Spreadsheet: 43277446-6479-4577-af89-5b1bf4bff70f
Sheet: INT-WC

Interrogatories | INT-WC
1. If you are only adopting the most recently approved bureau loss costs, then input "Adoption Only" in the SERFF "Product Name" field on the General Information tab and confirm by indicating "Yes" on this exhibit.
2. Is this filing the initial rate filing for this program?
2a. If No, what is(are) the six digit State Tracking Number(s) of your last approved LCM filing?
3. Confirm that a copy of the actual Insurance Expense Exhibit, as submitted with the Annual Statement, has been submitted with this filing.
4. What is the name of the [NAME] responsible for the contents of this filing?
4a. List Actuarial Organizations of which the [NAME] is a member as well as applicable designations.
4b. Identify any items in this rate filing for which the [NAME] is not responsible.
4c. Confirm that the filing complies with the following Actuarial Standards of Practice: Nos. 12, 13, 23, 25, 29, 30, 38, 39, 41, 43.
5. Have you changed any of your loss cost modification factor calculation methodologies since your last filing?
5a. If Yes, support your change in methodologies.
5b. If Yes, provide the impact (as a % of premium) of the methodology changes ("Minimal" and "Negligible" are not acceptable replies).
6. Confirm that you have submitted the Department's 2007-A, 2009-A and 2009-B forms by indicating "Yes."  (Forms 2009-A and 2009-B are required for loss cost adoption filings.  See [NAME] 2009-18 for required forms by filing type.)
6a. 2007-A Form - Confirm that all fields under the in-force column have been populated using current in-force data and confirm by indicating "Yes."
6b. 2009-A Form - Confirm that the "Effective Date of the Loss Costs Being Used" reflects the effective date of the bureau's lost costs and not the company's proposed effective date by indicating "Yes."
7. Does this filing deviate from the bureau's approved loss costs (i.e. a Loss Cost Modification Factor other than 1.0)?
7a. If yes, then confirm that you have provided supporting data and/or rationale for this modification by indicating "Yes."
8. Will this program be using a tiering structure?
8a. If yes, then provide the current and proposed average loss cost modification factors for each tier and the average premium amount in each tier and confirm by indicating "Yes."
8b. If yes, then provide the objective criteria that will be used to place individual risks into each tier and confirm by indicating "Yes."
9. Confirm that the selected expense provision for the Second Injury Fund (SIF) does not exceed the Department's maximum limit of 5% by indicating "Yes."
10.Confirm that the selected expense provision for the Guarantee Fund does not exceed the Department's maximum limit of 2% by indicating "Yes."
11. Confirm that your profit load has been offset by investment income and does not exceed the Department's maximum limit of 5% by indicating "Yes."
12. Confirm that a copy of the actual Insurance Expense Exhibit, as submitted with the Annual Statement, has been submitted with this filing by indicating "Yes."
13. If this program contains multiple LCMs, then confirm that a premium breakdown for each LCM has been provided by indicating "Yes."
14. Confirm that you have provided the premium weighted average of your current LCM(s) by indicating "Yes."
15. Confirm that you have provided the premium weighted average of your proposed LCM(s) by indicating "Yes."
16. Confirm that you have provided the percentage change of the difference between the current and proposed LCM(s) by indicating "Yes."
17. Confirm that all fields under the Rate/Rule Schedule tab (SERFF) have been populated with accurate data and confirm by indicating "Yes."
18. Confirm that the maximum/minimum % change values on the SERFF Rate/Rule Schedule tab reflect the impacts to individual policyholders, not the impacts to individual class codes by indicating "Yes."