Section 928.EXHIBIT D Illinois Medical Professional Liability Insurance Uniform Claims Reporting (IMPLIUCR) – Batch Reporting Requirements and Navigational User's Guide

State of Illinois

Department of Financial and Professional Regulation

Division of Insurance

May 2006

Illinois Medical Professional Liability Insurance Uniform Claims Reporting (IMPLIUCR)

Batch Requirements and Navigational User's Guide

To assist insurers and other reporting entities with electronic reporting, the Illinois Department of Financial and Professional Regulation-Division of Insurance (DOI) has created an electronic reporting application, which will be provided free of charge. Reporting entities will choose one of the two processes depending on how they prefer to file. One process will allow for data entry claim reporting and contain drop downs with choices. The other process will allow for batch reporting. This is the navigational user's guide for batch reporting.

Table of Contents:		Page

1.	General Submission Guidelines.................................................................................	3
2.	Quarterly Claim Report Submission Data Field Names and Record Format...............	6
3.	IMPLIUCR Automated Application Processes (Navigational) Application Start Up Instructions and System Menu..................................................................................	9
	Import of Industry Claim Report File & Validation Process.......................................	10
4.	Diskette Labeling and Mailing Instructions.................................................................	14

General Submission Guidelines

1) Data Collection Information

a) Data must be submitted on 3½" size diskette or compact disk (CD-R/RW).

b) Disks must conform to the filing specifications contained within this document.

2) Guidelines for Data Collection

a) Submission of data files must meet the filing specifications prescribed in this document.

b) DOI has created an electronic reporting application to help reporting entities enter and edit data and to create the quarterly claims report data file.

To access the on-line user guides for the electronic reporting applications, you must download Adobe Acrobat Reader software from URL: http://www.adobe.com/products/acrobat/main.html to access the on-line user guides.

c) If you have not received a copy of the electronic reporting application, you can download the software from the following URL: http://www.ins.state.il.us/exe/IMPLIUCRzip.exe

3) Data Format Standards

To simplify aspects of the data collection process for the DOI, data and file formats for diskettes will consist of a delimited common ASCII representation.

4) File Description and Reporting Requirements (edit program process).

DOI has adopted the following specifications to be used in formatting the claims report data file information prior to using the "edit program".

Tab or Comma delimited file:

· File one report for each defendant you insure.

· Include claims closed without payment.

· When an item calls for a dollar amount and no amount is involved, enter 0 in the space.

· Record all amounts in whole dollars.

· All dates shall be in the format MM/DD/YYYY and have leading zeroes.

Example: 01/01/2001 = January 1, 2001

· All names of individuals shall follow the following format:

Last Name Suffix, First Name MI. (e.g., Public Jr, John Q.)

· Insured Individual's name format:

Last Name Suffix, First Name MI. Professional Designation (e.g., Public Jr, John Q. MD)

· All fields for a given record, including fields that contain no data, shall have a Tab or Comma with a "full quote" text qualifier separator. There are a total of 75 fields that must be accounted for in each record (report).

General Submission Guidelines

Each of the following fields must have a Tab or Comma separator:

1)	Insurer Name,	39)	Person Responsible Title,
2)	Insurer FEIN,	40)	Contact Person Name,
3)	Claim ID,	41)	Contact Person Phone,
4)	Coverage Code,	42)	Contact Person Email Address,
5)	Injury Date,	43)	Attorney Name,
6)	Reported Date,	44)	Attorney City,
7)	Opened Date,	45)	Attorney State,
8)	Re-opened Date,	46)	Nature and Substance of Claim,
9)	Original Closure Date,	47)	Act or Omission Codes,
10)	Original Claim ID*,	48)	Severity of Injury Code,
11)	Insured Profession or Business Code,	49)	Date Claim Closed,
12)	Insured Profession Description,	50)	Disposition Code,
13)	Insured Practice Code,	51)	Settlement Code,
14)	Insured Name,	52)	Review Panel or Non-Binding
15)	Insured IL License Number,		Arbitration Code,
16)	Insured DOB,	53)	Binding Arbitration Code,
17)	Insured Specialty Code,	54)	Court Code,
18)	Insured Board Certified,	55)	Court County,
19)	Name of Board,	56)	Court Docket Number,
20)	Insured County,	57)	Amount Awarded by Circuit Court,
21)	Injury Place Code,	58)	Award Date,
22)	Injury Place Description,	59)	Circuit Court Appealed,
23)	Injury Place Location within	60)	Result of Appeal,
	Institution Code,	61)	Other Post-Trial Motions,
24)	Injury Place Location in	62)	Court Economic Damages Awarded,
	Institution Description,	63)	Court Non-Economic Damages
25)	Injury Place Institution Name,		Award,
26)	Injury Place County,	64)	Total Indemnity Paid/Payable by
27)	Injured Name,		Insurer,
28)	Injured Person's Gender,	65)	Economic Damages,
29)	Injured Person's Age Category,	66)	Non-Economic Damages,
30)	Injured Person's SSN,	67)	LAE to Defense Counsel,
31)	Injured Person's County Residence,	68)	All Other LAE,
32)	Total Number Defendants,	69)	Total Indemnity Insurer,
33)	Companion Claim ID A,	70)	Other Indemnity Deductible,
34)	Companion Claim ID B,	71)	Other Indemnity Excess Limits,
35)	Companion Claim ID C,	72)	Other Indemnity SIR,
36)	Companion Claim ID D,	73)	Other Indemnity Stop Loss,
37)	Companion Claim ID E,	74)	Claimed Medical Expense,
38)	Person Responsible,	75)	Claimed Wage Loss,

* If claim re-opened and a new Claim ID was assigned.

Examples using fields 1, 2, 3, 4, 5, 6, 7, 8

Example Tab delimited file:

InsurerName[tab]12-1234567[tab]220BBA[tab]1[tab]01/09/2001[tab]01/09/2001[tab]01/09/2001[tab]01/09/2001[tab] etc …

Example Comma delimited (with a "full quote" text qualifier) file:

"InsurerName","12-1234567","220BBA","1","01/09/2001","01/09/2001","01/09/2001","01/09/2001" etc …

5) Disk types

Disks submitted to the DOI shall be the 3½" size or Compact Disk (CD-R/RW) from an

IBM Personal computer or compatible. Disks will not be returned.

6) Computer Disk File Structures and Naming Conventions

Each disk submitted shall contain a physical file for Uniform Claims Reports.

A disk file name will be made up of two portions, a data name and an extension.

The extension name will always be "txt". The file name of each file on the diskette will be:

DOI-IMPLIUCR and the Quarter and year being filed

Example with additional information: DOI-IMPLIUCR-1stQtr2004.txt

NOTE: The submission file on the disk will be created for you by the IMPLIUCR.MDE application.

7) TO BEGIN: Load the application (see installation instructions). Then import the claims data file Open/ClosedClaimsData.txt) you created. Use the "Validate Batch File of IMPLI Uniform Claims Reports" button on the IMPLIUCR application's main menu to import and validate your data.

Quarterly Claim Report Submission – Data Field Names and Report Format

For Field/Data Definitions and Requirements see Exhibit B of this Part.

Company FEIN and Claim ID (Key Fields) are combined to make a unique claim report.

RI = Reporting Instructions numbering system reference.

Pos/RI	Column Name	Type	Maximum Size

1/1a	Insurer Name	Text	50
2/1b	Insurer FEIN	Text	11
3/2a	Claim ID	Text	35
4/2b	Coverage Code	Text	2
5/2c	Injury Date	Text	10
6/2d	Reported Date	Text	10
7/2e	Opened Date	Text	10
8/2f	Re-opened Date	Text	10
9/2g	Original Closure Date	Text	10
10	Original Claim ID*	Text	35
11/3a	Insured Profession or Business Code	Text	37
12/3a	Insured Profession Description	Text	30
13/3b	Insured Practice Code	Text	2
14/3c	Insured Name	Text	64
	Format: "Last Suffix, First MI. Profession"
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
	Professional Designation (e.g., MD)	Text	4
15/3d	Insured License Number	Text	15
16/3e	Insured DOB	Text	10
17/3f	Insured Specialty Code	Text	5
18/3g	Insured Board Certified	Text	2
19/3g	Name of Board	Text	25
20/3h	Insured County	Text	30
21/4a	Injury Place	Text	59
22/4a	Injury Place Description	Text	30
23/4b	Injury Place Location within Institution Code Text	Text	2
24/4b	Injury Place Location in Institution Description Text	Text	25
25/4c	Injury Place Institution Name	Text	40
26/4d	Injury Place County	Text	30
27/5a	Injured Name	Text	59
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
28/5b	Injured Gender	Text	1
29/5c	Injured Person's Age Category	Text	1
30/5d	Injured Person's SSN	Text	11
31/5e	Injured Person's County Residence	Text	30
32/6a	Total Number Defendants	Text	4
33/6b	Companion Claim ID A	Text	35
34/6b	Companion Claim ID B	Text	35
35/6b	Companion Claim ID C	Text	35
36/6b	Companion Claim ID D	Text	35
37/6b	Companion Claim ID E	Text	35
38/7a	Person Responsible	Text	64
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
39/7b	Person Responsible Title	Text	30
40/7c	Contact Person	Text	100
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
41/7d	Contact Person Phone	Text	20
42/7e	Contact Person Email Address	Text	40
43/8a	Attorney Name/Law Firm	Text	64
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
44/8b	Attorney City	Text	16
45/8c	Attorney State	Text	2
46/9a	Nature and Substance of Claim	Text	150
47/9b	Act or Omission Codes	Text	255
48/9c	Severity of Injury Code	Text	2
49/9d	Date Claim Closed	Text	10
50/9e	Disposition Code	Text	2
51/9f	Settlement Code	Text	2
52/9g	Review Panel or Non-Binding Arbitration Code	Text	2
53/9h	Binding Arbitration Code	Text