Section 4203.110 Record Layout for the Four Formats

The following table should assist users and data processing personnel in understanding the requirements of this Part. This Section provides the required fields for each line or type of insurance. Special attention should be given to the classes that are reported on a calendar year premium-only basis.

• The calendar year premium-only records for other liability, medical malpractice, earthquake (REQ), BOP, excess insurance, and commercial auto liability will have entries only in Fields 1-10 and 15. Please follow the specific instructions for each of these 11 fields. (Note that insurers that use a calendar year method of annual compilation for reporting earthquake (REQ) or excess insurance classes need not submit calendar year premium-only records for these classes.)

• The calendar year premium-only records for homeowner and residential fire will have entries only in Fields 1-10 and 13. Please follow the specific instructions for each of these 11 fields. (Note that calendar year premium-only records are not required for these lines if insurers use the calendar year method of annual compilation for reporting this data.)

• For the private passenger auto liability line, Fields 1-9, 14, 17, 18, 25, 26, 33, 34, 41, 42, 49, 50, and 51 are to be reported. Please follow the specific instructions for each of these 21 fields.

• Since private passenger auto physical damage is reported on a calendar year basis, no calendar year premium-only records are required.

• Zip code reporting is required for homeowner, residential fire, and private passenger liability for the calendar year premium-only records.

Due to space limitations, the following abbreviations were used in this table:

Wr Prem	=	Written Premium
OS	=	Outstanding
BI	=	Bodily Injury
Med Pay	=	Medical Payments
SL	=	Single Limit
E Prem	=	Earned Premium
ALAE	=	Allocated Loss Adjustment Expenses
PD	=	Property Damage
UM/UIM	=	Uninsured/Underinsured Motorists
Comp	=	Comprehensive
Pd	=	Paid
Coll	=	Collision, Other Liab, Medical

Other Liab, Medical Malpractice, Earthquake (REQ), BOP, Excess Insurance, and Commercial Auto Liab		Homeowners Res Fire	Priv Pass Auto Liability	Priv Pass Auto Physical Damage
1.	FEIN #	FEIN #	FEIN #	FEIN #
2.	Filing Method	Filing Meth	Filing Meth	Filing Meth
3.	Line of Business	Line of Bus	Line of Bus	Line of Bus
4.	State ID	State ID	State ID	State ID
5.	Experience Method	Exp Meth	Exp Meth	Exp Meth
6.	Statistical Data Yr	Stat Data Yr	Stat Data Yr	Stat Data Yr
7.	Classification Code	Zip Code³	Zip Code³	Zip Code³
8.	Form Type¹	Class Code	Amt BI Wr Prem	Amt Comp Wr Prem
9.	Amt of Wr Prem	Amt Wr Prem	Amt BI E Prem	Amt of Comp E Prem
10.	Amt of E Prem	Amt E Prem	Amt BI Pd Loss	Amt of Comp Pd Loss
11.	Amt of Pd Losses	Amt Pd Loss	Amt BI OS Loss	Amt of Comp OS Loss
12.	Amt of OS losses	Amt OS Loss	Amt BI Pd ALAE	Amt of Comp Wr Exp
13.	Amt of Pd ALAE¹	# of Wr Exp	Amt BI OS ALAE	# of Comp Pd Claims
14.	Amt of OS ALAE¹	# Pd Claims	# BI Wr Exp	# of Comp OS Claims
15.	# of Wr Exposures²⁾	# OS Claims	# of BI Pd Claims	Amt of Coll Wr Prem
16.	# of Pd Claims		# of BI OS Claims	Amt of Coll EPrem
17.	# of OS Claims		Amt of PD Wr Prem	Amt of Coll Pd Loss
18.			Amt of PD E Prem	Amt of Coll OS Loss
19.			Amt of PD Pd Loss	# of Coll Pd Claims
20.			Amt of PD OS Loss	# of Coll OS Claims
21.			Amt of PD Pd ALAE	Amt Other Wr Prem
22.			Amt of PD OS ALAE	Amt of Other E Prem
23.			# of PD Pd Claims	Amt of Other Pd Loss
24.			# of PD OS Claims	Amt of Other OS Loss
25.			Amt UM/UIM Wr Prem	# of Other Pd LClaims
26.			Amt UM/UIM E Prem	# of Other OS Claims
27.			Amt UM/UIM Pd Loss
28.			Amt UM/UIM OS Loss
29.			Amt Um/UIM Pd ALAE
30.			Amt UM/UIM OS ALAE
31.			# of UM/UIM Pd Claims
32.			# of UM/UIM OS Claims
33.			Amt of Med Pay Wr Prem
34.			Amt of Med Pay E Prem
35.			Amt of Med Pay Pd Losses
36.			Amt of Med Pay OS Losses
37.			Amt of Med Pay Pd ALAE
38.			Amt of Med Pay OS ALAE
39.			# of Med Pay Pd Claims
40.			# of Med Pay OS Claims
41.			Amt of Other Wr Prem
42.			Amt of Other E Pem
43.			Amt of Other Pd Losses
44.			Amt of Other OS Losses
45.			Amt of Other Pd ALAE
46.			Amt of Other OS ALAE
47.			# of Other Pd Claims
48.			# of Other OS Claims
49.			# of SL Wr Exposures
50.			Amt of SL Wr Prem
51.			Amt of SL E Prem
52.			Amt of BI SL Pd Losses
53.			Amt of BI SL OS Losses
54.			Amt of BI SL Pd ALAE
55.			Amt of BI SL OS ALAE
56.			# of BI SL Pd Claims
57.			# of BI SL OS Claims
58.			Amt of PD SL Pd Losses
59.			Amt of PD SL OS Losses
60.			Amt of PD SL Pd ALAE
61.			Amt of PD SL OS ALAE
62.			# of PD SL Pd Claims
63.			# of PD SL OS Claims

Table:

¹ This field should be left blank for earthquake data.

² This field should be left blank for earthquake, BOP, and excess insurance data.

³ This field should be left blank for multi-state data.

(Source: Amended at 31 Ill. Reg. 2287, effective January 22, 2007)