TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER vv: INSURANCE COST CONTAINMENT
PART 4203 INSURANCE DATA REPORTING REQUIREMENTS
SECTION 4203.70 CODING CONVENTIONS FOR OTHER LIABILITY/EXCESS INSURANCE, MEDICAL MALPRACTICE, EARTHQUAKE, COMMERCIAL AUTO LIABILITY, AND BUSINESS OWNERS PACKAGES


 

Section 4203.70  Coding Conventions for Other Liability/Excess Insurance, Medical Malpractice, Earthquake, Commercial Auto Liability, and Business Owners Packages

 

This Section provides instructions for coding the fields for other liability, medical malpractice, earthquake, commercial auto liability, and business owners packages (BOP).  The following provides a detailed description of each data field:

 

a)         FEIN – This alpha-numeric field reflects the Federal Employer Identification Number assigned to the insurer.  (Do not include the hyphen; for example 555555555.)

 

b)         Filing Method – This one-character alpha-numeric field identifies the source of the data as either an agent or an insurance company.  Possible codes are:

 

1

=

American Association of Insurance Services (AAIS)

2

=

Insurance Services Office, Inc. (ISO)

3

=

Property Casualty Insurers Association of America (PCI)

4

=

National Independent Statistical Service (NISS)

5

=

Company Direct – Partial

6

=

Company Direct – 100 Percent

7

=

Other

 

c)         Line of Business – This alpha-numeric field identifies the line or general classification to which the data belongs.  Possible codes are:

 

05.0

=

BOP (Business Owners Package)

11.0

=

Medical Malpractice

12.0

=

Earthquake

17.0

=

Other/Excess Liability

19.4

=

Commercial Auto Liability

 

d)         State Identifier – This field identifies the geographical source of the data.  Possible codes are:

 

12

=

Illinois only

MS

=

Multi-state

 

e)         Class Code – The data call requires specific data for each Type of Insurance and class code identified below.

 

05.0 = BOP (Business Owners Package)

 

77777

=

Business Owners Package (BOP)

 

Other

 

OTHR

=

All other coverage contained in line 05.1 and 05.2

 

11.0 = Medical Malpractice

 

Cardiac – Other

 

80281

=

cardiovascular disease – minor surgery by MD

84281

=

cardiovascular disease – minor surgery by DO

80255

=

cardiovascular disease – no surgery by MD

84255

=

cardiovascular disease – no surgery by DO

 

Cardiac – Surgery

 

80141

=

surgery – cardiac by MD

80150

=

surgery – cardiovascular disease by MD

84150

=

surgery – cardiovascular disease by DO

 

Critical Care Medicine

 

80283

=

intensive care medicine – applies to any general practitioner or specialist employed in intensive care hospital unit by MD

84283

=

intensive care medicine – applies to any general practitioner or specialist employed in intensive care hospital unit by DO

 

Dentists

 

80210

=

Oral surgery with anesthesia

80211

=

Oral surgery without anesthesia

 

Emergency Room – Other

 

80102

=

emergency room – no major surgery by MD

84102

=

emergency room – no major surgery by DO

 

Emergency Room – Surgery

 

80157

=

emergency medicine – including major surgery by MD

84157

=

emergency medicine – including major surgery by DO

 

General Surgery

 

80143

=

surgery – general – not otherwise classified. Does not apply to family or general practitioner or to any specialist who occasionally performs major surgery by MD

84143

=

surgery – general – not otherwise classified. Does not apply to family or general practitioner or to any specialist who occasionally performs major surgery by DO

 

Neurosurgery

 

80152

=

surgery – neurology – including child by MD

84152

=

surgery – neurology – including child by DO

80288

=

neurology – including child – minor surgery by MD

84288

=

neurology – including child – minor surgery by DO

 

Obstetrics/Gynecology – Other

 

80277

=

gynecology – minor surgery by MD

84277

=

gynecology – minor surgery by DO

80244

=

gynecology – no surgery by MD

84244

=

gynecology – no surgery by DO

 

Obstetrics/Gynecology – Surgery

 

80167

=

surgery – gynecology by MD

84167

=

surgery – gynecology by DO

80168

=

surgery – obstetrics by MD

80153

=

surgery – obstetrics – gynecology by MD

84153

=

surgery – obstetrics – gynecology by DO

 

Orthopedic Surgery

 

80154

=

surgery – orthopedic by MD

84154

=

surgery – orthopedic by DO

 

Physicians and Surgeons

 

80420

=

family physician or general practitioner – no surgery by MD

84420

=

family physician or general practitioner – no surgery by DO

80421

=

family physician or general practitioner – minor surgery by MD

84421

=

family physician or general practitioner – minor surgery by DO

80117

=

surgery – general practice or family practice by MD

 

Physicians, Surgeons, and Dentists

 

94999

=

physicians, surgeons, and dentists classes not specifically listed

90430

=

physicians, surgeons, and dentists individual insurer programs not rated using one of the exposure bases noted above

 

Plastic Surgery

 

80156

=

surgery – plastic – not otherwise classified by MD

84156

=

surgery – plastic – not otherwise classified by DO

80155

=

surgery – plastic – otorhinolaryngology by MD

84155

=

surgery – plastic – otorhinolaryngology by DO

 

Vascular Surgery

 

80146

=

surgery – vascular by MD

80144

=

surgery – thoracic by MD

84144

=

surgery – thoracic by DO

 

OTHER  

 

OTHR

=

All other coverage contained in line 11.0

 

12.0 = Earthquake

 

•           REQ    =          Residential Earthquake

•           OTHR =          All other coverage contained in line 12.0

 

17.0 = Other Liability

 

Day care

 

82115

=

day care center liability – day nurseries

41714

=

day care center liability – day care centers

81714

=

day care center liability individual insurance not rated using one of the exposure bases noted above.

 

Lawyer

 

81400

=

lawyers professional liability – lawyers

81420

=

lawyers professional liability – employed law clerks, investigators, abstractors and paralegals

81401

=

lawyers professional liability individual insurance not rated using one of the exposure bases noted above.

 

Liquor

 

70412

=

clubs

59211

=

package stores and other retail establishments

50911

=

manufacturers, wholesalers, and distributors

58161

=

restaurants, taverns, hotels, motels including package sales

58168

=

temporary licenses

58169

=

owners or lessors of premises used by others

11111

=

liquor liability – not otherwise classified

81111

=

liquor liability individual insurer programs not rated using one of the exposure bases noted above.1

 

Excess Coverage

 

9772

=

commercial auto

99930

=

personnel umbrella

99935

=

commercial umbrella

88888

=

excess insurance – all other

 

Other

 

•           OTHR =          All other coverage contained in line 17.1 and 17.2

 

19.4 = Commercial Auto Liability  

 

1A

=

fleet and non-fleet combined trucks, tractors, and trailers – zone rated (car-months (BI))

1B

=

fleet and non-fleet combined trucks, tractors, and trailers – zone rated (receipts)

1C

=

fleet and non-fleet combined trucks, tractors, and trailers – zone rated (number of miles)

2A

=

fleet and non-fleet combined trucks, tractors, and trailers – all other, regardless of miles (car-months (BI))

3A

=

fleet and non-fleet taxicabs, and public livery, regardless of mileage, including limousines (car-months (BI))

3B

=

fleet and non-fleet taxicabs, and public livery, regardless of mileage, including limousines (receipts)

3C

=

fleet and non-fleet taxicabs, and public livery, regardless of mileage, including limousines (number of miles)

OTHR

=

All other coverage contained in line 19.4

 

f)         Statistical Data Year – This four-character alpha-numeric field reflects the experience year.  (For example, for the November 2017 annual data filing, the statistical data year will be coded 2016.) 

 

g)         Field Not Currently Used

 

h)         Form Type – This alpha-numeric field reflects the form type that was used in providing coverage.  The insurer will report a separate record for each form type for each class and geographic location (Illinois-only or multi-state).  Possible codes are:

 

C

=

claims-made

O

=

occurrence

T

=

claims-made tail coverage

 

i)          Amount of Written Premium – This field reflects the amount of total written premiums corresponding to each of the class codes.

 

j)          Amount of Earned Premium – This field reflects the total amount of earned premiums corresponding to each of the class codes.

 

k)         Amount of Paid Losses – This field reflects the amount of paid losses corresponding to each of the class codes.  Please see Section 4203.30(g) for the definition of paid losses.  If the insurer is unable to separate paid losses from ALAE, the insurer will follow the instructions provided in Section 4203.30(h).

 

l)          Amount of Outstanding Losses – This field reflects the amount of outstanding losses corresponding to each of the class codes.  Please see Section 4203.30(g) for the definition of outstanding losses and Section 4203.30(h) for special instructions for those situations where separating outstanding losses and outstanding ALAE are not possible.

 

m)        Amount of Paid ALAE – This field reflects the amount of paid ALAE for each of the class codes.  If an insurer is unable to separate paid ALAE from the paid losses, the combined paid losses and paid ALAE will be reported in the paid losses field for the line and the code "combined" will appear in the paid ALAE field.  For the earthquake data, the amount of paid ALAE field should be blank.

 

n)         Amount of Outstanding ALAE – This field reflects the amount of outstanding allocated loss adjustment expenses for each of the class codes.  If an insurer is unable to separate outstanding ALAE from the outstanding losses, the combined outstanding losses and outstanding ALAE will be reported in the outstanding losses field for the line and the code "combined" will appear in the ALAE field.  For the earthquake data, the amount of outstanding ALAE field should be blank.

 

o)         Number of Written Exposures – This field reflects the count of written exposures for each of the class codes.  The field "number of exposures" for BOP, earthquake, and excess insurance will be left blank.

 

p)         Number of Paid Claims – This field reflects the paid claims count corresponding to each of the class codes.  Please see Section 4203.30(i) for the definition of paid claims.

 

q)         Number of Outstanding Claims – This field reflects the outstanding claims count corresponding to each of the class codes.  Please see Section 4203.30(j) for the definition of outstanding claims.

 

(Source:  Amended at 42 Ill. Reg. 20370, effective November 1, 2018)