report closed claim data required under
				chapter 48.140 RCW and this chapter to the commissioner.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-140, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-150 - May a self-insurer report claims on behalf of itself and an excess insuring entity?

Current through Register Vol. 24-14, July 15, 2024
A self-insurer may designate itself to be the principal
				reporting entity and report closed claim data on behalf of itself and any
				excess insurer. If the self-insurer designates itself to be the principal
				reporting entity, the self-insurer must:
(1) Notify the commissioner in writing of
			 this arrangement;
(2) Report closed
			 claim data required under chapter 48.140 RCW and this chapter on behalf of
			 itself and the excess insuring entity; and
(3) Accept responsibility for compliance with
			 RCW
			  48.140.020(2).
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-150, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-160 - When is a facility or provider principally responsible for reporting closed medical malpractice claims to the commissioner?

Current through Register Vol. 24-14, July 15, 2024
Under
				RCW
				 48.140.020(1), a facility or
				provider must report closed claims if the facility or provider:
(1)
(a)
			 Makes indemnity payments directly to the claimant or incurs ALAE expenses to
			 defend the claim, or both; and
(b)
			 There is no insurance coverage available from an insuring entity or
			 self-insurer to defend or pay for the claim; or
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-170 - What does "date of notice" mean?

Current through Register Vol. 24-14, July 15, 2024
RCW
				 48.140.030(8)(b) says that
				reporting entities must report the date that the insuring entity, self-insurer,
				facility or provider is presented with the claim. For reporting purposes, the
				"date of notice" is the date on which the:
(1) Insured notifies the primary insuring
			 entity or self-insurer of a claim if insurance coverage is available;
			 or
(2) Claimant notifies the
			 facility or provider of a claim if insurance coverage is not
			 available.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-170, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-180 - How should the type of medical specialty be reported?

Current through Register Vol. 24-14, July 15, 2024
When reporting medical specialties as required under
				RCW
				 48.140.030(2), reporting
				entities must use the
Specialty Codes
published by the
				National Practitioner Data Bank (NPDB).
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-180, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-190 - How should the type of health care facility be reported?

Current through Register Vol. 24-14, July 15, 2024
When reporting the type of health care facility under
				RCW
				 48.140.030(3), the reporting
				entity must use the
Type of Organization Codes
published by
				the NPDB. Public facilities, such as prisons and universities, must review the
				NPDB
Type of Organization Codes
and enter the most similar
				classification.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-190, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-200 - What should be reported as the primary location where the medical malpractice incident occurred?

Current through Register Vol. 24-14, July 15, 2024
When reporting the location within a facility where the
				incident occurred under
				RCW
				 48.140.030(4), the reporting
				entity must use the incident locations published by the Physician Insurers
				Association of America in conjunction with its data-sharing project. The
				reporting entity must report one of these locations:
(1) Catheterization lab;
(2) Critical care unit;
(3) Dispensary;
(4) Emergency department;
(5) Labor and delivery room;
(6) Laboratory;
(7) Nursery;
(8) Operating room;
(9) Outpatient department;
(10) Patient room;
(11) Pharmacy;
(12) Physical therapy department;
(13) Radiation therapy department;
(14) Radiology department;
(15) Recovery room;
(16) Rehabilitation center;
(17) Special procedure room;
(18) Location other than an inpatient
			 facility:
(a) Clinical support center, such a
			 laboratory or radiology center;
(b)
			 Office;
(c) Walk-in clinic;
			 or
(d) Other;
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-210 - How should the incident city be reported?

Current through Register Vol. 24-14, July 15, 2024
When reporting the incident city under
				RCW
				 48.140.030(5), the reporting
				entity must report the incident city based on the location of the facility
				where the incident occurred. If more than one incident led to the claim, the
				reporting entity must choose the location where the incident occurred that most
				directly caused the injury.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-210, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-220 - How should injury severity be reported using the National Practitioner Data Bank (NPDB) severity scale?

Current through Register Vol. 24-14, July 15, 2024
When reporting the severity of an injury under
				RCW
				 48.140.030(7), the reporting
				entity must report using the NPDB severity scale. This scale shows the medical
				outcome for temporary and permanent injuries, and is included below.
(1) Temporary injuries include:
(a) Emotional injury only, such as fright,
			 where no physical damage occurred;
(b) Insignificant injury such as lacerations,
			 contusions, minor scars or rash where no delay in recovery occurs;
(c) Minor injury such as infection, fracture
			 set improperly, or a fall in the hospital, where recovery is complete but
			 delayed; or
(d) Major injury such
			 as burns, surgical material left, drug side effect, brain damage, where
			 recovery is complete but delayed.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-230 - What should be reported as the reason for the medical malpractice claim?

Current through Register Vol. 24-14, July 15, 2024
When reporting the reason for a medical malpractice claim under
				RCW
				 48.140.030(11), the
				reporting entity must use the same
Allegation Group and Specific
				Allegation Codes
published by the National Practitioner Data
				Bank.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-230, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-240 - How should claim disposition information be reported?

Current through Register Vol. 24-14, July 15, 2024
When reporting the final method of claim disposition under
				RCW
				 48.140.030(9), reporting
				entities must describe the method of claim disposition using one of the
				descriptions listed below:
(1) Claim
			 abandoned by claimant.
(2) Claim
			 settled by the parties.
(3) Claim
			 is disposed of by a court when the court issues a:
(a) Directed verdict for plaintiff:
(b) Directed verdict for defendant;
(c) Judgment notwithstanding verdict for
			 plaintiff (judgment for defendant);
(d) Judgment notwithstanding verdict for
			 defendant (judgment for plaintiff);
(e) Involuntary dismissal;
(f) Judgment for plaintiff;
(g) Judgment for defendant;
(h) Judgment for plaintiff after appeal;
			 or
(i) Judgment for defendant after
			 appeal.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-250 - How should information about the timing of the settlement be reported?

Current through Register Vol. 24-14, July 15, 2024
When reporting the timing of the settlement under
				RCW
				 48.140.030(9), reporting
				entities must report whether the claim is settled:
(1) Before filing suit, requesting
			 arbitration or mediation hearing;
(2) Before trial, arbitration or
			 mediation;
(3) During trial,
			 arbitration or mediation;
(4) After
			 trial or hearing, but before judgment or award;
(5) After judgment or decision, but before
			 appeal;
(6) During an appeal;
			 or
(7) After an appeal.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-250, filed 6/4/07,
				  effective 7/22/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-24D - Medical malpractice closed claim data reporting rules for facilities and providers › Section 284-24D-260 - Are claim payments reported on a gross or net basis?

Current through Register Vol. 24-14, July 15, 2024
Reporting entities must report claim payments on a gross basis
				and provide the total amount paid to the claimant to settle the claim. The
				reporting entity must not deduct the value of offsets or recoverables, such
				as:
(1) Reimbursement for a deductible
			 by the insured;
(2) Reimbursement
			 for claim payments by a reinsurer; or
(3) Anticipated subrogation
			 recoveries.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.140.060, and
				  7.70.140. 07-12-057 (Matter No. R
				  2006-02), §
										284-24D-260, filed 6/4/07,
				  effective 7/22/07.