Section I - General Rules

All indemnity claim activities with jurisdiction state of Pennsylvania or federal claims associated with a Pennsylvania policy as well as employers’ liability claims are reportable. This includes all workers compensation claims for which an indemnity payment has been made or indemnity reserve established. This does not include medical-only claims (i.e., workers compensation claims in which there are no incurred indemnity losses reported and no anticipation of an indemnity payment in the future). The Jurisdiction State corresponds to the state or federal workers compensation act under which the claimant’s benefits are being paid.

All transactions must be submitted electronically to the Pennsylvania Compensation Rating Bureau, 30 S. 17th Street, Suite 1500, Philadelphia, PA 19103.

The Call began with indemnity claim activities occurring in Second Quarter 2020, due to the Pennsylvania Compensation Rating Bureau by September 30, 2020, regardless of the Accident Date or Policy Effective Date.

The Call includes the detailed indemnity benefit payments made to claimants, or on a claimant’s behalf, at a transactional level, reported to the PCRB as individual Transactional records, and summarized Paid-To-Date totals reported as Quarterly records. Indemnity payments (refer to the PCRB’s Statistical Plan Manual for rules regarding what is included in the indemnity loss) are defined as payments made for items such as:

• Temporary total or partial losses
• Scheduled or unscheduled permanent partial losses
• Disfigurement
• Vocational rehabilitation
• Death and burial expenses
• Claimant attorney
• Employer’s Liability

Refer to PCRB’s Statistical Plan Manual for rules regarding losses and expenses included in the indemnity loss.

1. Claims Included in the Indemnity Data Call
   1. The Indemnity Data Call applies to direct workers compensation, voluntary compensation, and employers liability indemnity claims where the claim’s jurisdiction state is Pennsylvania or federal act (Jurisdiction State Code 59). Therefore, medical-only claims and claims where the jurisdiction state is not Pennsylvania or federal act (Jurisdiction State Code 59) are not included in the Indemnity Data Call for Pennsylvania.
   2. Regarding reinsurance, do not submit claim data for assumed policies (e.g., exclude losses paid to other carriers on account of reinsurance assumed by the data provider). No deductions should be made by the data provider for losses recovered from other data providers due to ceded reinsurance.
   3. In addition, Indemnity data should not be reported for the following types of policies:
      • Employers liability insurance on residence and farm employees provided in conjunction with other liability insurance
      • Workers compensation on domestic workers provided in conjunction with homeowners insurance
      • Policies providing coverage under the National Defense Projects Rating Plan
      • Policies providing coverage on Nuclear Regulatory Commission projects
      • Policies providing excess coverage
2. Claims Not Included in the Indemnity Data Call
   1. The Indemnity Data Call does not apply to the following claim or claim reporting scenarios:
      • Medical-only claims
      • Claims where the jurisdiction state is not Pennsylvania or federal act (Jurisdiction State Code 59)
      • Claims that are later determined to be noncompensable or fraudulent as defined by NCCI’s Statistical Plan, Part 4—Loss and Expense Information, Item A-1-c (Fraudulent Claims) and Item A-1-d (Noncompensable Claims)
      • Reinsurance claims—do not submit data for assumed policies (e.g., exclude losses paid to other carriers on account of reinsurance assumed by the data provider). No deductions should be made by the data provider for losses recovered from other data providers due to ceded reinsurance.
      • Indemnity data for the following types of policies:
      • Employers liability insurance on residence and farm employees provided in conjunction with other liability insurance
      • Workers compensation on domestic workers provided in conjunction with homeowners insurance
      • Policies providing coverage under the National Defense Projects Rating Plan
      • Policies providing coverage on Nuclear Regulatory Commission projects
      • Policies providing excess coverage

This manual contains copyrighted material of National Council on Compensation Insurance, Inc. (NCCI), used with permission.

Participation is limited to carrier groups with at least 1% market share in the state of Pennsylvania over the most recent three years (overall average equals 1% or more). Once a carrier group meets the eligibility criteria, the group will be required to report even if the carrier group’s market share drops below the threshold. Participation is re-evaluated every three years. Questions regarding participation/eligibility of a carrier should be addressed to the PCRB.

1. Carrier Group Participation
   1. When a carrier group is included in the Call, all companies that are aligned within that group are required to report under the Call.  The carrier group is identified based on NAIC group code.
2. Reporting Responsibility
   1. Participants in the Call will have the flexibility of meeting their reporting obligation in several ways, including:
      1. Submitting all of their Call data directly to the PCRB
      2. Authorizing their vendor business partners (TPAs, etc.) to report the data directly to PCRB
   2. Regardless of who submits the Call to the PCRB, the data provider must report the standard record layout in its entirety with all data elements populated.  Refer to Section III—Record Layouts section of this manual.
   3. Note: Although data may be provided by an authorized vendor on behalf of a carrier or carrier group, quality and timeliness of the data is the responsibility of the carrier.
3. Mergers and Acquisitions
   1. If a carrier/group is required to report the Call prior to a merger or acquisition, the obligation to continue to report the Call remains.  If a carrier/group that was not previously required to report the Call merges with or becomes acquired by a reporting carrier/group, the acquired carrier/group is required to report the Call as part of that carrier/group. PCRB will provide lead time for the acquired carrier/group to begin reporting the Call.

      Example: Mergers and Acquisition Scenarios

      If. . .	And. . .	Then. . .
      Carrier A currently reports the Call	Merges with Carrier B, that does not report the Call	Carrier A will continue to report the Call; Carrier B will be provided lead time to report the Call
      Carrier A does not currently report the Call	Merges with Carrier B, that currently reports the Call	Carrier B will continue to report the Call; Carrier A will be provided lead time to report the Call
      Carrier A currently reports the Call	Merges with Carrier B, that currently reports the Call	Both Carrier A and Carrier B will continue to report the Call
      Carrier A currently reports the Call as part of reporting Group B	Leaves Group B	Both Carrier A and Group B will continue to report the Call
      Carrier A does not currently report the Call	Merges with Carrier B, that does not currently report the Call	Neither Carrier A nor B reports the Call unless a future participation evaluation deems AB eligible

The Indemnity Data call will begin with indemnity claim activities occurring in Second Quarter 2020. Data will be due by the close of the following quarter.

Transactional Record Reporting Table

For each quarter, the following table displays the Quarter, the corresponding Transaction Date Range, and the Due By Date:

Example: Transactional date range of 01/01-03/31 is due by June 30.

Quarterly Record Reporting Table

For each quarter, the following table displays the Quarter, the corresponding Transaction Date Range, and the Due By Date:

Example: Second quarter claim data is valued as of June 30 and is due by September 30.

The Claim Valuation Date, or the date of valuation, is the date that the values are to be determined for each quarterly record element.

Example: For 2nd Quarter Quarterly records, the Indemnity Paid-To-Date is the sum of all payments made from the inception date of the claim up to, and including 06/30. If the Indemnity Paid-To-Date is $25,000 on 06/30, and $25,500 on 07/01, then the Indemnity Paid-To-Date field should be $25,000, regardless of the date when you create the Quarterly record.

Indemnity Data Call transactions are to be submitted electronically to the PCRB through Compensation Data Exchange (CDX) or through Indemnity Data Manager. Instructions on this can be found in our Electronic Submission Guidelines on our website.

CDX provides a common platform for insurance carriers and data collection organizations (CDX Members) to exchange data that conforms to the industry approved WCIO format. The use of CDX for the submission or retrieval of data and to provide access to other services or products is subject to availability and the terms and conditions of use established by CDX or individual DCOs. These guidelines may be accessed through the CDX web site at www.cdxworkcomp.org. CDX disclaims all liability, direct or implied, and all damages, whether direct, incidental, or punitive, arising from the use or misuse of the CDX site or services by any person or entity.

Before data providers can send Indemnity Data Call production files using CDX, a completed Insurer User Management Group (UMG) Primary Administrator Application for each carrier/group must be on file, and each submitter’s electronic data submissions must pass Certification Testing.  Refer to the Insurer User Management Group (UMG) Primary Administrator Application section of this manual for details and the Appendix of this manual for a copy of the digital (online) form.

If a carrier group has already established an UMG primary administrator and currently submits policy data, unit statistical data or medical data to the PCRB via CDX, a carrier does not need to submit an additional application to submit Indemnity Data Call transactions.

Each applicant is required to designate an Insurer User Management Group (UMG) Primary Administrator for the entire Group.  The UMG primary administrator shall be solely responsible for the following activities: (a) establishing, controlling, and maintaining Applicant’s access to CDX and its products and services; (b) creating and maintaining accounts for the Applicant; (c) establishing and maintaining all Carrier User account levels; and (d) assessing and responding to all security issues and breaches.

For instructions on creating an Insurer User Management Group Primary Administrator, please visit www.cdxworkcomp.org to fill out and submit an application.

It is expected that 100% of indemnity transactions from workers compensation claims in the state of Pennsylvania will be reported in the Indemnity Data Call.  The PCRB does recognize that in certain limited circumstances this can be very difficult, if not impossible, for participants (carrier groups) to comply with reporting 100% of the expected claims data.

Accordingly, a carrier group participating in the Call may exclude data for claims that represent up to 15% of gross premium (direct premium gross of deductibles) for the state of Pennsylvania from its reporting requirement. This option may be utilized for small subsidiaries and/or business segments (e.g., coverage providers, branches, TPAs) where it may be more difficult for these entities to establish the required reporting infrastructure.  The exclusion option must be based on a business segment, not claim type or characteristics. All requests for such exclusions must be presented to the PCRB for acceptance.  Refer to Requests for Business Exclusion in this section.

The 15% exclusion does not apply to selection by:

• Policy types (e.g., large deductible policies)
• Claim characteristics such as claim status (e.g., open, closed)
• Claim types such as specific injury types (death, permanent total disability, etc.)

PCRB will annually review previously filed exclusion requests to determine if a reexamination is warranted based upon changes in market share.  Additionally, business exclusions will be reviewed when participation/eligibility is re-evaluated.

Once a claim has been reported under the Call, all data pertaining to the Indemnity Data Call must be reported according to the reporting requirements of the Call.

Example: The need to exercise the Business Exclusion Option

A carrier group has a TPA that does not process indemnity payments electronically. The premium associated with this TPA represents less than 15% of the participant’s gross premium. The carrier group may request to exclude the TPA’s transactions from Call reporting.

Note: If a participant has unique circumstances that cannot be accounted for within the exclusion option, contact the PCRB’s Indemnity Data Reporting Department to submit documentation describing these circumstances. The PCRB will address these situations on a case-by-case basis.

1. Requests for Business Exclusion
   1. Participants in the Call are required to submit their basis for exclusion to the PCRB for review
   2. All exclusion requests must include the following documentation:
      1. The nature of what data is to be excluded (e.g., any vendors or entities).
      2. An explanation as to why you are requesting the exclusion.
      3. Output used to demonstrate that the excluded segment(s) will be less than 15% of gross Refer to Method of Determining Gross Premium for Business Exclusion in this section of the manual for an example of premium determination.
      4. Contact information for the individual responsible for the review documentation.
2. Methods of Determining Gross Premium for Business Exclusion
   1. The measurement of the 15% business exclusion is based on direct workers compensation premiums, gross of deductibles. The measurement should be made across the states where the Indemnity Data Call applies. Below are four methods for estimating the proportion of business excluded; any of these four are acceptable to the PCRB.
   2. Below are four methods of determining gross premium for business exclusion which are considered acceptable to PCRB. Some methods use the NAIC Direct Premium, which is reported in the Exhibit of Premium and Losses (Statutory Page 14) in the NAIC Annual Statement. This premium can either be written or earned premium, whichever is more convenient, and is net of deductibles.
      1. Method 1—Carriers with Large Deductible Direct Premium less than 0.3% of their total premium (NAIC Direct Premiums) may determine their estimated exclusion using Direct Premium, without adjustment. The information to be submitted to the PCRB for review must include the premium for the excluded entities in each applicable state(s) in comparison to the carrier’s total premium in the state(s).
         1. A participant with Large Deductible Direct Premium less than 0.3% of its total needs to exclude business for two small subsidiaries. The participant determines the exclusion on January 1, 2020, utilizing Direct Written Premium to determine the percentage of excluded premium.

         2. Column A	Column B	Column C	Column D
            Entities for Proposed Exclusion	Entities’ Calendar Year Written Premium	Carrier Group Calendar Year Written Premium	Entities’ Written Premium as % of Carrier Group
            			(Col. B/Col. C)
            Subsidiary #1	$1,500,000
            Subsidiary #2	$2,000,000
            TOTAL	$3,500,000	$357,500,000	1.00%

         3. The following steps are performed to determine whether the proposed exclusions are less than 15% of the total gross written premium.
            1. Based on premium data that it maintains, the carrier group determines the Calendar Year Direct Premiums Written in Pennsylvania or Federal Act for each subsidiary to be excluded. It enters the information in Column B.
            2. Add up the data in Column B to get the Pennsylvania premium proposed to be excluded.
            3. Determine the 2018 Calendar Year Direct Premiums Written in Pennsylvania—the participant finds this information on Schedule T of its 2018 NAIC Annual Statement (due on April 1, 2019). This information is entered on the Total line in Column C.
            4. Calculate percentages for Column D (equals Column B divided by Column C).
            5. Compare the Total line percentage to the 15% requirement. In this case the proposed exclusion is less than 15% so it is allowable.
         4. Refer to Appendix of this manual for Premium Verification Worksheet and Instructions – Method and submission instructions.
      2. Method 2—Carrier Groups with Large Deductible Direct Premium greater than 0.3% of their total premium (NAIC Direct Premiums) may use the table Large Deductible Net to Gross Ratio, included in this section, to determine their estimated exclusion using Direct Premium.
         1. Determine the Large Deductible Net Ratio by calculating the ratio of excluded Large Deductible Direct Premium to total Direct Premium for Pennsylvania. Use this net ratio to look up the gross ratio using the Large Deductible Net to Gross Ratio table below. Calculate the ratio of excluded non-Large Deductible Direct Premium to total Direct Premium. Add the corresponding Gross Ratio found in the table to the ratio of excluded non-Large Deductible Direct Premium (if any) to determine the percentage of excluded Direct Premium.

         2. Large Deductible Net to Gross Ratio
            Net Ratio	Gross Ratio
            0.00%	0.00%
            0.10%	0.50%
            0.20%	1.00%
            0.30%	1.50%
            0.40%	2.00%
            0.50%	2.50%
            0.60%	2.90%
            0.70%	3.40%
            0.80%	3.90%
            0.90%	4.30%
            1.00%	4.80%
            1.10%	5.30%
            1.20%	5.70%
            1.30%	6.20%
            1.40%	6.60%
            1.50%	7.10%
            1.60%	7.50%
            1.70%	8.00%
            1.80%	8.40%
            1.90%	8.80%
            2.00%	9.30%
            2.10%	9.70%
            2.20%	10.10%
            2.30%	10.50%
            2.40%	10.90%
            2.50%	11.40%
            2.60%	11.80%
            2.70%	12.20%
            2.80%	12.60%
            2.90%	13.00%
            3.00%	13.40%
            3.10%	13.80%
            3.20%	14.20%
            3.30%	14.60%
            3.40%	15.00%
            3.50%	15.40%

         3. Example: Premium Determination—Method 2
            1. A participant with Large Deductible Direct Premium greater than 0.3% of its total must exclude one of its data providers. The participant had the following premium values:
               1. Total Direct Premium in Pennsylvania is $1,000,000
               2. Large Deductible Direct Premium to be excluded for Pennsylvania is $20,000
               3. Non-Large Deductible Direct Premium to be excluded for Pennsylvania is $40,000
         4. The following steps are performed to determine whether the proposed exclusion is less than 15% of the total gross written premium:
            1. Calculate the Large Deductible Net Ratio—$20,000 (Large Deductible Direct Premium to be excluded) divided by $1,000,000 (Total Direct Premium), multiplied by 100 equals a Large Deductible Net Ratio of 2.0% ($20,000 / $1,000,000 x 100 = 2.0%)
            2. Use the Large Deductible Net Ratio of 2.0% and the table to determine the corresponding gross ratio of 9.3%
            3. Calculate the excluded Non-Large Deductible Ratio–$40,000 (non-Large Deductible Direct Premium to be excluded) divided by $1,000,000 (Total Direct Premium), multiplied by 100 equals an excluded non-Large Deductible ratio of 4.0% ($40,000 / $1,000,000 x 100 = 4.0%)
            4. Determine the percentage of excluded premium—4.0% (excluded non-Large Deductible ratio) added to 9.3% (Large Deductible gross ratio) equals excluded premium of 13.3% (4.0% + 3% = 13.3%)
            5. Compare the excluded premium percentage to the 15% requirement; in this case, the proposed exclusion is less than 15%, so it is allowable
         5. Refer to Appendix of this manual for Premium Verification Worksheet and Instructions – Method and submission instructions.
      3. Method 3—This is another option for carrier groups with Large Deductible Direct Premium greater than 0.3% of their total premium (NAIC Direct Premiums) is to use the following Gross Premium Estimation Worksheet.
         1. Fill in items A, B, C, and D, and use the formulas to complete the worksheet. Only include premium from Pennsylvania.

         2. Premium Verification Worksheet—Method 3
            Item	Description	Formula	Amount
            	NAIC Direct Written Premium:
            A	Total including Large Deductible
            B	Large Deductible
            C	Large Deductible to be excluded
            D	Non-Large Deductible to be excluded
            	Estimated Gross Premium:
            E	Large Deductible to be excluded	5 times C (5 x C)
            F	Total Excluded	Sum of D and E (D + E)
            G	Add-on for Large Deductible business	4 times B (4 x B)
            H	Estimated Total	Sum of A and G (A + G)
            I	Ratio	F divided by H (F / H)

         3. Example: Premium Determination—Method 3
            1. A participant with Large Deductible Direct Premium greater than 0.3% of its total must exclude one of its data providers. The participant has the following premium values:
               1. Total Direct Premium including Large Deductible for Pennsylvania is $1,000,000
               2. Large Deductible Direct Premium for Pennsylvania is $300,000
               3. Large Deductible Direct Premium to be excluded for Pennsylvania is $20,000
               4. Non-Large Deductible Direct Premium to be excluded for Pennsylvania is $40,000

               5. Premium Verification Worksheet—Method 3
                  Item	Description	Formula	Amount
                  	NAIC Direct Written Premium:
                  A	Total including Large Deductible		$1,000,000
                  B	Large Deductible		300,000
                  C	Large Deductible to be excluded		20,000
                  D	Non-Large Deductible to be excluded		40,000
                  	Estimated Gross Premium:
                  E	Large Deductible to be excluded	5 times C (5 x C)	100,000
                  F	Total Excluded	Sum of D and E (D + E)	140,000
                  G	Add-on for Large Deductible business	4 times B (4 x B)	1,200,000
                  H	Estimated Total	Sum of A and G (A + G)	$2,200,000
                  I	Ratio	F divided by H (F / H)	6.40%

            2. The following steps are performed to determine whether the proposed exclusions are less than 15% of the total gross written premium:
               1. From its records, the carrier group determines its Direct Written Premium for all Large Deductible policies, excluded Large Deductible policies, excluded non-Large Deductible policies, and the total for all policies including Large Deductibles
               2. Input these values into the Amount column of the applicable row (Items A through D) of the Premium Verification Worksheet
               3. Calculate Items E through I of the Premium Verification Worksheet
               4. Compare the excluded premium percentage (Item I) to the 15% requirement; in this case, the proposed exclusion is less than 15%, so it is allowable
            3. Refer to Appendix of this manual for Premium Verification Worksheet and Instructions – Method 3 and submission instructions.
      4. Method 4—Use the gross (of deductible) premium in Unit Statistical Plan data (reported in the Premium Amount field of the Exposure Record). Calculate the ratio of total gross premium on business to be excluded to total gross premium on all business and compare the excluded premium percentage to the 15% requirement. Only include premium from the state of Pennsylvania or Federal Act.
         1. Example: Premium Determination—Method 4
            1. A participant needs to exclude business for two subsidiaries that represent 1% of total gross premium. The participant determines the exclusion on July 1, 2018, utilizing gross premium to determine the percentage of excluded premium.

            2. Column A	Column B	Column C	Column D
               Entities for Proposed Exclusion	Entities’ Gross Premium	Affiliate Group	Entities’ Gross Premium as % of Affiliate Group
               		Gross Premium	(Col. B / Col. C)
               Subsidiary #1	$1,500,000
               Subsidiary #2	$2,000,000
               TOTAL	$3,500,000	$357,500,000	1.00%

            3. The following steps are performed to determine whether the proposed exclusions are less than 15% of the total gross written premium:
               1. Based on premium data that it maintains, the affiliate group determines the gross premiums for Pennsylvania or Federal Act for each subsidiary to be excluded. It enters the information in Column B.
               2. Add up the data in Column B to get the premium proposed to be excluded.
               3. Determine the 2017 workers compensation gross premiums for the entire affiliate group for Pennsylvania or Federal Act.  This information is entered on the Total line in Column C.
               4. Calculate the percentage for Column D (equals Column B divided by Column C).
               5. Compare the Total line percentage to the 15% requirement.  In this case, the proposed exclusion is less than 15%, so it is allowable.
            4. Refer to Appendix of this manual for Premium Verification Worksheet and Instructions – Method 4 and submission instructions.
      5. Other Premium Determination Methods
         1. Contact the PCRB for guidance if the methods described in this section are not appropriate for determining the exclusion percentage. The methods are not appropriate if they do not closely approximate prospective premium distribution in the current calendar year (e.g., a significant shift has occurred in a participant’s book(s) of business since the last NAIC reporting; or the participant writes a significant number of large deductible policies).
      6. Business Exclusion Request Form
         1. An example of the Business Exclusion Request Form is provided in the Appendix of this manual.