filing at a glance - am best · 2014-10-16 · filing at a glance company: acuity, a mutual...

Filing at a Glance Company: ACUITY, A Mutual Insurance Company

Product Name: Workers Compensation

State: Illinois

TOI: 16.0 Workers Compensation

Sub-TOI: 16.0004 Standard WC

Filing Type: Rate/Rule

Date Submitted: 10/13/2014

SERFF Tr Num: ACUT-129758766

SERFF Status: Closed-Filed

State Tr Num:

State Status:

Co Tr Num: 30-10-13-14R

Effective DateRequested (New):

On Approval

Effective DateRequested (Renewal):

On Approval

Author(s): Heidi White

Reviewer(s): Amanda Wiggers (primary)

Disposition Date: 10/14/2014

Disposition Status: Filed

Effective Date (New): 10/13/2014

Effective Date (Renewal): 10/13/2014

SERFF Tracking #: ACUT-129758766 State Tracking #: Company Tracking #: 30-10-13-14R

State: Illinois Filing Company: ACUITY, A Mutual Insurance Company

TOI/Sub-TOI: 16.0 Workers Compensation/16.0004 Standard WC


Project Name/Number: Tricia/14035

PDF Pipeline for SERFF Tracking Number ACUT-129758766 Generated 10/15/2014 06:41 AM

General Information

Company and Contact

Filing Fees

State Specific

Project Name: Tricia Status of Filing in Domicile: Not Filed

Project Number: 14035 Domicile Status Comments:

Reference Organization: Reference Number:

Reference Title: Advisory Org. Circular:

Filing Status Changed: 10/14/2014

State Status Changed: Deemer Date:

Created By: Heidi White Submitted By: Heidi White

Corresponding Filing Tracking Number:

Filing Description:

ACUITY, A Mutual Insurance Company has added Blanket Waiver of Subrogation rating to endorsement WC 00 03 13C,Waiver of Our Right to Recover from Others Endorsement. A corresponding step was added to the algorithm. We are alsofiling for a deviation from part c of NCCI’s rule 3-A-22. The waiver minimum premium, if applicable, will be included in thepolicy minimum premium rather than in addition to the policy minimum premium.

We request these changes be effective upon approval.

Filing Contact InformationHeidi White, Regulatory Filing Technician [email protected]

2800 S. Taylor Drive

Sheboygan, WI 53081

920-458-9131 [Phone] 1909 [Ext]

Filing Company InformationACUITY, A Mutual InsuranceCompany

2800 S. Taylor Drive

Sheboygan, WI 53081

(920) 458-9131 ext. 1539[Phone]

CoCode: 14184

Group Code:

Group Name:

FEIN Number: 39-0491540

State of Domicile: Wisconsin

Company Type: Property &Casualty

State ID Number:

Fee Required? No

Retaliatory? No

Fee Explanation:

Refer to our checklists prior to submitting filing (http://insurance.illinois.gov/Prop_Cas_IS3_Checklists/IS3_Checklists.asp ).:OKRefer to our updated (04/06/2007) SERFF General Instructions prior to submitting filing. They have been updated to clarifywhat rates and rules are required to be filed as well as what rates and rules are not required to be filed. Also, the "ProductName" is the Filing Title and not the Project Number.: OKNO RATES and/or RULES ARE REQUIRED TO BE FILED FOR LINES OF COVERAGE SUCH AS COMMERCIAL AUTO(except taxicabs), BURGLARY AND THEFT, GLASS, FIDELITY, SURETY, COMMERCIAL GENERAL LIABLITY, CROPHAIL, COMMERCIAL PROPERTY, DIRECTORS AND OFFICERS, ERRORS AND OMMISSIONS, COMMERCIAL MULTI







PERIL just to mention a few. However, a Summary Sheet (RF-3) is required to be filed. Please refer to the State Specific Fieldbelow for what rates/rules are required to be filed and to our checklists for specific statutes, regulations, etc. :http://insurance.illinois.gov/Prop_Cas_IS3_Checklists/IS3_Checklists.asp .: OKMedical Malpractice rates/rules may now be submitted using SERFF effective January 1, 2012.: NAThe only rates and/or rules that are required to be filed are Homeowners, Mobile Homeowners, Dwelling Fire and Allied Lines,Workers' Compensation, Liquor Liability, Private Passenger Automobiles, Taxicabs, Motorcycles and Group Inland MarineInsurance which only applies to insurance involving personal property owned by, being purchased by or pledged as collateralby individuals, and not used in any business, trade or profession per Regulation Part 2302 which says in part, "each companyshall file with the Director of Insurance each rate, rule and minimum premium before it is used in the State of Illinois.": OKWhen selecting a form filing type for a multiple form filing, use the dominant type from these choices: APP - application; CER -certificate; COF - coverage form; DPS - declaration page; END - endorsement; POJ - policy jacket; ORG - Companiesadopting an Advisory or Rating Organization's filing. Example: If you are submitting a policy as well as endorsements, adeclaration page and an application, you would select "POL" for policy.: NA







Correspondence Summary DispositionsStatus Created By Created On Date SubmittedFiled Amanda Wiggers 10/14/2014 10/14/2014







Disposition

Disposition Date: 10/14/2014

Effective Date (New): 10/13/2014

Effective Date (Renewal): 10/13/2014

Status: Filed

Comment:

Company

Name:

Overall %

Indicated

Change:

Overall %

Rate

Impact:

Written Premium

Change for

this Program:

Number of Policy

Holders Affected

for this Program:

Written

Premium for

this Program:

Maximum %

Change

(where req'd):

Minimum %

Change

(where req'd):ACUITY, A MutualInsurance Company

0.000% 0.000% $0 2,385 $63,214,145 0.000% 0.000%

Schedule Schedule Item Schedule Item Status Public AccessSupporting Document Explanatory Memorandum Yes

Supporting Document DO NOT SUBMIT RATES/RULES. Only a SummarySheet (RF-3) is Required.

Yes

Supporting Document Request to Maintain Data as Trade Secret Information Yes

Supporting Document Manual Yes

Rate Algorithm Yes

Rate Endorsements Yes







Rate Information Rate data applies to filing.

Filing Method: Use and File

Rate Change Type: Neutral

Overall Percentage of Last Rate Revision: -2.400%

Effective Date of Last Rate Revision: 01/01/2014

Filing Method of Last Filing: Use and File

Company Rate Information

Company

Name:

Overall %

Indicated

Change:

Overall %

Rate

Impact:

Written Premium

Change for

this Program:

Number of Policy

Holders Affected

for this Program:

Written

Premium for

this Program:

Maximum %

Change

(where req'd):

Minimum %

Change

(where req'd):ACUITY, A MutualInsurance Company

0.000% 0.000% $0 2,385 $63,214,145 0.000% 0.000%







Rate/Rule Schedule

Item

No.

Schedule Item

Status Exhibit Name Rule # or Page # Rate Action

Previous State

Filing Number Attachments1 Algorithm F1 Replacement F-Algorithm.pdf2 Endorsements WC 00 03 13C Replacement Endorsements.pdf







Supporting Document Schedules Satisfied - Item: Explanatory MemorandumComments:Attachment(s): IL Workers Comp Explanatory Memo.pdfItem Status:Status Date:

Satisfied - Item: DO NOT SUBMIT RATES/RULES. Only a Summary Sheet (RF-3) is Required.Comments:Attachment(s): IL Work Comp RF-3.pdfItem Status:Status Date:

Bypassed - Item: Request to Maintain Data as Trade Secret InformationBypass Reason: NAAttachment(s):Item Status:Status Date:

Satisfied - Item: ManualComments:

Attachment(s):

Table of Contents.pdfA-Affiliation.pdfB- Premium Discount Plan.pdfC- Experience Rating Plan.pdfD-Retrospective Rating Plan.pdfE-Class Deviations.pdfF-Algorithm.pdfG-Reserved.pdfH-Endorsements.pdfI-Schedule Rating Plan.pdf

Item Status:Status Date:







Workers CompensationRate and Rule Filing Manual

Illinois Affiliation - Page A1

01-2014 Edition

*A. AFFILIATION ACUITY, A Mutual Insurance Company uses the National Council on Compensation Insurance (NCCI) loss costs to determine rates. We also use the rules as filed on our behalf by NCCI. Our Loss Cost Multiplier applied to the NCCI advisory loss costs is 1.668.


Illinois Premium Discount Plan - Page B1

01-2008 Edition

*B. PREMIUM DISCOUNT PLAN An account that develops an estimated annual premium of more than $10,000 is eligible for a premium discount. The amount of discount depends upon the size of the premium. The following NCCI Type A Premium Discount table below will apply.

Premium Discount

First 10,000 0.0% Next 190,000 9.1% Next 1,550,000 11.3% Over 1,750,000 12.3%


Illinois Experience Rating Plan - Page C1

01-2008 Edition

*C. EXPERIENCE RATING PLAN ACUITY, A Mutual Insurance Company uses the Experience Rating Plan manual filed on its behalf by NCCI.


Illinois Retrospective Rating Plan - Page D1

01-2007 Edition

D. RETROSPECTIVE RATING PLAN ACUITY, A Mutual Insurance Company uses the Retrospective Rating Plan manual filed on its behalf by NCCI. Commission on retrospective policies is based on the standard premium, not the retrospective premium.


Illinois Class Deviations - Page E1

01-2007 Edition

E. CLASS DEVIATIONS ACUITY, A Mutual Insurance Company does not deviate from the classification schedule filed by NCCI.

Workers Compensation

Rate and Rule Filing Manual

Illinois Algorithm - Page F1

10-2014 Edition

*F. ILLINOIS WORKERS COMPENSATION PREMIUM ALGORITHM (EFFECTIVE 01 SEPTEMBER 2008)

The following algorithm provides the framework for premium charges and credits. Where not specified, the premium base would be the result from the prior line.*

PREMIUM ELEMENTS EXPLANATORY NOTES

MANUAL PREMIUM [(PAYROLL / 100) * RATE] + Supplementary Disease (foundry, abrasive,

sandblasting) [(SUBJECT PAYROLL / 100) * DISEASE RATE]

+ USL&H Exposure for non-F classification codes [(SUBJECT PAYROLL / 100) * (RATE * USL&H FACTOR)]

TOTAL MANUAL PREMIUM + Employers Liability (E/L) increased limits factor [% applied to Total Manual Premium]

+ Employers Liability increased limits charge [Balance to E/L increased limits minimum premium]

+ Employers Liability increased limits factor (Admiralty, FELA)

[Factor applied to the portion of Manual Premium where Admiralty/FELA coverage is applicable]

+ Employers Liability/Voluntary Compensation flat charge

[Coverage in Monopolistic State Funds}

- Small Deductible credit [% applied to Total Manual Premium] + Blanket Waiver of Subrogation** 2% of manual premium subject to $50

minimum or $5,000 maximum premium. TOTAL SUBJECT PREMIUM x Experience Modification (Exp Mod) TOTAL MODIFIED PREMIUM x Contracting Class Prem Adj Program factor

(1 - CCPAP credit %)

+ Employee Leasing Rating Adjustment + Supplemental Disease Exposure (Asbestos, NOC)† + Atomic Energy Radiation Exposure NOC† + Charge for nonratable catastrophe loading† + Aircraft Seat Surcharge + Scheduled Waiver of Subrogation** ($50 flat charge per contract) + Balance to Minimum Premium (State Act) [Balance to minimum premium at Standard

Limits] + Balance to Minimum Premium (Admiralty, FELA) TOTAL STANDARD PREMIUM‡ - Premium Discount§ [% applied to Standard Premium]

+ Coal Mine Disease Charge [Underground, surface, surface auger] + Expense Constant + Terrorism [(PAYROLL / 100) * TERRORISM VALUE)] + Catastrophe (Other Than Certified Acts of Terrorism) [(PAYROLL / 100) * CATASTROPHE (OTHER

THAN CERTIFIED ACTS OF TERRORISM) VALUE]

ESTIMATED ANNUAL PREMIUM



Illinois Algorithm - Page F2

09-2008 Edition

Illinois Workers Compensation Premium Algorithm (Effective 01 September 2008) continued * The above rating method would be used in absence of independent carrier filings.

** Premium charges established for Waiver of Subrogation are not filed by NCCI for the voluntary market.

† Nonratable Element Premiums generated by nonratable portion of manual rate are subject to all applicable premium elements applied to the policy, however, they are not subject to experience rating or retrospective rating.

‡ Statistical calls for ratemaking data contain a different definition of “Standard premium.” Refer to the Reporting Guidebook for the Annual Calls for Experience.

§ For policies subject to premium adjustments under a retrospective rating plan, premium discount does not apply.

NOC = Not Otherwise Classified.

Note: For short rate cancellations, short rate percentage/short rate penalty premium factor is subject to experience rating, included in Total Subject Premium, and applied prior to Experience Modification.



Illinois Reserved - Page G1

01-2012 Edition

G. RESERVED FOR FUTURE USE


Illinois Endorsements

01-2007 Edition

H. ENDORSEMENTS Table of Contents

WC 00 03 13C Waiver of Our Right to Recover From Others Endorsement

WC 00 04 21C Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement

WC 00 04 22A Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement



10-2014 Edition

*WC 00 03 13C WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

Scheduled Waiver Rate: $50 flat charge per contract Blanket Waiver Rate: 2% manual Work Comp premium Minimum Manual WC Blanket Waiver Premium: $50 Maximum Manual WC Blanket Waiver Premium: $5,000 ACUITY is deviating from NCCI’s Workers’ Compensation Waiver of Right to Recover From Others (Subrogation) rule (3-A-22) with respect to part c. The waiver minimum premium, if applicable, will be included in the policy minimum premium rather than in addition to the policy minimum premium.



09-2008 Edition

*WC 00 04 21C CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT Premium for above endorsement is calculated on the basis of total payroll. A risk's total payroll in each state is divided by units of $100 and multiplied by the Catastrophe (Other Than Certified Acts of Terrorism) Value. The calculation is expressed as (Payroll/100 x Catastrophe (Other Than Certified Acts of Terrorism) Value = Premium). This premium is applied after the standard premium and is not subject to any other modifications including, but not limited to, premium discount, experience rating, schedule rating, or retrospective rating.



09-2008 Edition

*WC 00 04 22A TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT Premium for above endorsement is calculated on the basis of total payroll. A risk's total payroll in each state is divided by units of $100 and multiplied by the Terrorism Value. The calculation is expressed as (Payroll/100 x Terrorism Value = Premium). This premium is applied after the standard premium and is not subject to any other modifications including, but not limited to, premium discount, experience rating, schedule rating, or retrospective rating.


Illinois Schedule Rating Plan - Page I1

01-2008 Edition

I. SCHEDULE RATING PLAN Eligibility - Any workers’ compensation policy with annual premium at manual rates of at least: $1,000 Schedule Rating Table: Range of Modification

Debit Credit

Premises 10% to -10%

This may include but is not limited to the physical condition of the premises, control of hazards, housekeeping, documented inspection and preventative maintenance, industrial hygiene, ergonomics, workplace design, workflow, resource distribution, administrative controls, and security features.

Medical Facilities 5% to -5%

This may include but is not limited to whether the first aid program is with Red Cross or equivalent certified employees, whether this is a nurse on premises, the distance to medical facilities, the existence of emergency and disaster plans, use of managed care, if there is a company designated physician, the company’s return to work policy, if the company has a first aid room, eyewash station, and shower facilities, and whether emergency medical numbers are posted near the telephone.

Safety Devices 10% to -10%

This may include but is not limited to whether there is machine and equipment guarding, lifting and material handling equipment, personal protective equipment, seat belt usage whenever vehicles are driven, a safety equipment inspection program, and whether there is a maintenance program. Employees - Training, Supervision, Management 15% to -15%

This may include but is not limited to written job application with reference checking, pre-employment physical examinations, drug and alcohol screening, motor vehicle record screening for driver positions, experience level of employees, employee turnover, level of supervision, formal training program, job specific training such as defensive driving course, material handling and lifting procedures, and job site safety.

Classification Peculiarities 10% to -10%

This may include but is not limited to whether the class selected anticipates all exposures, whether the class selected anticipates larger/different exposures, technology or methodology variations, employee distribution, whether an appropriate class is available, and whether the operations that caused previous losses were discontinued.


Illinois Schedule Rating Plan - Page I2

01-2008 Edition

Schedule Rating Plan (continued) Management: Cooperation with insurance carrier 10% to -10%

This may include but is not limited to evidence of commitment to workplace safety, cooperation with Loss Control department, compliance with Loss Control recommendations, prompt claims reporting, cooperation with accident investigations, prompt and accurate payroll reporting, and prompt premium payments - no late payments. Safety program 10% to -10%

This may include but is not limited to written safety policy, written safety rules established and enforced, management accountable for safety, safety committee with employee involvement, regular safety meetings, safety coordinator position, monitor use of personal protective equipment, reward system for maintaining safe workplace, active accident investigation and analysis with corrective action, and whether there is accurate and detailed record keeping. The maximum schedule debit or credit will be 70%.

ACUITY, A Mutual Insurance Company has added Blanket Waiver of Subrogation rating to endorsement WC 00 03 13C, Waiver of Our Right to Recover from Others Endorsement. A corresponding step was added to the algorithm. We are also filing for a deviation from part c of NCCI’s rule 3-A-22. The waiver minimum premium, if applicable, will be included in the policy minimum premium rather than in addition to the policy minimum premium. We request these changes be effective upon approval.


Illinois Table of Contents

01-2012 Edition

TABLE OF CONTENTS SECTION TITLE PAGES A AFFILIATION A1 B PREMIUM DISCOUNT PLAN B1 C EXPERIENCE RATING PLAN C1 D RETROSPECTIVE RATING PLAN D1 E CLASS DEVIATIONS E1 F ALGORITHM F1 - F2 G RESERVED FOR FUTURE USE G1 H ENDORSEMENTS I SCHEDULE RATING PLAN I1 - I2 * Denotes a Change

filing at a glance - am best · 2014-10-16 · filing at a glance company: acuity, a mutual...

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