Section II - Reporting Requirements

1. Experience reports shall be submitted on a monthly basis, except that the carrier may submit reports more frequently if the carrier so desires.
2. Electronic reports must be submitted to the PCRB. Refer to the Unit Data Statistical Reporting Electronic Submission Guidelines at www.pcrb.com for further information.

1. Report Number. Report the 2-digit numeric code that corresponds to the loss valuation date.
   • First Reports are valued as of the 18th month after the month in which the policy became effective, and the report shall be filed not later than 20 months after the effective date of the policy.
   • Subsequent Reports
     Second reports are valued exactly 30 months from the policy effective date.
     Third reports are valued exactly 42 months from the policy effective date.
     Fourth reports are valued exactly 54 months from the policy effective date.
     Fifth reports are valued exactly 66 months from the policy effective date.
     Sixth reports are valued exactly 78 months from the policy effective date.
     Seventh reports are valued exactly 90 months from the policy effective date.
     Eighth reports are valued exactly 102 months from the policy effective date.
     Ninth reports are valued exactly 114 months from the policy effective date.
     Tenth reports are valued exactly 126 months from the policy effective date.
2. Correction Report Number. Report the 2-digit sequential number that corresponds to the number of correction reports submitted within a particular report level. Refer to Section 1, Item L.8 for conditions requiring a correction report. Example: 3rd correction to a first report = Report Number “01”, Correction Number “03” Report blanks for original report level submissions.
3. Correction Type. Report the 1-position alphabetic code that indicates the type of correction report being submitted. Applicable only to correction reports.
   H – Header Record Correction
   E – Exposure Record Correction (First Reports Only)
   L – Loss Record Corrections
   T – Total Record Correction
   M – Correction to Multiple Record Types
4. Carrier Code. Report the carrier code assigned to the reporting company. Refer to the National Council on Compensation Insurance, Inc. for the appropriate 5-digit code number.
5. Policy Number. The complete policy number must be reported on the unit statistical report AND MUST AGREE WITH THE POLICY NUMBER REPORTED ON THE POLICY INFORMATION PAGE. The complete policy number including prefixes and suffixes, if used, must remain the same throughout the life of the policy. In those cases where a policy is renewed by a renewal certificate, the policy number must be reported. If the carrier desires, the certificate number may also be reported under the field Certificate Number.
6. Policy Effective Date. The effective date should correspond exactly with that reported on the policy information page or endorsements. In the case of an interstate policy endorsed after its effective date to provide coverage for Pennsylvania, the effective date reported on the risk report for Pennsylvania shall be the effective date of the interstate policy. The effective date of the coverage for Pennsylvania shall be reported in the State Effective Date field.
7. Policy Expiration Date. The expiration date shall be the expiration date reported on the policy information page unless the policy is canceled. In that event, the cancellation date shall be recorded as the expiration date.
8. Exposure State. Report the 2-digit numeric code that represents the state in which coverage has been provided.
   Pennsylvania — 37
9. State Effective Date. The date coverage begins in Pennsylvania on a multi-state policy where Pennsylvania is added mid-term. Otherwise leave blank.
10. Risk ID Number. The Risk ID Number is not required by the PCRB.
11. Page Number. The Page Number is not required by the PCRB.
12. Insured Name. Report the name of the person or business with whom an insurance contract is made and who is specifically designated by name in Item 1 of the policy information page or as endorsed.
13. Insured Address. The Insured Address is not required by the PCRB.
14. Federal Employer ID Number. Report the Federal Employer Identification Number as reported on the policy information page.
15. Modification Effective Date. The Modification Effective Date is required for all exposures. If the modification changes in accordance with Experience Rating Plan rules, report the effective date of the modification that applies to the class code, rate, exposure, and premium.
16. Rate Effective Date. The Rate Effective Date is required for all exposures. Report the rate effective date that corresponds to the class code and its associated rate, exposure and premium. If the rating value changes during the policy period, report the rate effective date that applies to the reported class code, rate, exposure and premium.

1. No Exposure in the State – When a policy is issued, either on an “if any” basis or as a multi-state policy, and upon audit it is determined that exposure did not develop, a first level unit statistical report must be submitted containing either 1) no exposure records at all or 2) a single exposure record containing Class Code 1111, No Exposure. If the Class Code 1111 option is chosen, it must be reported with no corresponding exposure, rate or premium amounts. All “no exposure” unit totals (exposure, premium, loss, etc.) must be equal to zero, and there should be no corresponding exposure or loss records reported. The use of either Option 1) or 2) above will alert the PCRB that no exposure developed in the state.
2. Payrolls reported must be audited payrolls even on minimum premium risks. When a final audit has not been made at the time of filing a report, the policy condition field Estimated Audit Code should be marked with the symbol “Y” and without further request MUST be replaced by a revised report as soon as audited payrolls are available.
3. Payrolls must be appropriately separated as of the effective date of the changes whenever there is a change in experience modification.
4. The total payroll for all classifications is to be reported in Total Standard Exposures.
5. The payroll exposures for non-ratable (supplemental and catastrophe loadings) portions are not to be included in the Total Standard Exposure.
6. The Manual rules provide that the payroll of all employees exposed to a foundry, abrasive, sand blasting hazard, carcinogen, radiation or federal black lung (except those rated under a classification where the PCRB Rating Values provide coverage for silicosis) will have a special supplementary disease rate charge in addition to the PCRB Loss Cost. Such payroll, together with the manual premium derived from the supplemental rate charge, shall be assigned to the appropriate code, such as 0066, 0133, 9985, 0176, or 0164. Refer to Section III Item B.3. of this Plan for a complete list. The payroll reported for these codes shall be reported but shall not be used in determining the risk’s total payroll. However, the premium resulting from the application of the supplemental disease rates shall be included in the total premium.
7. The Manual rules provide that the payroll of all employees exposed to or engaged in the following hazards will have a mandatory catastrophe reserve rate which is not subject to experience or retrospective rating in addition to the PCRB Loss Cost. Such payroll, together with the manual premium from the mandatory catastrophe reserve rate charge, shall be assigned to the appropriate code:
   

   Class	Hazard	Code
   0615	Tunneling and Shaft Sinking	0152
   0810	Truck deliveries of coal from a mine or tipple/hauling of coal	0162
   4771	Manufacturing of Explosives or Ammunition	0771
   7405	All members of the flying crew of scheduled and supplemental air carriers	7445
   7413	All members of the flying crew of commuter air carriers	7453

   To provide coverage for Federal Black Lung on class Code 0615, Tunneling and Shaft Sinking, the additional non-ratable disease loading Code 0164 and rating value must be applied to the payroll.

1. Per Capita Classifications. Experience on per capita classifications shall be reported in the Exposure Amount field. An employee covered under a per capita classification for a period of one year shall be reported as an exposure of 1.0. Similarly, if coverage is terminated before the expiration of a year, the exposure reported per person shall be that decimal part of a year, expressed to the nearest tenth, for which the coverage was in effect. For example, an employee covered for four months should be reported as an exposure of 0.3. Exposure shall be governed by the duration of the coverage and not by the number of days worked.
2. Volunteer Firemen – Class 0994. Where the policy provides coverage for Volunteer Firemen, enter the total population serviced.
3. Volunteer Ambulance Companies – Class 0993. Where the policy provides coverage for Volunteer ambulance companies, report the number of such companies for the exposure amount, carried to the nearest tenth.
4. Per Person Week – Workfare Program Employees – Class 0982. Where the policy provides coverage for Community Work Experience Program employees or Workfare, report the number of employees on a per person week basis for the exposure amount, carried to the nearest tenth. The premium derived is not subject to experience or retrospective rating.
5. Per Company – Volunteer Hazardous Materials Response Team – Class 0996. Where the policy provides coverage for Volunteer Hazardous Materials Response Team, report the number of such company/teams in the space provided for the exposure amount, carried to the nearest tenth.
   Note: Premium for the Code 9740, Terrorism and Code 9741, Catastrophe (other than Certified Acts of Terrorism), does not apply to these classifications.

1. Premium by Classification. The premium reported by Manual classification shall be that obtained by extension of the payroll or other exposure at the carrier’s rating values, and shall be reported in the Premium field. Where a classification includes a non-ratable element or supplemental loading, the ratable portion of the premium is applicable to the experience modification factor and the non- ratable portion is not applicable to the experience modification factor.
   Note: The non-ratable element or supplemental loading is subject to deviation, if applicable.
2. Miscellaneous Premium. The PCRB rules provide for additional premium charges for various special conditions or additional coverage, such as Excess Limits under Part II, etc. These additional premium charges shall be reported in the Premium Amount under appropriate Class Code. (See Item B.3. of this Section). The exposure items, if any, shall be reported in the Exposure Amount field.

1. Premium Totals on Risks Subject to Experience Modification.
   1. Total Subject Premium. The total of the premium subject to experience modification, as per subsection a. and b. above, shall be reported in the Total Subject Premium field.
   2. Experience Modification. The experience modification used to develop charged premium, expressed as a decimal (e.g., .950 for 5% credit, 1.000 for a “neutral” modification, or 1.050 for a 5% debit), shall be reported in the premium field of the Experience Modification. If a change in the experience modification occurs subsequent to inception date of the policy, the payrolls and corresponding premium shall be split and reported on separate split periods. The period covered by each shall be reported by appropriate notation in the Mod Effective Date and/or Rate Effective Date fields.
      Note: A “neutral” modification (1.000) may not be used for a non-rated risk.
   3. Total Standard Exposure. Report the sum of all dollar value exposures in standard exposure.
   4. Total Standard Premium. Report the sum of all premium dollars for all split periods, both subject and not subject to modification, which are to be included in standard premium.

1. Premium Subject to Experience Modification
   1. Premium for Increased Limits under Part II Codes 9803, 9805, 9806, 9807, 9808, 9810, 9811, 9812, 9814, 9815, 9816 and 9837 to be reported in the aggregate in the Premium Amount field, assigned to the appropriate code. Refer to Section III for limits.
      Note: Increased limit factors applied to non-ratable classification exposures should be reported as not subject to the experience modification. The PCRB Manual rules provide that the premium for limits in excess of the standard limits shall be determined by applying the appropriate factors to the total premium, at the carrier’s rates, before any applicable experience modification. The codes to be used are listed in Section III, Item B.3.These codes should not be used in connection with the reporting of excess premium developed for increased limits on voluntary compensation policies. For such cases, the PCRB Manual rules contemplate that the premium for coverage in excess of standard limits is provided by an appropriate increase in the carrier’s rate. In those cases where the additional premium resulting from the application of the appropriate limit factor to total premium is less than the corresponding minimum premium established by the carrier for such increased limits, the corresponding minimum premium shall be reported opposite the appropriate Code 9848.
   2. Additional Premium Resulting from Flat Increase on Outstanding Policies – Code 0998. For policies where the effect of a law amendment has been applied during the term of the policy as a flat increase on total premium for the unexpired portion, the additional aggregate premium resulting from the flat increase shall be reported on a carrier’s Manual rate basis and shall be assigned to Code 0998 and reported in the Premium Amount field.  The Exposure Amount and Manual Rate fields shall be left blank.
   3. Premium Credit Resulting from Flat Decrease on Outstanding Policies – Code 0994. For policies where the effect of a law amendment has been applied during the term of the policy as a flat decrease on total premium for the unexpired portion, the premium credit resulting from the flat decrease shall be reported on a carrier’s Manual rate basis and shall be assigned to Code 0994 and reported in the Premium Amount field. The Exposure Amount and Manual Rate fields shall be left blank.
   4. Waiver of Subrogation – Code 0930. For policies where the carrier waives subrogation rights, the premium charge associated with such waiver of subrogation shall be reported as Code 0930. The Exposure Amount and the Manual Rate fields shall be left blank.
2. Premium Not Subject to Experience Modification
   1. Loss Constant – Code 0032. On each policy where a loss constant has been charged, the amount so charged shall be assigned code 0032 for all industry groups.
   2. Short Rate Penalty Premium – Code 0931
      Where policies are canceled prior to normal expiration, the cancellation date shall be reported in the field captioned Policy Expiration Date and the symbol “Y” reported in the Policy Condition Field Canceled Mid-Term. When a policy is canceled short rate, the payroll and manual premium by classification shall be reported on the basis of the actual exposure. Any deviation applied to manual premium and the experience modification, if any, shall then be applied to the manual premium to determine the total modified premium. The additional premium resulting from application of the short rate cancellation table to such modified premium extended to full annual basis shall be assigned to Code 0931 and reported in the premium Amount field. The Exposure Amount and Manual Rate fields shall be left blank.
   3. Pennsylvania Construction Classification Premium Adjustment Program (PCCPAP) Credit – Code 9046
      For carriers using an approved PCCPAP credit, the premium adjustment resulting from the application of the credit factor to the manual premium (after the application of the experience modification) shall be reported under Code 9046.
   4. Certified Safety Committee Credit Program (CSCCP) – Code 9890
      Workplace Safety Committee established in its workplace, for the purpose of hazard detection and accident prevention. Employers who gain certification shall receive a 5% discount –. The 5% rate credit shall continue if the employer annually submits certification renewal affidavits acceptable to the Department of Labor and Industry. For carriers using an approved CSCCP credit, the premium adjustment resulting from the application of the credit factor to the manual premium (after application of the experience modification) shall be reported under Code 9890.
   5. Merit Rating Plan Adjustments – Applicable to risks not eligible for experience modification.
      Code 9884 – Neutral Adjustment – no credit or debit
      Code 9885 – 5% Credit Adjustment – to be subtracted when calculating standard premium
      Code 9886 – 5% Debit Adjustment – to be added when calculating standard premium
      Merit Rating Adjustments are applicable to manual premium before application of any schedule rating, Pennsylvania Safety Committee Credit or Pennsylvania Construction
      Classification Premium Adjustment Program.
   6. Schedule Rating Plan Adjustments Schedule Rating Plan Adjustments must be applied as a percentage factor applicable to manual premium after application of experience/merit rating but prior to any other credit (i.e., Pennsylvania Safety Committee credit, Pennsylvania Construction Classification Premium Adjustment
      Program)
      Code 9887 Schedule Rating Credit – to be subtracted when calculating standard premium
      Code 9889 Schedule Rating Debit – to be added when calculating standard premium
      NOTE: USE ONLY POSITIVE VALUES
3. Premium Not Subject to Experience Rating and not part of Standard Premium
   1. Premium Discount – Code 006.  If premium discount is applied, the total amount of the discount for the state should be reported in the premium field and shall be assigned to Statistical Code 0063 for Schedule “Y” carriers or Code 0064 for Schedule “X” carriers. THIS AMOUNT MUST NOT BE INCLUDED IN THE TOTAL STANDARD PREMIUM AMOUNT REPORTED.
   2. Expense Constant – Code 0900.  On each policy where an expense constant has been charged, the amount so charged shall be reported to Code 0900 for all industry groups. Do not include the expense constant in the Total Standard Premium.
   3. Flat Charge Waiver of Subrogation – Code 9115. For policies where a flat charge has been levied for a waiver of subrogation rights, the amount shall be assigned to Code 9115. Do not include the flat charge waiver of subrogation premium in the Total Standard Premium. (See Item B. 9. a. (4) of this section.)
   4. Terrorism – Code 9740. Premium charge for Terrorism is reported subsequent to experience modification after the expense constant, if applicable, but prior to employer assessment. The premium charge for Code 9740 is calculated by dividing a risk’s total payroll by $100 and multiplying the result times the carrier’s rating value for Code 9740. Premium developed under Terrorism is not included in Total Standard Premium. Non-payroll exposures are not subject to premium charges for Terrorism.
   5. Catastrophe (other than Certified Acts of Terrorism) – Code 9741
      Premium charge for Catastrophe (other than Certified Acts of Terrorism) is reported subsequent to experience modification after the expense constant, if applicable, but prior to employer assessment. The premium charge for Code 9741 is calculated by dividing a risk’s total payroll by $100 and multiplying the result times the carrier’s rating value for Code 9741. Premium developed under Catastrophe (other than Certified Acts of Terrorism) is not included in Total Standard Premium. Non-payroll exposures are not subject to premium charges for Catastrophe (other than Certified Acts of Terrorism).
4. Employer Assessment Not Subject to Experience Rating Employer Assessment Factor – Code 0938 Calculation of Employer Assessment Premium Base proceeds by adding back to the total policy premium the amount of any deductible credits.
5. Audit Noncompliance Charge (ANC) – Code 9757
   For policies where the carrier has chosen to apply an audit noncompliance charge because the employer would not allow the carrier to examine and audit its records. The premium for Code 9757 is a flat charge applied after the Employer Assessment (Code 0938).
   Note: When the Exposure on the 1st report includes Code 9757, report the Estimated Audit Code as “U” in the applicable Policy Conditions, Estimated Audit Code field.
   If subsequent to reporting Statistical Code 9757, and the final policy premium is determined in accordance with the Basic Manual rules, the statistical code and its accompanying charge must be removed. Additionally, the Estimated Audit Code must be changed to “N” and the exposure and premium must reflect the final audit.
6. Premium Adjustment Related to Filing Differences – Code 1994
   For use on policies written between April 1, 2018 and December 31, 2018, where the carrier has chosen to apply a flat decrease for purposes of reporting premium adjustments related to filing C-370 differences. Code 1994 may also be used on policies written between January 1, 2019 and January 31, 2019 where the carrier has chosen to apply a flat decrease for purposes of reporting premium adjustments for Classification Code 994, Firefighter – Volunteer Fire Company, related to filing C-375. For those carriers who have chosen to report adjusted rating values on the unit statistical report, this code should not be used. This code must be used as a flat decrease.
7. Paid Furloughed Employees – Code 1212
   Paid furloughed employees means employees who continue to receive payments during a temporary layoff or an involuntary leave and are not performing any work duties for an employer. Effective March 1, 2020, payments by any employer or any public governmental entity to paid furloughed employees as a result of federal, state, and or/local emergency orders, laws or regulations, issued due to the COVID-19 (coronavirus) pandemic which impact an employer’s staffing or business operations must be reported to Statistical Code 1212 – Paid Furloughed Employees. Such payments do not include any appropriated funds or loans received by an employer as authorized by law or regulations, or public governmental entity, that are used by an employer specifically to retain or hire working employees. Code 1212 may be used as a Statistical Code to report the payments only. If a carrier is unable to report this experience as a statistical code, please contact the PCRB to discuss reporting requirements. Payments reported to Code 1212 are excluded from premium only if the employer keeps separate, accurate and verifiable records. For any claims attributable to an employee occurring prior to or after a temporary layoff or an involuntary leave, report losses to the classification for work normally performed by the employee that corresponds to the employee’s payroll. No claim can be reported to Code 1212 – Paid Furloughed Employees. The expiration date of this code will be determined at a later date as circumstances warrant in consultation with Pennsylvania regulatory authorities.

1. Conditions Requiring a Correction Report
   1. A correction report shall be filed whenever there is an error of any kind on a report previously filed, whether such error is discovered by the carrier or by the PCRB.
   2. Correction reports as defined above should be forwarded to the PCRB immediately.
2. All correction reports should, in the Correction Type field, indicate the type of correction being submitted. For example, due to an audit where the previous report was an estimate, the correction type would be “E” exposure. (For a list of Correction Type refer to Item A.6.c. of this Section)
3. Where the exposure previously reported has been changed by reason of an audit, or by a re-audit or any other adjustment affecting classifications, exposure or premiums, a revised report shall be filed showing the amounts reported previously, as well as revised amounts for those classifications where there have been changes.
4. Total Subject Premium, Experience Modification and Total Modified Premium, (if these fields have been used on the prior report), together with the Total Standard Exposure and Total Standard Premium, shall be reported as revised only.
5. If the exposure does not change but the risk total standard premium previously reported is revised due solely to a change in the experience modification, it shall be necessary to submit a revised report showing only each item affected by the modification change on a previously reported and revised basis.
6. Previous premium discounts and revised discounts also shall be reported in the space provided.

1. Report the alphanumeric code that uniquely identifies the claim excluding blanks, punctuation marks and special characters. The complete claim number, including suffixes and prefixes, if used, must remain the same throughout the life of the claim.

1. Death Cases Code – 01
   1. Report each death case, unless it has been established that the carrier has incurred no liability. The amount reported as indemnity incurred shall include all paid and outstanding benefits, including compensation paid to the deceased prior to death, burial expenses, with a maximum of $7,000 and payments to the state.
      If there is compensation paid on a permanent total, permanent partial or a temporary claim prior to the death of a claimant and the death is not related to work injuries, the loss is to be reported on the basis of the injury for which payments have been previously made.In valuing a surviving spouse’s benefits in death cases, Table I, Surviving Spouse Pension Table, shall be used.    In valuing the portion of reserves in death cases for lump sum dowry benefits payable to the surviving spouse upon remarriage, Table II, Present Value of Remarriage Award Table, shall be used. In valuing the benefits for certain death claims where there is no surviving spouse, but a parent, brother or sister receiving benefits which are payable for life, Table III, Lifetime Benefits (Other Than Surviving Spouse) Pension Table shall be used. (Refer to Section IV for the Tables.)
   2. USL&HW Benefits on Death Cases. In valuing a surviving spouse’s benefits in death cases under USL&HW Coverage, Table USL&HW-I, Surviving Spouse Pension Table, shall be used. In valuing the portion of reserves in death claims under USL&HW Coverage for lump sum dowry benefits payable to the surviving spouse upon remarriage, Table USL&HW-II, Present Value of Remarriage Award Table, shall be used. In valuing the portion of reserves for certain death cases under USL&HW Coverage where there is no surviving spouse, but a parent, brother or sister receiving benefits which are payable for life, Table USL&HW-III, Lifetime Benefits (Other Than Surviving Spouse) Pension Table, shall be used.
2. Permanent Total Disability Code – 02
   1. Report as permanent total each case which has been adjudged to constitute permanent total disability or which is defined as such under the law, or which in the judgment of the carrier will result in permanent total disability. In general, permanent total disability includes cases involving the loss, or loss of use, of both hands, both arms, both feet, both legs, or both eyes. If a lump sum settlement is made or, in judgment of the carrier, will be received to settle future benefits, the injury code should be changed from a permanent total to a permanent partial.
      In establishing reserves on permanent total cases Table III, Lifetime Benefits (Other Than Surviving Spouse) Pension Table shall be used, as found in Section IV.
   2. USL&HW Benefits on Permanent Total Cases. In valuing the disabled’s life portion of the reserve for permanent total cases under USL&HW Coverage, Table USL&HW-III, Lifetime Benefits (Other Than Surviving Spouse) Pension Table, shall be used. In valuing the portion of the reserve for permanent total cases in which survivorship benefits are payable, Table USL&HW-IV, Present Value of Survivorship Benefits Table, shall be used.
3. Temporary Total or Temporary Partial Disability Code – 05
   Report as Temporary every case which involves or is expected to involve indemnity benefits but which does not constitute a case of Death, Permanent Total or Permanent Partial as defined above.
4. Medical Only Claims Code – 06
   When reporting medical only claims, no Incurred Indemnity should be reported.
5. Contract Medical Code – 07
   Contract medical costs which cannot be allocated to individual claims shall be reported in the aggregate in the Medical Incurred field. Such medical shall be assigned to the governing classification of the risk. Contract medical costs allocated to individual claims shall be reported in connection with these claims and shall not be included in the amount reported as contract medical. The amount reported as contract medical shall be the actual incurred cost to the company for such medical contracts, including payments to physicians and hospitals under contract.
6. Permanent Partial Disability Code – 09
   1. Cases involving partial disability or permanent injuries, as defined in Sections 306(b) or 306(c) respectively of the Workers’ Compensation Act. Such cases involve loss, or loss of use, of members of the body, sight or hearing and disfigurement of the head, neck or face. Do not include permanent injuries defined as Permanent Total above.
   2. Cases involving total disability, other than permanent total disability, if either of the following holds true:
      • The duration of the disability benefits exceeds, or is expected to exceed, one year.
      • In the judgment of the carrier, the extent of liability for future payments is indeterminate.
        The amount reported as indemnity incurred shall include specific benefits and compensation for temporary disability as well as loss of earning capacity.

Type of Loss

Type of Recovery

Type of Claim

Type of Settlement

1. Report Catastrophe Code Number 48 for all claims directly arising from the commercial airline hijackings of September 11, 2001 and the resulting subsequent events with accident dates of September 11, 2001 through September 14, 2001.
2. Report Catastrophe Number 87 for all occupational diseases claims emanating from the rescue, recovery and clean-up operations at the World Trade Center site that were undertaken between September 11, 2001 and September 12, 2002, as defined in Article 8-A of the New York Workers’ Compensation Law (Chapter 446 of the Laws of 2006).
3. Report Catastrophe Code Number 12 for claims applicable and/or attributable to Coronavirus Disease 2019 (COVID-19) with accident dates of December 1, 2019 and subsequent.
   Note: Catastrophe Code Number 48 and 87 will apply to both single and multiple claims.