Section 4203.APPENDIX A Filing Requirements for Medical Malpractice Reporting

General Instructions

● All reports shall include only direct Illinois medical malpractice insurance business.

● Each company must provide a Reconciliation as outlined in these Filing Requirements.

● Sample tables are provided to assist companies in understanding the required data elements. They are provided for illustrative purposes only.

● Reporting will be segregated by policy type. The policy types are as follows:

1) Claims made policy type that includes prior acts coverage

2) Occurrence policy type that includes extended reporting endorsements

● Reporting by claims made policy type will be aggregated by county.

● Illinois counties will be identified in the data submission by a three digit code. The following table lists the names of the 102 Illinois counties and the code designation for each:

County Name	County #
ADAMS	001
ALEXANDER	002
BOND	003
BOONE	004
BROWN	005
BUREAU	006
CALHOUN	007
CARROLL	008
CASS	009
CHAMPAIGN	010
CHRISTIAN	011
CLARK	012
CLAY	013
CLINTON	014
COLES	015
COOK	016
CRAWFORD	017
CUMBERLAND	018
DE KALB	019
DEWITT	020
DOUGLAS	021
DU PAGE	022
EDGAR	023
EDWARDS	024
EFFINGHAM	025
FAYETTE	026
FORD	027
FRANKLIN	028
FULTON	029
GALLATIN	030
GREENE	031
GRUNDY	032
HAMILTON	033
HANCOCK	034
HARDIN	035
HENDERSON	036
HENRY	037
IROQUOIS	038
JACKSON	039
JASPER	040
JEFFERSON	041
JERSEY	042
JO DAVIESS	043
JOHNSON	044
KANE	045
KANKAKEE	046
KENDALL	047
KNOX	048
LAKE	049
LA SALLE	050
LAWRENCE	051
LEE	052
LIVINGSTON	053
LOGAN	054
MCDONOUGH	055
MCHENRY	056
MCLEAN	057
MACON	058
MACOUPIN	059
MADISON	060
MARION	061
MARSHALL	062
MASON	063
MASSAC	064
MENARD	065
MERCER	066
MONROE	067
MONTGOMERY	068
MORGAN	069
MOULTRIE	070
OGLE	071
PEORIA	072
PERRY	073
PIATT	074
PIKE	075
POPE	076
PULASKI	077
PUTNAM	078
RANDOLPH	079
RICHLAND	080
ROCK ISLAND	081
SAINT CLAIR	082
SALINE	083
SANGAMON	084
SCHUYLER	085
SCOTT	086
SHELBY	087
STARK	088
STEPHENSON	089
TAZEWELL	090
UNION	091
VERMILION	092
WABASH	093
WARREN	094
WASHINGTON	095
WAYNE	096
WHITE	097
WHITESIDE	098
WILL	099
WILLIAMSON	100
WINNEBAGO	101
WOODFORD	102
OTHER	103

● For all reports requiring by county information, the company may group the data by policy issuing county or other method that is consistent with its ratemaking practices. The company must identify which method is used. The company must use a consistent method to group the data in all by county reports. Data grouped by territory is unacceptable.

● Reporting by occurrence policy type will be aggregated by state and will include only Illinois data.

● Reports will contain 10 years of information on paid losses, paid allocated loss adjustment expenses, paid claim counts, incurred losses, incurred allocated loss adjustment expenses, incurred claim counts, earned exposures and earned premium, all on a direct reporting basis.

● Provide the name, phone number and email address of the person responsible for filing this report with the Department of Insurance.

● Reports should be submitted via either Excel worksheet or .txt file format. The submission shall be made electronically to the Illinois Department of Insurance.

Company Defined Items

● Describe any changes made to the way in which the data has been grouped during the past 10 years and the impact of the changes on the reports.

● Describe any changes made to reserving or claim payment practices in the past 10 years and the impact of the changes on the reports.

● Explain/define the corporate policies written by the company.

Exhibits − Claims Made Policy Type

● Direct paid losses by county for each of the past 10 report years. For claims made policy type, direct paid losses and direct paid allocated loss adjustment expenses shall be reported separately.

● Direct paid allocated loss adjustment expenses by county for each of the past 10 report years. For claims made policy type, direct paid losses and direct paid allocated loss adjustment expenses shall be reported separately.

● Direct paid claim counts by county for each of the past 10 report years.

● Direct incurred losses by county for each of the past 10 report years. For claims made policy type, direct incurred losses and direct incurred allocated loss adjustment expenses shall be reported separately.

○ Incurred losses equal paid losses plus case reserves.

○ Total incurred losses are required, not just incurred on open claims.

○ An accurate estimate for the claims related to that report year and county is required. Average incurred severities are unacceptable.

● Direct incurred allocated loss adjustment expenses by county for each of the past 10 report years. For claims made policy type, direct incurred losses and direct incurred allocated loss adjustment expenses shall be reported separately.

○ Total incurred allocated loss adjustment expenses are required, not just incurred on open claims.

● Direct incurred claim counts by county for each of the past 10 report years.

● Direct earned exposures by county for each of the past 10 report years.

● Direct earned premium by county for each of the past 10 report years.

Examples of Reports for Claims Made Policy Type:

Paid Losses
	Current Year	1 Year Prior	2 Year Prior	3 Year Prior	4 Year Prior	5 Year Prior	6 Year Prior	7 Year Prior	8 Year Prior	9 Year Prior

County
001	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
002	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
003	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
004	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
005	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
006	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
007	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
…	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$

Paid ALAE
	Current Year	1 Year Prior	2 Year Prior	3 Year Prior	4 Year Prior	5 Year Prior	6 Year Prior	7 Year Prior	8 Year Prior	9 Year Prior
County
001	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
002	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
003	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
004	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
005	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
006	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
007	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
…	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$

Paid Counts
	Current Year	1 Year Prior	2 Year Prior	3 Year Prior	4 Year Prior	5 Year Prior	6 Year Prior	7 Year Prior	8 Year Prior	9 Year Prior

County
001	##	##	##	##	##	##	##	##	##	##
002	##	##	##	##	##	##	##	##	##	##
003	##	##	##	##	##	##	##	##	##	##
004	##	##	##	##	##	##	##	##	##	##
005	##	##	##	##	##	##	##	##	##	##
006	##	##	##	##	##	##	##	##	##	##
007	##	##	##	##	##	##	##	##	##	##
…	##	##	##	##	##	##	##	##	##	##

Incurred Losses
	Current Year	1 Year Prior	2 Year Prior	3 Year Prior	4 Year Prior	5 Year Prior	6 Year Prior	7 Year Prior	8 Year Prior	9 Year Prior

County
001	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
002	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
003	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
004	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
005	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
006	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
007	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
…	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$

Incurred ALAE
	Current Year	1 Year Prior	2 Year Prior	3 Year Prior	4 Year Prior	5 Year Prior	6 Year Prior	7 Year Prior	8 Year Prior	9 Year Prior
County
001	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
002	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
003	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
004	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
005	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
006	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
007	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
…	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$

Incurred Counts
	Current Year	1 Year Prior	2 Year Prior	3 Year Prior	4 Year Prior	5 Year Prior	6 Year Prior	7 Year Prior	8 Year Prior	9 Year Prior

County
001	##	##	##	##	##	##	##	##	##	##
002	##	##	##	##	##	##	##	##	##	##
003	##	##	##	##	##	##	##	##	##	##
004	##	##	##	##	##	##	##	##	##	##
005	##	##	##	##	##	##	##	##	##	##
006	##	##	##	##	##	##	##	##	##	##
007	##	##	##	##	##	##	##	##	##	##
…	##	##	##	##	##	##	##	##	##	##

Earned Exposures
	Current Year	1 Year Prior	2 Year Prior	3 Year Prior	4 Year Prior	5 Year Prior	6 Year Prior	7 Year Prior	8 Year Prior	9 Year Prior

County
001	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
002	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
003	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
004	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
005	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
006	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
007	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
…	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$

Earned Premium
	Current Year	1 Year Prior	2 Year Prior	3 Year Prior	4 Year Prior	5 Year Prior	6 Year Prior	7 Year Prior	8 Year Prior	9 Year Prior

County
001	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
002	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
003	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
004	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
005	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
006	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
007	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
…	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$

Exhibits – Occurrence Policy Type

● Exhibits require information and data pertaining to only Illinois medical malpractice liability business written. This data should be aggregated to state level detail.

● Direct paid losses and allocated loss adjustment expenses for each of the past 10 accident years by evaluation date. For occurrence policy type, direct paid losses and direct paid allocated loss adjustment expenses will be reported together. This data array shall be reported in accordance with NAIC Annual Statement Schedule P Instructions. The difference between a company's Schedule P and this requirement is that this array should contain direct Illinois medical malpractice data.

● Direct paid claim counts for each of the past 10 accident years by evaluation date. This data array shall be reported in accordance with NAIC Annual Statement Schedule P Instructions. The difference between a company's Schedule P and this requirement is that this array should contain direct Illinois medical malpractice data.

● Direct incurred losses and incurred allocated loss adjustment expenses for each of the past 10 accident years by evaluation date. For occurrence type policies, direct incurred losses and incurred allocated loss adjustment expenses shall be reported together. This data array shall be reported in accordance with NAIC Annual Statement Schedule P Instructions. The difference between a company's Schedule P and this requirement is that this array should contain direct Illinois medical malpractice data.

● Direct incurred claim counts for each of the past 10 accident years by evaluation date. This data array shall be reported in accordance with NAIC Annual Statement Schedule P Instructions. The difference between a company's Schedule P and this requirement is that this array should contain direct Illinois medical malpractice data.

● Direct earned exposures by accident year for each of the past 10 years.

● Direct earned premium by accident year for each of the past 10 years.

Examples of Reports for Occurrence Policy Type:

Paid Losses and ALAE
Years in which losses were incurred	9 Year Prior	8 Year Prior	7 Year Prior	6 Year Prior	5 Year Prior	4 Year Prior	3 Year Prior	2 Year Prior	1 Year Prior	Current Year

9 Year Prior	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
8 Year Prior		$$	$$	$$	$$	$$	$$	$$	$$	$$
7 Year Prior			$$	$$	$$	$$	$$	$$	$$	$$
6 Year Prior				$$	$$	$$	$$	$$	$$	$$
5 Year Prior					$$	$$	$$	$$	$$	$$
4 Year Prior						$$	$$	$$	$$	$$
3 Year Prior							$$	$$	$$	$$
2 Year Prior								$$	$$	$$
1 Year Prior									$$	$$
Current Year										$$

Paid Counts
Years in which losses were incurred	9 Year Prior	8 Year Prior	7 Year Prior	6 Year Prior	5 Year Prior	4 Year Prior	3 Year Prior	2 Year Prior	1 Year Prior	Current Year

9 Year Prior	##	##	##	##	##	##	##	##	##	##
8 Year Prior		##	##	##	##	##	##	##	##	##
7 Year Prior			##	##	##	##	##	##	##	##
6 Year Prior				##	##	##	##	##	##	##
5 Year Prior					##	##	##	##	##	##
4 Year Prior						##	##	##	##	##
3 Year Prior							##	##	##	##
2 Year Prior								##	##	##
1 Year Prior									##	##
Current Year										##

Incurred Losses and ALAE
Years in which losses were incurred	9 Year Prior	8 Year Prior	7 Year Prior	6 Year Prior	5 Year Prior	4 Year Prior	3 Year Prior	2 Year Prior	1 Year Prior	Current Year

9 Year Prior	$$	$$	$$	$$	$$	$$	$$	$$	$$	$$
8 Year Prior		$$	$$	$$	$$	$$	$$	$$	$$	$$
7 Year Prior			$$	$$	$$	$$	$$	$$	$$	$$
6 Year Prior				$$	$$	$$	$$	$$	$$	$$
5 Year Prior					$$	$$	$$	$$	$$	$$
4 Year Prior						$$	$$	$$	$$	$$
3 Year Prior							$$	$$	$$	$$
2 Year Prior								$$	$$	$$
1 Year Prior									$$	$$
Current Year										$$

Incurred Counts
Years in which losses were incurred	9 Year Prior	8 Year Prior	7 Year Prior	6 Year Prior	5 Year Prior	4 Year Prior	3 Year Prior	2 Year Prior	1 Year Prior	Current Year

9 Year Prior	##	##	##	##	##	##	##	##	##	##
8 Year Prior		##	##	##	##	##	##	##	##	##
7 Year Prior			##	##	##	##	##	##	##	##
6 Year Prior				##	##	##	##	##	##	##
5 Year Prior					##	##	##	##	##	##
4 Year Prior						##	##	##	##	##
3 Year Prior							##	##	##	##
2 Year Prior								##	##	##
1 Year Prior									##	##
Current Year										##

Earned Exposures
Years in which losses were incurred	Direct and Assumed

9 Year Prior
8 Year Prior
7 Year Prior
6 Year Prior
5 Year Prior
4 Year Prior
3 Year Prior
2 Year Prior
1 Year Prior
Current Year

Earned Premium

Years in which losses were incurred	Direct and Assumed

9 Year Prior
8 Year Prior
7 Year Prior
6 Year Prior
5 Year Prior
4 Year Prior
3 Year Prior
2 Year Prior
1 Year Prior
Current Year

Reconciliation

Each company shall take steps to determine the data submitted under these requirements is accurate, reasonable, and appropriately reconciles to the most recently filed annual statutory financial statement.

Describe the process used to reconcile the 1204 data, filed under this requirement, to the annual statutory financial statement. Please include the magnitude of any discrepancies, a description of the differences, and the reasons for the differences.

The company's senior financial officer and a qualified actuary must certify that the data filed under these requirements is accurate and reasonably reconciles with the most recently filed annual statutory financial statement.

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