Section 4203.APPENDIX B Guidelines for Submission of Medical Malpractice Reporting

State of Illinois

Department of Financial and Professional Regulation

Division of Insurance

Guidelines for the Submission of Medical Malpractice Insurance Information

Pursuant to Section 1204 of the Illinois Insurance Code [215 ILCS 5/1204]

To assist insurers and other reporting entities in the submission of medical malpractice insurance information as required by the State of Illinois and outlined in Section 1204, the Illinois Department of Financial and Professional Regulation-Division of Insurance (DOI) offers these instructions containing submission guidelines and other useful information.

TABLE OF CONTENTS

OVERVIEW............................................................................................................................... 16

FILE PROTOCOLS................................................................................................................... 16

A) File Types................................................................................................................. 16

1. CONTROL FILE.................................................................................................... 16

2. DATA FILE........................................................................................................... 16

3. WORD/PDF DOCUMENT.................................................................................... 16

b) File Formats............................................................................................................ 17

1. TEXT FORMATTING............................................................................................ 17

2. DECIMAL FORMATTING.................................................................................... 17

3. LIMITS FORMATTING......................................................................................... 17

FILE NAMING CONVENTIONS............................................................................................ 18

A) standard Files........................................................................................................ 18

1. DATA FILES......................................................................................................... 18

2. CONTROL FILES................................................................................................. 18

3. WORD/PDF DOCUMENT................................................................................... 18

B) ZIP Files................................................................................................................... 19

SUBMISSION OF MEDIA....................................................................................................... 19

A) Electronic Submission − Browser..................................................................... 19

B) Electronic Submission − DOS.............................................................................. 23

C) Mail Submission..................................................................................................... 26

TYPE CATEGORIES................................................................................................................. 26

POLICY TYPE................................................................................................................ 26

EXPOSURE TYPE......................................................................................................... 27

HEALTH CARE INSURER TYPE............................................................................... 27

LOSS TYPE.................................................................................................................... 27

RESERVE STUDY LOSS TYPE................................................................................... 27

CLAIM TYPE................................................................................................................. 27

COUNTY CODES...................................................................................................................... 27

RECORD LAYOUTS................................................................................................................. 30

Control File − ASCII Formatted.............................................................................. 30

File 1 − Exhibit 1 − ASCII Formatted........................................................................ 31

File 2 − Exhibit 2a Reserves − ASCII Formatted..................................................... 33

File 3 − Exhibit 2a Surplus − ASCII Formatted1..................................................... 34

File 4 − Exhibit 2b − Word/PDF Document............................................................... 35

Guidelines for the Submission of Medical Malpractice Insurance Information

Pursuant to Section 1204 of the Illinois Insurance Code [215 ILCS 5/1204]

OVERVIEW

Section 1204 of the Illinois Insurance Code [215 ILCS 5/1204] requires medical malpractice insurers to file insurance information with the Illinois Department of Financial and Professional Regulation's Division of Insurance. Section 1204 mandates that every medical malpractice insurer shall file an annual submission with the Director of the Division of Insurance. The purpose of this document is to provide uniform guidelines to assist medical malpractice insurers in the proper and timely submission.

FILE PROTOCOLS

A) File Types

There will be three types of files contained in an insurer's submission.

1. CONTROL FILE

As its name implies, this file will contain control information that allows DOI to track the submission, such as the insurer FEIN, NAIC control code and company contact information. There will only be one control file with each submission.

2. DATA FILE

These files will contain Exhibit 1, Exhibit 2a Reserve and Exhibit 2a Surplus data records as defined in this document. There will be one of each of these files for each reporting year in a submission.

3. WORD/PDF DOCUMENT

This document will contain answers to the Exhibit 2b Reserve and Exhibit 2b Surplus questions. Additionally, it will contain the Consulting Actuarial Report and Data Supporting the Company's Rate Filing, a listing and descriptions of Company Defined Items and a narrative description regarding the Reconciliation of the data as set forth in Appendix A Filing Requirements for Medical Malpractice Reporting.

The record layouts, which are displayed following these guidelines, are based on the actuarial specifications set forth in this document. Each record in the control and data file will end in a standard carriage return/line feed (CRLF). A separate file will be created for each year of data submitted.

The document containing the responses to the Exhibit 2b Reserve and Surplus Study questions, the Consulting Actuarial Report and Data Supporting the Company's Rate Filing, Company Defined Items and the Reconciliation narrative will be stored either in a Microsoft^® Word compatible format or in portable document format (PDF) compatible with Adobe^® Acrobat Reader 6.0 or greater.

B) File Formats

1. TEXT FORMATTING

The control file and data files will be stored in ASCII formatted, non-delimited text files. Text fields will be non-delimited and may be mixed case. Text fields may also contain spaces.

2. DECIMAL FORMATTING

In any field where the number formatting is designated to be Dec (3, 2) or Dec (5,3), the number is considered to be a percentage item. For example, a percentage of 23.5% in a field designated Dec (3,2) should be shown in the field as 02350.

In Exhibit 1civ of the file that holds Exhibit 1 data, there is a field that holds the corresponding tail factor for the Maturity Year. This is a numeric, non-percentage field formatted as Dec (1,3). For example, a tail factor of 0.925 would be shown in the field as 0925.

3. LIMITS FORMATTING

For reporting policy limits, both occurrence and aggregate limits are to be provided. The format for reporting limits is as follows: occurrence limit/aggregate limit with the ending ($000) omitted. For example, a limit of $1,000,000 per occurrence and $3,000,000 aggregate would be reported as "1000/3000". This field will be read as text, so leading zeros are not necessary.

FILE NAMING CONVENTIONS

A) STANDARD FILES

1. DATA FILES

Data file names will be based on the type of exhibit data and the reporting year contained in the file. For example,

EXHIBIT1_123456789_1998.TXT

will contain Exhibit 1 data for the 1998 calendar reporting year from an insurer with a FEIN of 12-3456789. A file named

EXHIBIT2a_Surplus_987654321_2001.TXT

will contain Exhibit 2a Surplus Study actuarial data from the 2001 calendar reporting year from an Insurer with a FEIN designation of 98-7654321. Note that all data files will carry a .txt extension.

2. CONTROL FILES

The control file contains insurer-specific company and contact information vital for a successful data submission. The file name will classify it as a control file and specify the FEIN to identify the submitting company. A file named

Control_123456789.txt

will be recognized as the file containing control information for the insurer with FEIN ID 12-3456789.

3. WORD/PDF DOCUMENT

This will be word processor file in a format compatible with Microsoft^® Word or in portable document format (PDF) compatible with Adobe^® Acrobat Reader 6.0 or greater. Since it will contain responses to Exhibit 2b Reserve and Surplus Study questions, the Word document will be named

EXHIBIT2b_123456789.DOC

which will identify the file as the Exhibit 2b Reserve and Surplus Study file for the company with FEIN ID 12-3456789, and the .doc extension will classify the file as a Word document. In the event that Adobe^® Acrobat Reader 6.0 or greater is the chosen format, the file will be named

EXHIBIT2b_123456789.PDF

which will identify it as the Exhibit 2b Reserve and Surplus Study file for the company with FEIN ID 12-3456789, and the .pdf extension will classify the file as an Adobe^® Acrobat Reader document.

B) ZIP FILES

Since most submissions will contain a large number of files, if you have file archiving software, such as WinZip^® or PKZip^®, the control, data and documentation files may be archived in a zipped or self-expanding zipped file to shorten the upload process. In the event this process is utilized, the naming convention will be

Control_999999999.zip for a zipped archive file

Control_999999999.exe for a self-expanding archive file

where 999999999 is the insurer's nine digit FEIN ID.

SUBMISSION OF MEDIA

Media may be submitted electronically using file transfer protocol or by mail on CD-ROM. Insurers may choose which of the two methods best suits their needs.

A) Electronic Submission − Browser

1. Start your web browser (this example uses Internet Explorer). Type ftp://163.191.27.5 in the address line and click or press Enter

2. A pop up box will appear for the login process. If your browser is using a pop up blocker, you will need to enable pop ups and will probably be prompted to do so. In the User name box, type ildpr\ftp then press Tab to move to the password box. For your password, type fprftp (exactly as written – the password is case sensitive). Now click the Log On button.

3. When you see the folder FPRFTP in the browser window, you know you have connection. Double click the folder to open it.

4. Go to the file to upload on your computer. The screen shots below show a file on a local computer in a folder called C:\Word on the left and the FTP site on the right. Click on your file, hold down the left mouse button and drag to the FTP window. If multiple files need to be transferred, they can be done as a group.

The status box shows the file copying:

5. When the files appear in both windows, the upload was successful. Click on the in the upper corners of both windows to close.

B) Electronic Submission − DOS

1. FTP file transfer can also be achieved using the DOS command line. Click on Start, and then Run. On the Open: line, type cmd and click OK.

2. At the C:\> prompt, type ftp followed by a space, then type 163.191.27.5. Press Enter.

3. When prompted for the User name, type ildpr\ftp and press Enter. At the password prompt, type Ftp&Fpr (remember, the password is case-sensitive and will not appear on screen) and press Enter. Once signed in you will be at an ftp> prompt.

4. This process utilizes a file transfer command called "Put" to upload your file. Type put followed by the complete path and file name of the file you wish to transfer. This example shows the file named medmal.txt in the C:\word folder being transferred. Type the command as follows:

put c:\word\medmal.txt

then press Enter. You will get a message acknowledging when the transfer is complete.

This transfer method works best when using a zip file or self-expanding zip file archive.

After the transfer is complete, type the command quit at the ftp> prompt, and you will be returned to your C:\> prompt. Type exit, then press Enter to close the session.

C) Mail Submission

Data submitted by mail should be on recordable compact disc media (CD-R) in a sturdy mailer in order to prevent damage to the media during shipping. The media should be readable by software running under the Microsoft^® Windows operating system. The sealed media should be mailed to:

Illinois Department of Financial and Professional Regulation

Division of Insurance

1204 Data

320 W. Washington

Springfield IL 62786

Attn: Casualty Actuarial Section

If submitting by mail, we recommend sending the media by certified mail, return receipt requested. This will provide a record of delivery.

TYPE CATEGORIES

Certain data elements being collected require a DOI defined code. These elements will be designated by the word (Code) following their name in the record layout later in this document. The category types, codes and their descriptions are as follows:

POLICY TYPE

CMPA = Claims Made Including Prior Acts

OERE = Occurrence Including Extended Reporting Endorsements

EXPOSURE TYPE

INDL = Individual Policies

CORP = Corporate Policies

HEALTH CARE INSURER TYPE

PHSU = Physicians, Surgeons and Osteopaths

HOSP = Hospitals

OHCP = Other Health Care Professionals (including Dentists)

OHCF = Other Health Care Facilities

LOSS TYPE

PYPL = Policy Year Paid Losses

PYPA = Policy Year Paid Allocated Loss Adjustment Expenses

PYPL = Policy Year Incurred Losses

PYIA = Policy Year Incurred Allocated Loss Adjustment Expenses

RESERVE STUDY LOSS TYPE

ILDC = Incurred Direct and Assumed Loss and Defense & Cost Containment Expenses Reported at Yr. End

PLDC = Cumulative Direct and Assumed Paid Loss & Defense & Cost Containment Expenses Reported at Yr. End

IBNR = Bulk and IBNR Reserves on Direct and Assumed Loss and Defense & Cost Containment Expense Reported at Yr. End

CLAIM TYPE

CCWP = Cumulative Number of Claims Closed with Loss Payment, Direct & Assumed at Yr. End

COUT = Number of Claims Outstanding, Direct & Assumed at Yr. End

CREP = Cumulative Number of Claims Reported, Direct & Assumed at Yr. End

COUNTY CODES

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

RECORD LAYOUTS

Each record in the files should follow the format contained in the following tables:

Control File − ASCII Formatted

*File Name: Control_999999999.txt* *where 999999999 = Insurer FEIN*
*DESCRIPTION*	*START*	*END*	*LENGTH*
FEIN Number	1	10	10
NAIC Company Code	11	15	5
Contact last name	16	55	40
Contact first name	56	80	25
Contact 10 digit telephone (numbers only)	81	90	10
Contact telephone extension (if any)	91	96	6
Contact email address	97	146	50

File 1 – Exhibit 1 − ASCII Formatted

*File Name: Exhibit1_999999999_xxxx.txt* *where 999999999 = Insurer FEIN* *And* *xxxx = Reporting Year*
*DESCRIPTION*	*START*		*END*		*LENGTH*
FEIN Number	1		10		10
NAIC Company Code	11		15		5
Exhibit 1a
Policy Year Loss Type (Code)	16		19			4
Policy Year	20		23			4
Policy Type (Code)	24		27			4
County (Code)	28		30			3
Loss Amount	31		40			10
Limit	41		52			12
Exposure Type (Code)	53		56			4
Exhibit 1b
Policy Year		57	60			4
Policy Type (Code)		61	64			4
ISO Code		65	69			5
County		70	89			20
Amount		90	95			6
Limit		96	107			12
Claims Made Age		108	109			2
Exposure Type (Code)		110	113			4
Exhibit 1ci
Policy Type (Code)		114	117			4
Accident Year		118	121			4
Report Year		122	125			4
Relative Accident Year		126	127			2
Amount		128	133			6
Exposure Type (Code)		134	137			4
Exhibit 1cii
Accident Year		138	141			4
Calendar Year of Development		142	145			4
Open Claims (OC)		146	150			5
Claims Closed with Indemnity (CWI)		151	155			5
Claims Closed with Expense (CWE)		156	160			5
Claims Closed with No Payment (CNP)		161	165			5
Indemnity Paid on CWI		166	175			10
Allocated Loss Adjustment Expense (ALAE) Paid on CWI and/or CWE		176	184			9
Indemnity Reserves on OC		185	194			10
ALAE Reserves on OC		195	203			9
Indemnity Paid on OC		204	213			10
ALAE Paid on OC		214	222			9
Exhibit 1ciii
Report Year		223	226			4
Calendar Year of Development		227	230			4
Open Claims (OC)		231	235			5
Claims Closed with Indemnity (CWI)		236	240			5
Claims Closed with Expense (CWE)		241	245			5
Claims Closed with No Payment (CNP)		246	250			5
Indemnity Paid on CWI		251	260			10
Allocated Loss Adjustment Expense (ALAE) Paid on CWI and/or CWE		261	269			9
Indemnity Reserves on OC		270	279			10
ALAE Reserves on OC		280	288			9
Indemnity Paid on OC		289		298		10
ALAE paid on OC		299		307		9
Exhibit 1civ
Maturity Year		308	309			2
Corresponding tail factor for maturity year – Dec(1,3)		310	313			4
Exhibit 1cv
Expense − Dec (3,2)		314	318			5
Contingency − Dec (3,2)		319	323			5
DDR − Dec (3,2)		324	328			5
Commission − Dec (3,2)		329	333			5
Tax − Dec (3,2)		334	338			5
Impact of territory and/or class relativity changes (off-balance) − Dec (3,2)		339	343			5
Miscellaneous factors used to establish rates – Dec (3,2).		344	348			5
Named miscellaneous factor – the factor that generated the current record. Repeats – there will be a new record for each occurrence of a named miscellaneous factor. A named miscellaneous factor will be one of the following: a) profit b) reinsload c) invincome d) debits e) credits f) other		349	363			15

File 2 – Exhibit 2a Reserves − ASCII Formatted

*File Name: Exhibit2A_Reserves_999999999_xxxx.txt* *where 999999999 = Insurer FEIN* *And* *xxxx = Reporting Year*
*DESCRIPTION*	*START*		*END*			*LENGTH*
FEIN Number	1		10			10
NAIC Company Code	11		15			5
Exhibit 2A Reserve Part 1
Health Care Insurer Type (Code)	16		19				4
Policy Type (Code)	20		21				2
Year Premium Earned	22		25				4
Direct and Assumed Premiums Earned	26		32				7
Direct and Assumed Loss Payments	33		39				7
Direct and Assumed Defense and Cost Containment Payments	40		45				6
Direct and Assumed Adjusting and Other Payments	46		50				5
Total Direct and Assumed Losses and Loss Expenses Paid	51		57				7
Direct and Assumed Case Basis Losses Unpaid	58		64				7
Direct and Assumed Bulk and IBNR Losses Unpaid	65		69				5
Direct and Assumed Case Basis Defense and Cost Containment Unpaid	70		75				6
Direct and Assumed Bulk and IBNR Defense and Cost Containment Unpaid	76		80				5
Direct and Assumed Adjusting and Other Unpaid	81		85				5
Total Direct and Assumed Losses and Loss Expenses Unpaid	86		92				7
Total Direct and Assumed Losses and Loss Expenses Incurred	93		99				7
Direct and Assumed Loss and Loss Expense Percentage – Dec (3,2)	100		104				5
Exhibit 2A Reserve Part 2
Calendar Year of Development		105		108	4
Reserve Study Loss Type (Code)		109		112	4
Reserve Study Loss Type Amount		113		119	7
Exhibit 2A Reserve Part 3
Claim Type (Code)		120		123	4
Claim Type Amount		124		128	5
Exhibit 2A Reserve Part 4
Cumulative Premiums Earned Direct and Assumed at Yr. End		129		135	7

File 3 – Exhibit 2a Surplus − ASCII Formatted

*File Name: Exhibit2A_Surplus_999999999_xxxx.txt* *where 999999999 = Insurer FEIN* *And* *xxxx = Reporting Year*
*DESCRIPTION*	*START*	*END*	*LENGTH*
FEIN Number	1	10	10
NAIC Company Code	11	15	5
Surplus Year	16	19	4
Net Income Amount	20	28	9
Change in Net Unrealized Capital Gains	29	37	9
Change in Net Deferred Income Tax	38	44	7
Change in Nonadmitted Assets	45	51	7
Change in the Provision for Reinsurance	52	58	7
Capital/Surplus Changes and Adjustments	59	65	7
Dividends to Stockholders	66	73	8
Other Changes to Surplus repeats − a new record will be generated for each occurrence of “Other Changes to Surplus"	74	82	9
Total Change in Surplus for the Year – the sum of the preceding eight columns a) Net Income Amount b) Change in Net Unrealized Capital Gains c) Change in Net Deferred Income Tax d) Change in Nonadmitted Assets e) Change in the Provision for Reinsurance f) Capital/Surplus Changes and Adjustments g) Dividends to Stockholders h) Other Changes to Surplus	83	94	12
Total Net Written Premium to Surplus Ratio – Dec (5,3)	95	102	8
Medical Malpractice Direct Written Prem to Total Direct Written Prem – Dec (5,3)	103	110	8
Total Net Reserves to Surplus Ratio – Dec (5,3)	111	118	8
Medical Malpractice Net Reserves to Surplus Ratio – Dec (5,3)	119	126	8
Medical Malpractice Net Reserves to Total Net Reserves Ratio – Dec (5,3)	127	134	8

File 4 – Exhibit 2b – Word/PDF Document

File Name: Exhibit2B_999999999.doc

Exhibit2B_999999999.PDF

where 999999999 = Insurer FEIN

DESCRIPTION

This document will be stored in a file format compatible with either Microsoft^® Word or Adobe^® Acrobat Reader 6.0 or greater. The document will contain general and specific information about the insurer's Exhibit 2B Reserve Study, Exhibit 2B Surplus Study, Consulting Actuarial Report and Data Supporting the Company's Rate Filing, Company Defined Items and Reconciliation. This information will be in the form of a narrative response/description based on the Filing Requirements instructions.

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