on ISOnetsm

USER MANUAL

March, 2010

I N S U R A N C E S E R V I C E S O F F I C E, I N C. © ISO Services Properties, Inc., 2010 Version 7.0 ISO Confidential/Proprietary Information

______________________________________________________________________________________________________________ Use of a term in this publication shall be construed as granting any right, title, or interest in or to any patent, trademark, copyright, or other right in or to the information. All information contained in this publication remains the property of ISO or the applicable third party. THE SYSTEM DESCRIBED IN THIS DOCUMENT IS CONFIDENTIAL AND PROPRIETARY TO INSURANCE SERVICES OFFICE, INC. (ISO) OR IT’S LICENSORS. NO PART OF THIS PUBLICATION MAY BE REPRODUCED, COPIED, SOLD, DISTRIBUTED IN ANY MANNER OR BY ANY MEANS, WITHOUT THE EXPRESS WRITTEN PERMISSION FROM ISO. The terms and conditions governing the licensing and use of ISO systems consist solely of those set forth in the written contracts between ISO and its customers. ISO makes no warranty of any kind with regard to this material, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose. ISO shall not be liable for errors contained herein or for damages in connection with the furnishing, performance, or use of this material. Information in this publication is subject to change without notice. NOTICE: © ISO Services, Inc., 2009. This Documentation includes proprietary trade secrets and confidential information of ISO.

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TABLE OF CONTENTS

GENERAL USER INFORMATION .......................................................................................................................... 1 

OVERVIEW OF ISO CLAIMSEARCH ................................................................................................................... 1 INTRODUCTION ..................................................................................................................................................... 2 SUNSETTING OF MONOLINE FORMAT SYSTEMS.......................................................................................... 3 LOGGING ONTO ISO CLAIMSEARCH ................................................................................................................ 4 CHANGING YOUR PASSWORD ........................................................................................................................... 5 PRIVACY AND SECURITY ................................................................................................................................... 6 USER PROFILE ....................................................................................................................................................... 7 ISO CLAIMSEARCH HOME .................................................................................................................................. 8 IF YOU NEED HELP ............................................................................................................................................... 9 

CLAIMS REPORTING – GENERAL INFORMATION ....................................................................................... 12 

MY REPORTS PAGE ............................................................................................................................................ 13 OFFICE REPORTS ................................................................................................................................................ 15 CLAIM SUBMISSION – GENERAL INFORMATION ........................................................................................ 16 FIRST TIME USERS - REPORTING A CLAIM ................................................................................................... 17 SETTING UP YOUR PREFERENCES .................................................................................................................. 17 LOSS & POLICY INFORMATION ....................................................................................................................... 18 BASIC INFORMATION ........................................................................................................................................ 19 INVOLVED PARTY INFORMATION ................................................................................................................. 21 COVERAGE INFORMATION .............................................................................................................................. 23 CLAIM SUMMARY .............................................................................................................................................. 24 AKA INFORMATION ........................................................................................................................................... 25 SERVICE PROVIDER INFORMATION .............................................................................................................. 26 VERIFICATION OF SUBMISSION ...................................................................................................................... 27 GLOSSARY –FIELD DEFINITIONS .................................................................................................................... 28 

CLAIMS REPORTING – CASUALTY (INJURY/LIABILITY) .......................................................................... 36 

LOSS & POLICY ................................................................................................................................................... 36 BASIC INFORMATION ........................................................................................................................................ 37 INVOLVED PARTY – INSURED ......................................................................................................................... 39 INVOLVED PARTY – CLAIMANT ..................................................................................................................... 41 COVERAGE INFORMATION .............................................................................................................................. 43 GENERAL CASUALTY INFORMATION ........................................................................................................... 44 GENERAL CASUALTY INFORMATION (ADDITIONAL) ............................................................................... 46 CASUALTY COVERAGE INFORMATION ........................................................................................................ 47 CLAIM SUMMARY .............................................................................................................................................. 48 VERIFICATION OF SUBMISSION ...................................................................................................................... 49 

CLAIMS REPORTING – PROPERTY ................................................................................................................... 50 

LOSS & POLICY ................................................................................................................................................... 50 BASIC INFORMATION ........................................................................................................................................ 51  COVERAGE INFORMATION ............................................................................................................................. 54 COVERAGE INFORMATION .............................................................................................................................. 55 PROPERTY LOSS INFORMATION ..................................................................................................................... 56 CLAIM SUMMARY .............................................................................................................................................. 57 VERIFICATION OF SUBMISSION ...................................................................................................................... 58 

CLAIMS REPORTING – AUTOMOBILE ............................................................................................................. 59 

LOSS & POLICY ................................................................................................................................................... 59 BASIC INFORMATION ........................................................................................................................................ 60 

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INVOLVED PARTY – INSURED ......................................................................................................................... 62 COVERAGE INFORMATION – Insured Coverage .............................................................................................. 64 VEHICLE COVERAGES ....................................................................................................................................... 65 

GENERAL VEHICLE INFORMATION .............................................................................................................. 65 VEHICLE COVERAGE INFORMATION ........................................................................................................... 67 

CLAIM SUMMARY PAGE ................................................................................................................................... 68 ADDING INVOLVED PARTIES .......................................................................................................................... 69 COVERAGE INFORMATION – Claimant Coverage ........................................................................................... 70 COVERAGE INFORMATION .............................................................................................................................. 70 ADDING MULTIPLE VEHICLES ........................................................................................................................ 71 

CLAIM SUMMARY – ADD VEHICLE ............................................................................................................... 71 GENERAL VEHICLE INFORMATION .............................................................................................................. 72 COVERAGE INFORMATION ............................................................................................................................ 73 VEHICLE COVERAGE INFORMATION ........................................................................................................... 74 CLAIM SUMMARY – MULTIPLE VEHICLES ................................................................................................... 75 ADD COVERAGE FOR MULTIPLE VEHICLE CLAIM .................................................................................... 75 

CLAIM SUMMARY PAGE ................................................................................................................................... 76 VERIFICATION OF SUBMISSION ...................................................................................................................... 77 

CLAIMS REPORTING – PERSONAL COMBINATION POLICIES ................................................................. 78 

CLAIMS REPORTING – CMS REPORTING ....................................................................................................... 79 

LOSS & POLICY INFORMATION ....................................................................................................................... 80 BASIC INFORMATION ........................................................................................................................................ 80 INVOLVED PARTY – INSURED ......................................................................................................................... 84 INVOLVED PARTY – CLAIMANT ..................................................................................................................... 86 COVERAGE INFORMATION .............................................................................................................................. 88 GENERAL CASUALTY INFORMATION ........................................................................................................... 88 GENERAL CASUALTY INFORMATION (ADDITIONAL) ............................................................................... 90 CASUALTY COVERAGE INFORMATION ........................................................................................................ 94 CLAIM SUMMARY .............................................................................................................................................. 95 ADDING A REPRESENTATIVE .......................................................................................................................... 96 ADDING AN ADDITIONAL CMS CLAIMANT ................................................................................................. 98 CLAIM SUMMARY WITH CMS INFORMATION ............................................................................................. 99 VERIFICATION OF SUBMISSION .................................................................................................................... 100 

CLAIMS REPORTING – EXISTING CLAIMS ................................................................................................... 101 

SUNSETTING OF MONOLINE FORMAT SYSTEMS...................................................................................... 101 RETRIEVING AN EXISTING CLAIM ............................................................................................................... 101 UPDATING CLAIM INFORMATION – MONOLINE OR UNIVERSAL ......................................................... 102 RESEARCHING A CLAIM – MONOLINE OR UNIVERSAL .......................................................................... 102 UPDATING A MONOLINE CLAIM TO UNIVERSAL FORMAT ................................................................... 103 

CLAIM REPORTS .................................................................................................................................................. 105 

REPORT TYPES .................................................................................................................................................. 105 SEARCH METHODS ........................................................................................................................................... 106 SUBMITTED REPORT ONLY ............................................................................................................................ 107 SUBMITTED REPORT + .................................................................................................................................... 108 MATCH REPORT ................................................................................................................................................ 109 AUTOMATIC UPDATE ...................................................................................................................................... 112 RECOVERY NOTICE .......................................................................................................................................... 113 AUTOMATIC IMPOUND UPDATE ................................................................................................................... 114 OTHER VEHICLE MATCH INFORMATION ................................................................................................... 114 ADDITIONAL MESSAGES ................................................................................................................................ 116 

ADDITIONAL CLAIMS REPORTING SERVICES ........................................................................................... 119 

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STANDARD ADDITIONAL SERVICES ............................................................................................................ 120 EDR INVESTIGATETM ...................................................................................................................................... 120 MANDATORY – STATUTORY REPORTING FOR THE INDUSTRY .............................................................. 122 NHTSA VEHICLE RECALL INFORMATION .................................................................................................. 125 

OPTIONAL ADDITIONAL SERVICES ............................................................................................................. 126 APD FASTCHECKSM ........................................................................................................................................ 126 APPEND-DSSM ................................................................................................................................................. 126 CLAIMDIRECTORSM ........................................................................................................................................ 127 CSEA/ CSLN/ OCSE REPORTING ................................................................................................................... 131 MARINE INDEX BUREAU CLAIMS ................................................................................................................ 132 MEDICARE SECONDARY PAYER REPORTING SERVICE (CMS) ............................................................... 133 

CLAIMS INQUIRY ................................................................................................................................................. 138 

ABOUT QUESTTECHSM ..................................................................................................................................... 139 SEARCH METHODS ........................................................................................................................................... 140 SINGLE PARTY SEARCH .................................................................................................................................. 142 TWO PARTY SEARCH ....................................................................................................................................... 143 SEARCH RESULTS ............................................................................................................................................. 144 

NAME SUMMARY ............................................................................................................................................ 144 MATCH REPORTS ........................................................................................................................................... 145 ADDITIONAL MESSAGES ............................................................................................................................... 147 NUMEROUS MATCHES .................................................................................................................................. 150 

PREVIOUS MATCHES ....................................................................................................................................... 151 DEFERRED REPORTS ........................................................................................................................................ 151 IQ DOWNLOADS ................................................................................................................................................ 151 AMA SEARCHES ................................................................................................................................................ 152 

VIN DECODING WITH VINASSIST® ........................................................................................................................ 153 

SIU CASE MANAGER ........................................................................................................................................... 155 

NICB REFERRAL – HOME PAGE .............................................................................................................................. 157 

NICB REFERRAL – QUESTIONABLE CLAIM SUBMISSION ....................................................................... 158 SUBMITTING A REFERRAL ............................................................................................................................. 158 REFERRING PREVIOUSLY REPORTED CLAIMS (MONLINE OR UNIVERSAL FORMAT) .................... 159 UPDATING A CLAIM AS QUESTIONABLE CLAIM ...................................................................................... 160 CLAIMS REPORTING MATCH REPORT WITH NICB REFERRAL .............................................................. 164 CLAIMS INQUIRY SEARCH RESULTS WITH NICB REFERRAL ................................................................ 164 

DECISION NET® ................................................................................................................................................... 166 

OFAC ........................................................................................................................................................................ 167 

OFAC COMPLIANCE SOLUTIONS .................................................................................................................. 169 STANDARD OFAC SERVICE .......................................................................................................................... 169 PREMIUM OFAC SERVICE ............................................................................................................................ 169 OFAC HISTORICAL SWEEP ........................................................................................................................... 169 OFAC ENTERPRISEWIDE SOLUTION .......................................................................................................... 169 

ACCOUNT MANAGEMENT ................................................................................................................................ 170 

MANAGEMENT REPORTS .............................................................................................................................. 170 

WHO TO CALL ...................................................................................................................................................... 171 

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GENERAL USER INFORMATION

OVERVIEW OF ISO CLAIMSEARCH Insurance Service Offices, Inc. (ISO) has produced the industry’s only All-Claims Database. Known as ISO ClaimSearch®, this powerful and massive database incorporates new fraud fighting techniques developed through the integration and enhancement of the industry’s long-standing claims systems. The systems include: the Index System (casualty); the Property Insurance Loss Register (PILR), and the vehicle information databases formerly administered by the National Insurance Crime Bureau (NICB). ISO ClaimSearch is a single, enhanced system, providing state-of-the-art claims research to users across the country. ISO ClaimSearch furnishes the data that every company needs to protect itself against paying questionable or possibly fraudulent claims through a report delivery system that equips claims personnel with essential data for researching prior loss histories, identifying claims patterns, and detecting potentially fraudulent claims. It is the only national clearinghouse to which insurance professionals can turn for vital data on auto physical damage, theft, salvage, and property and casualty claims. The ISO ClaimSearch database now holds information on over 668 million claims, including 31 million property claims, 149 million individual bodily injury claims, 353 million automobile records, and 124 million Universal Format claims. The System receives over 55 million claims each year and generates over 40 million match reports. In addition to its basic claim handling support functions, the system also provides support for special investigations units. The basic system capabilities, available to authorized users through the Internet platform, are: • Claims Reporting, including ClaimDirector Scoring, CMS Reporting, and NMVTIS Reporting • Claims Inquiry (Investigations Queries or IQ) • VIN Decoding • SIU Case Manager • NICB Submission • Decision Net Searches • OFAC Searches • Account Management Companies qualify for access to the Casualty, Property and/or Auto segments of ISO ClaimSearch by participation. The system is open to insurers; self-insured organizations; third-party claims administrators (TPAs); and accident and health writers. Individual users of the system are authorized for various levels of access by their organizations. Company participation allows an organization to authorize any number of its personnel for access.

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INTRODUCTION This manual serves as a guide to help you navigate through the ISO ClaimSearch website. It is intended to provide instructions and basic information on how to login, change passwords, submit claims and inquire about claims. The web site provides the following services: Claims Reporting — Users may report property, casualty, and auto claims for each layer that you are members of in the ISO ClaimSearch database. Each type of claim report will yield various pages where you may submit any information pertinent to the claim. After submitting the most complete and accurate information possible, you can view and print matching search reports within minutes. Through the Claims Reporting function, you can also access the many Optional Additional Services provided by ISO ClaimSearch, such as ClaimDirector Scoring, Medicare Secondary Payer Reporting Service and NMVTIS Reporting. Claims Inquiry — Users can initiate searches of the ISO ClaimSearch database on various fields of information. Before using Claims Inquiry, the underlying claim must first be submitted through Claims Reporting either through the ISO ClaimSearch website or a system-to-system interface. Note: Claims Inquiry is the replacement to SOS, SOS Plus, Eye-Q or IQ. VIN Decoding — ISO’s VIN Decoding with VINAssist® is a Web-based application that enables you to edit and decode the 17-character Vehicle Identification Numbers (VINs). Errors found in VINs may denote a number of circumstances such as erroneously recorded VINs, altered VINs, VINs switched from another vehicle, or VINs that describe vehicles never manufactured. Information used for VIN verification is received voluntarily from participating vehicle manufacturers. VIN Decoding alone should not determine the validity of a VIN and further investigation is strongly suggested. SIU Case Manager – ISO developed this with expert input from the industry as a workflow solution for SIU operations. Its automated functionality includes case assignment, diary, reporting, compliance and an ISO ClaimSearch interface. NICB Submission — Questionable claims can be referred to the National Insurance Crime Bureau (NICB) Questionable Claims Database. This can be claims already reported via Claims Reporting, or an initial claim reported at the time of the NICB Submission. Decision Net® — Authorized users can access public records, criminal records, police reports, and medical records to search for information on individuals and businesses. Available information includes names, addresses, telephone numbers, bankruptcy information, Social Security numbers, dates of birth, previous addresses, nearest neighbors, state and federal tax liens, real estate data, professional licenses, automobile and driver license data, business data, Universal Commercial Code (UCC) filings, and civil and criminal records. OFAC - The Office of Foreign Assets Control (OFAC) of the U.S. Department of Treasury administers and enforces economic and trade sanctions against a master list of more than 5,000 “specially designated nationals and blocked persons.” U.S. insurance companies and their employees are responsible for screening claims against this master list. OFAC Lookup (single name searching) and OFAC Reports (Compliance and Enterprisewide) can be accessed through the website. Account Management — Authorized management and users can access account management information for ClaimSearch, Decision Net and ClaimDirector including management reports and billing details. Medicare Secondary Reporting Payer Service reports are also included in this section of the website. Please see the individual sections of this user manual to find out more information regarding the specific applications.

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SUNSETTING OF MONOLINE FORMAT SYSTEMS ISO ClaimSearch has supported multiple formats for the processing of insurance claims for many years. Some of these systems have become known as our Monoline Format or Legacy Format systems. The systems include: the Index System (casualty); the Property Insurance Loss Register (PILR), and the vehicle information databases formerly administered by the National Insurance Crime Bureau (NICB). Effective January 1, 2010, users are no longer able to submit new initial claims via the ClaimSearch website in the Monoline Formats. All companies were switched to Universal Format reporting to report new initial claims via the website. This does not affect a user’s ability to make changes to or reindex existing Monoline Format claims. The January 1, 2010, date also does not affect Monoline Format system-to-system customers. Effective January 1, 2012, all companies must switch to Universal Format reporting for both the website AND for system to system reporting. This will complete our sunset of our legacy systems and allow ISO ClaimSearch staff to concentrate our support on our newer more robust Universal Format and XML Format for the reporting of claims. Therefore this manual has been redesigned with this sunset in mind. The manual is geared to the reporting of Universal Format claims. A smaller section is still included for making changes to, reindexing, or converting existing Monoline Format claims, however the initial reporting sections and the match report sections have been removed. If you continue to need assistance on the Monoline Format pages of the website after January 1, 2010, please contact ISO ClaimSearch Customer Support at 800-888-4476 or njsupport@iso.com.

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LOGGING ONTO ISO CLAIMSEARCH What you need to begin: • Standard Web browser (either Microsoft Internet Explorer version 5.01 or higher or Netscape version

4.06 or higher) • ISO ClaimSearch User ID - 5 characters alphanumeric • ISO ClaimSearch User Password - User password is case-sensitive. • Office Code for Claims Reporting – 9 characters alphanumeric Enter the web address (https://claimsearch.iso.com) into your internet browser to get to the home page shown below. Click in the user ID and password fields in the upper right-hand corner to enter the appropriate information. Each time you login to ISO ClaimSearch, you will be required to agree to the “reasonably necessary” clause by checking the box under the Log In information in order to proceed. This relates to ISO’s requirement for the security of the system. Then click the blue <Log In> button. The <Reset> button will simply clear the User ID and Password fields, not reset your password. For questions or problems regarding ISO ClaimSearch, please call 800-888-4476, or e-mail njsupport@iso.com. This page also provides information to contact ISO directly for website technical support, to inquire about ISO ClaimSearch, or to ask about other products and services offered by ISO.

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CHANGING YOUR PASSWORD After you have initially logged in, the page below will appear. You must change your password to ensure the privacy and integrity of your account. Current Password – The password you just used to log into the system. New Password – All passwords must be 8 characters minimum, must contain at least one letter and one number, and special characters may be used. Confirm Password – Repeat the password as entered in the New Password field. The <Reset> button will clear any information you have typed in. The <Update> button will change your password in the system. Note: ISO will prompt you to change your password every sixty days, though you have the option of changing it more often. If you wish to change your password between the automatic 60-day prompts, you can access this screen at any time via the USER PROFILE page. Click on the User Profile link on the bottom of the page. On the bottom left of the USER PROFILE page there is a button to <Change Password>.

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PRIVACY AND SECURITY The first time you log in, the PRIVACY AND SECURITY section shown below will appear. Please review this section carefully. Systems security and data confidentiality are of utmost importance to ISO. Given the private nature of information in the database, ISO has adopted special security precautions. The ISO ClaimSearch “Privacy and Security Policy” complies with federal and state privacy legislation, the National Association of Insurance Commissioners’ Insurance Information and Privacy Protection Model Act, as well as the Health Insurance Portability Accountability Act (HIPAA). When you enter your User ID and password, you will be asked to read and agree with the ISO ClaimSearch Privacy and Security Policy in order to proceed. Click <Agree> to continue into the site. Click <Disagree> to exit out of the site.

Note: ISO has implemented 128-bit encryption on the ISO ClaimSearch website. This is the highest form of security available for Web browser transactions. This means enhanced protection of customer data coming into ISO ClaimSearch and of reports being returned to customers.

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USER PROFILE After you agree to the ISO Privacy and Security access statements, you will be directed to the USER PROFILE page. This page allows you to update your contact information and security validation responses. This page also provides a link to change your password via the <Change Password> button. (See Change Password for further information on password requirements.) Click <Update> to submit the information. The <Reset> button will reset to the values present when the screen was opened. Please contact Customer Service (800-888-4476) to make changes to User Name or Company Name.

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ISO CLAIMSEARCH HOME Once logged on, the ISO ClaimSearch HOME page appears. This is where you will be able to access all of the system's services. News – This section provides the latest information on product or service enhancements. The ISO ClaimSearch What’s New link will take you to a listing of all announcements released in the last 3 years. Menu – This section provides links to and descriptions of the various products and services provided by ISO ClaimSearch. Clicking the link will take you directly to that product or service. If you do not have access to a specific product, a pop up box will appear informing you of this. Resources – This section provides links to various resources, such as Reference Guides, access to your User Profile, and information on contacting ISO ClaimSearch. Note: Most Menu and Resource options can be accessed from any screen in the website by clicking on the links at the top and bottom of the page. Click on the title of the product or service that you need (blue and underlined hyperlink) to be taken directly to that product or service.

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IF YOU NEED HELP If You Need Immediate Assistance Please contact ClaimSearch by calling 800-888-4476 or by e-mailing njsupport@iso.com. Password resets cannot be handled by email for security reasons. For password resets, please follow the prompts to the ISO Technical Help Desk. For all other calls, including NEW USER ID’s, please direct your call to ISO ClaimSearch Customer Support. For Law Enforcement Users, please contact the NICB for support by calling (800) 447-6282, or by e-mail at nicbcsg@nicb.org. Online User Manual and Guides You can find help by clicking on the USER MANUAL AND GUIDES link of the ISO ClaimSearch website, which will give you the opportunity to download the manuals and training programs below:

Medicare Secondary Payer Reporting Service

• ISO ClaimSearch Medicare Secondary Payer Reporting Service User Guide • Universal Format Manual (Specifications) • XML Manual (Specifications) • Layouts for File Returned From CMS • July 15 ISO ClaimSearch Medicare Secondary Payer Reporting Service Webinar Recording • July 15 ISO ClaimSearch Medicare Secondary Payer Reporting Service Webinar PowerPoint

Presentation • Pre-Query Extract File Information and Layouts • ISO ClaimSearch Medicare Secondary Payer Reporting Service Web Manual User Manuals/Guides/Notes

• ISO ClaimSearch User Manual • ISO ClaimSearch System and Services Overview • ISO ClaimSearch Quick Reference Guide • Decision Net User Manual • VLM User's Guide • VLM Quick Reference Guide • VLM Release Notes • Universal Format Manual (Specifications) • XML Manual (Specifications) • Online Utilization Report Reference Guide • Integrated Statistics Report Reference Guide • ISO ClaimSearch Billing Detail Reference Guide Training Programs

• ISO ClaimSearch User Orientation Units • VLM Training Program • VLM Upgrade Training Program Access Authorization Form

• ISO ClaimSearch Access Authorization Form The blue <?> button on Universal Format screens also provides access to extensive Help menus.

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Contact ISO ClaimSearch Online Form The ISO ClaimSearch HOME page has a link to Contact ISO ClaimSearch. Through this link you are able to request training either via the web or in person, request further information, or make general comments and suggestions. Below is the beginning of this form. Please complete all required fields on the online form marked with an (*) in order for ISO ClaimSearch to respond to your request.

ISO ClaimSearch User Meetings: ISO ClaimSearch provides free periodic User Group meetings for our subscribers in major cities nationwide. The meetings provide: • an overview of the system's development • an overview of the system's capabilities • training on how to use the system efficiently • descriptions of optional services For more information on ISO ClaimSearch training tools contact ISO ClaimSearch Customer Support at 800-888-4476. To find the schedule for the ISO ClaimSearch User Group meetings near you, visit us at www.iso.com, click “Conferences,” then “ISO ClaimSearch User Meetings”. Check the site regularly as new sessions are added routinely.

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Free CD-ROM To request one of the CD-ROM’s listed below, please contact Customer Support by calling 800-888-4476, or by emailing njsupport@iso.com. • ISO ClaimSearch ViewLink Manager CD-ROM Demonstration Program • ISO ClaimSearch User Orientation Units (CD-ROM)

Orientation units include:

System and Services Overview Quick Reference Guide to Using ISO ClaimSearch on the Internet Logging-on for the First Time How to Report Claims Universal Format — an Overview Using Claims Inquiry — the Investigations Query Function Using VIN Decoding with NICB VINAssist® Using NICB Submission for Questionable Claim Referrals Using Decision Net Data

This CD also includes the following user manuals:

The User Manual for ISO ClaimSearch on ISOnetSM ISO ClaimSearch Decision Net User Manual

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CLAIMS REPORTING – GENERAL INFORMATION Upon clicking the Claims Reporting link on the Home Page, you will be brought to the initial “Reports” page. From this page, you can:

View, print, and delete Match Reports on claims submitted under your user ID; Switch to Office Reports to view and print Match Reports on claims submitted by other users

within the same office; Click on “Claim Submission” to enter a new claim or edit an existing claim on the system; Click on “APD FastCheck” to enter an Auto Physical Damage claim using the Optional Additional

Service – APD FastCheck (see Additional Services in this manual); Click on “Preferences” to enter or edit Adjuster Name(s) or Office Code(s) associated with your

user ID.

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MY REPORTS PAGE The initial Reports page of Claims Reporting is known as the My Reports page. On this page, the user can view claims reports submitted under his/her user ID. To view Match Reports submitted under other users within the same office, please see OFFICE REPORTS. Column Headings - Reports can be sorted using the headers at the top of each column. For example, clicking “REPORT DATE” sorts the reports by date starting with the oldest (ascending). Do it again and the reports sort out by date starting with the newest (descending.) below. Report Date – This is the date the report was generated. Report Types – This column shows the Type of Report that has been generated based on a user’s Claim Submission or a System-Generated Report. (See Claims Reports for further information.) Adjuster – This is the Adjuster Name as entered on the coverage page. If multiple adjuster names were entered under separate coverages, then the first one entered is displayed here. All adjuster names will display in the report details. Score – If your company is a ClaimDirector subscriber and has requested a claim to be scored, the numeric score will appear in this column as well as in the details of the report itself. Claim Number - To view an individual match report, click on the Claim Number of the report. This will take you into the detailed report. Additional Symbols (Next to Claim Number) - • NEW - A red “NEW” next to the claim number indicates the report has not been viewed or printed. As

soon as this report has been viewed or printed, the NEW will disappear. • Yellow Flag – This claim has ClaimDirector Claims Handling Characteristics associated with it.

Further details are listed in the report. • Red Box/White “!” – This claim has a Medicare eligible claimant with missing or invalid information in

Medicare required fields. Routing – The information displayed here is the Routing/Misc Information as entered on the Basic Information page or Coverage pages. If multiple were entered, then the first one entered is displayed here. All Routing/Misc Information will display in the report details. Function Buttons - <Print New>; <Print Selected>; or <Delete Selected> will allow a user to perform the specified function on up to 50 reports at a time. <View All Office Reports> is described under the Office Reports section of the manual. NOTE - If the box next to a claim is checked and you click on <Delete Selected>, the selected report will be remove from the MY REPORTS page as well as the OFFICE REPORTS page , but will not remove the claims from the database. Once a report has been deleted from the REPORTS pages, the claim will need to be resubmitted in order to generate a new report. Page Numbers - Clicking on page numbers (if they appear) will take you to that particular page to view the next group of reports. Show All Reports – This will show all pages on one screen that can be scrolled through using a gray scrollbar on the right of the page.

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USE THE CLAIMSEARCH FILE NUMBER TO RETRIEVE MATCH REPORTS Each claim reported to ClaimSearch is assigned a unique File Number by the system. If you know the ClaimSearch File Number of your initiating claim, you can use the ID to search the match reports currently displayed for your office for all reports containing that File Number. Enter the 11-character ClaimSearch file number in the blank field and click on <Retrieve>. You will be navigated directly to the match report for that claim. If more than one match report is found, you will see a listing of match reports and can select the match report you are interested in viewing. NOTE - This feature will only work for reports displayed in the current listing. It will not find the match reports once they have been deleted from the MY REPORTS page by either the user or the system.

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OFFICE REPORTS If you want to look at claims submitted by other users within your office, you can click on <View All Office Reports> in the bottom right-hand corner of the MY REPORTS page. This will show all reports for all users who have the same office code as you. If you have access to view more than one office code, you must first select the office from the drop down menu, then click on <View All Office Reports For:>

<Print Selected Reports> will allow users to print up to 50 reports at a time. <View My Reports> returns you to the MY REPORTS page. <View All Office Reports For:> will appear for users who have access to view more than one office code along with a drop down menu from which to choose an office.

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CLAIM SUBMISSION – GENERAL INFORMATION Moving Between Fields: You may use the <TAB> key to move from field to field or you may use your mouse by clicking in the field where you want to enter information. If you make a mistake, you can easily return to a previous field to correct the mistake. Just press the <SHIFT> and <TAB> keys simultaneously, or click with your left mouse button in the field you want to return to. When you have completed entering the information on a page, click on the <Next> button to proceed to the next page. When selecting a record to work with, you can click once to select it and then click the appropriate button, or you can also select a record by double clicking on it. Some fields also have pull-down menus allowing you to select your entry from a list. Special Markings on Field Names: R - Required fields. These must be completed to move to the next page. S - Searchable fields (in addition to the required fields). If data is entered, it is added to search criteria.

- Fields that should be completed by ClaimDirector subscribers to improve scoring results. * - Fields that are required for Medicare Section 111 Reporting. Moving Between Pages: NOTE: DO NOT USE YOUR BROWSER’S NAVIGATION BUTTONS! YOU WILL LOSE ALL CLAIM INFORMATION AND HAVE TO RE-ENTER THE CLAIM FROM THE BEGINNING. On most pages, there are navigation buttons: <Previous>; <Next>; <OK>; <Skip>; <Cancel>; <Submit>; and <Delete>. The <Previous> button allows you to return to a previous page. This button does not appear if you are on the first/only page. The <Next> and <OK> buttons allow you to save the information entered and bring you to the next page. This button does not appear if you are on the last/only page. The <Skip> button allows you to skip over the page without entering information. When this button is on the page, you cannot move back to the previous page. In order to make changes on the previous page, you must click on the <Skip> button until you reach the CLAIM SUMMARY page. From there you can choose the page you wish to change. The <Cancel> button allows you to close out of the window. In this case, none of your changes are saved including any claim information entered thus far. The <Submit> button becomes enabled when you have entered the minimum required fields of information to submit the claim. Clicking this button will save the claim information to the database. The Delete hyperlink allows you to delete an entire page of information from the Claim Summary page by clicking the hyperlink on the line of information you wish to delete.

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FIRST TIME USERS - REPORTING A CLAIM To report a claim, click the Claims Reporting link at the top left of the screen or at the top of the Menu section of the ISO ClaimSearch HOME page. The REPORTS page will appear. Before you can report a claim, you will first need to complete the required information on the PREFERENCES page. To do this, click on the Preferences link.

SETTING UP YOUR PREFERENCES If you are reporting a claim for the first time, the preferences for your office must be entered. You will only need to enter this information once, but you may make changes to it at any time. Click on Claims Reporting on the HOME page, and then click on the Preferences link at the top of this page. Once you are on the USER PREFERENCES page, you will need to do the following: Type in the Adjuster Name, Office Code and Location information; click <Add> after each section. You will see your information added to the appropriate panel on the right. It is important that you use the 9-character office code that accompanies your login ID. Location refers to a description of the office code to assist the user in distinguishing one code from another. If you are entering multiple office codes, you may want to differentiate by city, department, company, etc. You may also add multiple adjuster names which, when entering a claim, will provide a pull-down menu to select from. If the information is accurate, click the <Update> button at the top of the page to proceed. A pop-up window will appear that states the updates are successful. Click the Claim Submission link at the top of the page. You are now ready to submit a claim. If you need to remove an adjuster name or office code from the list, highlight the information and click the <REMOVE> button below the information to be removed. You must then click <Update> to properly have the removal of the adjuster or office code saved in the system. Note: You must always have at least one adjuster and one office code entered in order to submit a claim.

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LOSS & POLICY INFORMATION Reporting to ISO ClaimSearch can provide you with information to help evaluate the claim, identify meritorious claims, and suspect claims. The information provided by the system can lead to the denial of a claim, negotiation of a reduced award, or further investigations by insurers or law enforcement. In order to enhance the quality of the database for claim professionals and special investigators, please submit as much information as possible. To begin submitting a claim, enter the appropriate information about the claim that is being reported to the system. After completing the required fields – Office Code, Claim Number, Date Of Loss, and Policy Number, click the <Next> button to proceed to the next page. NOTE: This page is common to all claim types (casualty, property and auto). If you have reported a previous claim or claims with identical data in the required fields, we will pull up the original claim(s) submitted. By providing you with the original claim, you may make a change to it, request a new search, or update it from Monoline format to Universal Format (see CLAIMS REPORTING – EXISTING CLAIMS). If a previous claim is not pulled up based on the data entered in the required fields, you will be brought to the BASIC INFORMATION page for the new claim. In addition, please note the following: • Dashes or spaces in the policy number and claim number fields will be removed during processing. • Self-insureds who do not maintain policy numbers should enter claim numbers in both fields.

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BASIC INFORMATION The Basic Information Page records general information about the claim you are submitting to ISO. These data elements, which include policy type, addresses, loss and policy information, etc., apply to the claim as a whole. Policy Type – Use the drop-down list to select a Policy Type. The Policy Type chosen here will affect the options on the pages that follow. Once you move past this page and select a coverage type, you will not be able to alter the policy type on this page. You will need to exit the claim without submitting it and start again. If the claim was already submitted, then you will need to contact ISO ClaimSearch Customer Support (800-888-4476) for assistance with the claim. Show List - The Show List hyperlink will bring up a list of U.S. states and Canadian provinces, or Foreign Countries to select the abbreviated code for that field. Physical Risk Information – This address is used when the location of the physical risk is separate from the Insured’s address or the location of loss; generally used in Commercial Property accounts with multiple locations or buildings. CAT Indicator/Number – These fields should be populated if the claim is due to a catastrophe as identified by PCS (Property Claim Service). For example, a claim due to hurricane damage. Agency Notified of Loss and Police/Fire Report Case No – These fields are to indicate if Police or Fire agencies were notified of the loss and provided a case number. Routing Info – This 20 byte field is purely for your internal use to help with the handling of the claim. If provided, routing information will appear on the MY REPORTS page. Vessel/Call Number and 8F Fund Claim – These fields are used for Marine Workers Comp claims for Federal Longshore and Harborworkers claims.

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BASIC INFORMATION (continued) Mailing Address Information – This information is completed when the mailing address of the insured is different than the Location of Loss or the Insured’s primary address. (For example, an address with a PO BOX would be entered here.) SIU Information – If the claim or any part of the claim has been assigned to an SIU for further investigation, please provide the SIU’s contact information. For Medicare Reporting – This section must be completed for claims utilizing the Medicare Secondary Payer (CMS) Reporting Service. Please see the CLAIMS REPORTING – CMS REPORTING section for further information. Submit Claim Only – DO NOT SEARCH - Users should check this box on the BASIC INFORMATION page to submit a “No Search” claim. If this box is checked, no Match Report will be generated. This feature should only be used for special circumstances. Please contact ISO ClaimSearch Customer Support at 800-888-4476 for further information concerning this option. When all information has been completed, please click on the <Next> button at either the top or the bottom of the page.

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INVOLVED PARTY INFORMATION The INVOLVED PARTY INFORMATION page records information about the individuals or businesses involved in the claim you are submitting to ISO. The data elements gathered on this page are only for the individual or business involved in the claim in the role type indicated at the top of the page. A separate INVOLVED PARTY INFORMATION page will be added for each individual or business directly involved in the claim. Parties that are associated with the claim but not directly involved may be entered as a Service Provider (see SERVICE PROVIDER INFORMATION). Role- The appearance of, and the choices, available in the Role field will depend on the Policy Type you entered on the previous page. “Insured” should be used to indicate a person or organization that holds the policy, but is not injured or claiming property damage themselves. “Both Claimant & Insured” should be used to indicate a person or organization that holds the policy, and is making a claim against that policy. Some Policy Types restrict what role is available on the first INVOLVED PARTY INFORMATION page. (For example, Workers Compensation will limit the first party to the Insured role whereas Automobile policies will provide the choices shown below.) Name/Address/Phone - Complete all known information for the Involved Party with the role indicated at the top of the page. You will have the opportunity to complete a separate Involved Party page for each party involved in the claim. Show List – This will open a pop-up window listing appropriate State and Territory or Country Codes. Occupation – This is the occupation of the individual named on this page. The field can have up to 50 characters.

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INVOLVED PARTY INFORMATION (continued) DOB – This is the Date of Birth submitted as MMDDYYYY (Month, Day, Year) without separators (- . /). This will enhance searches on the name of this involved party if provided. SSN – This is the 9 digit Social Security Number (for individuals) without hyphens. This provides a nationwide search against all SSN’s provided. Matches on this number will be provided in the Match Reports, but the number will be masked on the output in the format of (xxx-xx-9999). TIN – This is the 9 digit Tax Identification Number (for organizations) without hyphens. Driver’s License Information – This is the driver’s license number and state of the Involved Party. This information will be searched against the database. Matches on this number will be provided in the Match Reports. Investigation Details (involving this party) – If the claim as a whole has been assigned to an SIU for further investigation, then please complete these fields to indicate THIS NAMED party’s role in the investigation. Please complete these separately on each INVOLVED PARTY INFORMATION page. Click on <Previous> to return to the BASIC INFORMATION page. Click on <Next> to go on to the COVERAGE INFORMATION page for this involved party.

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COVERAGE INFORMATION The COVERAGE INFORMATION page allows you to select the coverages that apply to an Involved Party. The list of available coverages shown on this page is determined by the combination of Policy Type (selected on the BASIC INFORMATION page), and the Role (selected on the INVOLVED PARTY page). Select the coverages that apply to this involved party by clicking on the box to the left of the coverage type. Selected coverages are designated by a check mark. You may select multiple coverages for this involved party. To deselect a coverage, click the box again and the check mark will disappear. Click <Next> to assign the selected coverages to the involved party. The applicable pages are displayed for data entry of the specific information related to those coverages. At least one box must be selected before you proceed. NOTE: When you are adding coverages to an Involved Party (by choosing <Add Coverages> from the CLAIM SUMMARY page), only the coverages that are not currently selected are displayed as unchecked. For instance, on a vehicle claim, coverages such as Collision, PIP, and Rental Reimbursement may apply. If you selected Collision initially, and are now adding another coverage to the same involved party, the list of available coverages will not show Collision as an option. This occurs because once you assign a coverage to an involved party, you cannot assign it a second time to the same involved party.

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CLAIM SUMMARY This is the summary page to show what has been added to the claim information. From this page, you are able to add involved parties (such as second insureds or partners) using the <Add Party> button. You may also add Coverages, AKA (Also Known As) information, or Service Provider information (such as mortgagees or contractors) using the hyperlinks next to the role of the associated involved party. If you wish to change the BASIC INFORMATION page, please click on the <Edit Basic Info> button to take you to the page to make changes. NOTE: You cannot change Policy Type from the CLAIM SUMMARY page. To change Policy Type, click on CLAIM SUBMISSION at the top of the page to exit the claim without submitting it and start the claim anew. If you wish to change information on an Involved Party, AKA information, Service Provider information, or Coverage Information, make sure you click on the appropriate hyperlink that is listed on the line of information you wish to alter. You may use the Delete hyperlinks to delete an entire page of information by clicking on the appropriate hyperlink that is listed on the line of information you wish to alter. NOTE: Each claim is required to have at least one insured and one coverage. Generate ClaimDirector Score – If your company is signed up for ClaimDirector scoring and submits claims via the website. You will need to check this box for EACH claim you wish to have scored. You may score each claim a maximum of 6 times. Recall Search – Insured Vehicles – Checking this box requests ClaimSearch to search for NHTSA Vehicle Recall information associated with the Insured’s vehicle(s). If a Recall is in effect at the time of the accident, it may have bearing on how the claim is handled. When you have completely added all information to the claim, click on <Submit> to add the claim to the database.

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AKA INFORMATION AKA (Also Known As) information can be added to indicate prior addresses, other names used, and maiden names. AKA information can be added for any involved party or service provider on the claim. We recommend that AKA information is added to the claim where known as it improves our database and therefore your match results. Make sure that when adding AKA information, you click on the appropriate hyperlink (see CLAIM SUMMARY). Address, City, and State are not required on this page. If a name is entered without an address, then the address listed on the INVOLVED PARTY INFORMATION page for this party will be used in searching for matching claim information. Click on <Cancel> to return to the CLAIM SUMMARY page without making changes. Click on <Next> to add the AKA Information to the CLAIM SUMMARY page.

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SERVICE PROVIDER INFORMATION A Service Provider is generally any person or business providing services due to the loss (ex. Doctor or Lawyer), but is not an involved party in the loss (ex Insured or Claimant). Service Provider information can be added for any involved party on the claim. We recommend that Service Provider information is added to the claim where known as it improves our database and enhances special investigation search results. Make sure that when adding Service Provider information, you click on the appropriate hyperlink (see CLAIM SUMMARY). Although Address, City, and State are not required on this page, entering a full name and address will enhance Special Investigator search results. Investigation Details (involving this party) – If the claim as a whole has been assigned to an SIU for further investigation, then please complete these fields to indicate this named party’s role in the investigation. Please complete these separately on each SERVICE PROVIDER INFORMATION page. Click on <Cancel> to return to the CLAIM SUMMARY page without making changes. Click on <Next> to add the AKA Information to the CLAIM SUMMARY page.

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VERIFICATION OF SUBMISSION When all claim information has been added or updated, please click on <Submit> on the CLAIM SUMMARY page. A pop-up window should appear confirming that you wish to add the record to the database. Click <OK> and the claim will then become a permanent part of the database. Click <Cancel> to return to the CLAIM SUMMARY and make any necessary changes or click on any other link to cancel out of the claim without submitting it.

You should then see the message below notifying you that your submission was received. Click on the <View Reports> button to view reports for your claim. To see the different types of reports, go to CLAIM REPORTS. Click on <Add New Claim> if you want to begin entering information on your next claim.

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GLOSSARY –FIELD DEFINITIONS Actual Cash Value The actual cash value (fair market value or replacement cost less depreciation) of the vehicle (or other property) in dollars prior to the loss. Address The street address of the person or business involved in the claim. Add Party To add an additional person to a loss (choose from pull-down menu). Adjuster The name of the insurance company adjuster responsible for the claim. Adjusting Company Code The 9 character alphanumeric code assigned by ISO to the company that is adjusting the loss. Agency The name of the law enforcement agency requesting claim information. Agency Notified of Loss The name of the law enforcement agency to which the loss was reported. Air Bag Info Indicates the status of the vehicle’s airbags after the loss. AKA Also Known As – prior name and address information for this individual or business (may include maiden names, nicknames, and previous or additional residences). Alleged Injury/Property Damage A free form field (up to 50 characters) describing the injury or the property damage of the Involved Party named on the page. Anti-Theft Device Indicates if the vehicle was equipped with an anti-theft device (choose from pull-down menu). Appraised The appraised value of the vehicle in dollars. Assigned Risk Indicator Indicates if the vehicle was in a state assigned high-risk auto insurance plan. Benefit Type The type of Workers Compensation benefits received (choose from pull-down menu). Boat Length The specific length of the boat in feet. Boat Make The manufacturer of the boat. If the boat is homemade, enter “homebuilt”. Boat Model The specific model name and/or number assigned by the manufacturer to the boat.

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Boat Type The type of boat (choose from the pull-down menu). Boat Year The most current year that the boat has been registered. Business A free form field containing the name of the business involved in the record (up to 50 characters Buyer Information The name of the individual or business that has purchased the salvaged vehicle. CAT Indicator Indicates if the loss was related to a PCS (Property Claims Service) designated catastrophe. CAT Number Catastrophe number as designated by PCS (Property Claims Service) Chassis The serial number of the chassis. City The name of the city of the person or business involved in the record, or city location where the loss occurred. Claimant Indicates the business or individual making a claim against the policy held by the insured. Claim Number A reference number used by an insurance company to identify a specific claim. (This is a key field that must always be referenced as originally reported.) Claim Status Indicates the claims status (such as open or closed). Select from pull-down menu. Classification Indicates the vehicle recovery classification (choose from pull-down menu). Color Indicates the color code of the vehicle (choose from pull-down menu). Company The complete name of the insurance company involved in the record. Company Received Date The date the company received the claim. Condition of the Recovered Vehicle The condition of the vehicle upon recovery (choose from pull-down menu). Country The two character abbreviation for the country (choose from list). Court Filed The type of court in which the lawsuit was filed in (e.g. Federal, District, Supreme, etc.).

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Court Filed Date The date on which the lawsuit was filed with the court. Coverage Type Indicates the type of insurance coverage for the claim (choose from pull-down menu). CPT Code This is a numeric code that describes the medical treatment provided as reported by a medical provider. Customer Code (Office Code) See Office Code. Date Claim Closed The date the claim was closed by the insurer. Date of Loss The date the loss occurred. (This is a key field that must always be referenced as originally reported.) Date of Recovery The date the vehicle was reported as recovered. Date of Salvage The date the vehicle was salvaged. Date of Settlement The date the lawsuit was settled. Date of Theft The date the vehicle was reported stolen. DOB The date of birth of an individual involved in the claim. Driver’s License Number The unique number provided by the state on the driver’s license. Driver’s License State The two-character state code indicating the state in which the driver’s license was issued. Edit Basic Info. After a claim has been entered you may edit any of the information before submitting the claim. Employment Status A code used to indicate the employee’s primary work code status at the time of the injury with the covered employer. Engine HP The numeric value of the horsepower of the engine. Engine The serial number of the engine. Engine Manufacturer The name of the engine manufacturer.

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Engine Missing Indicates if the engine was missing from the vehicle at the time of salvage. Estimated Loss Amount The estimated dollar amount for a claim. 8F Fund Claim A Federal program which reimburses the second employer for a reinjured marine worker. First Name The first name of an individual involved in a record. Gender The gender of the individual involved in a record. HIN Hull Identification Number of the boat as assigned by the manufacturer. Incendiary Fire Fire other than accidental origin. Insured The business or individual that is covered by an insurance policy. Insured Operator at Fault Indicates whether the insured operator was at fault. Last Name The last name of an individual involved in a record. Last Year Registered The most current year that the vehicle was registered. Law Enforcement Agency The name of the law enforcement agency holding the theft report on the vehicle. License Plate Type Indicates the category of the use of the vehicle (choose from pull-down menu). Location of Loss The physical location where the loss occurred. Loss Type Indicates the type of loss (choose from pull-down menu). Loss Time Start Date On a marine workers comp claim, the first date the claimant was unable to work as a result of the injury. Loss Time End Date On a marine workers comp claim, the last day that the claimant was unable to work as a result of the injury. MI The middle initial of an individual involved in a record.

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Mailing Address Information The mailing address of the insured if different than the insured location. Make Free form field for the make of the vehicle. It will be pre-loaded if the VIN passes edit. Match Report Report sent by ISO ClaimSearch to participating companies that identifies a claim in the database found as a result of a claim submitted. Medical/Professional License The number assigned to an individual to indicate a valid medical or professional license. Mileage The odometer reading of the vehicle in miles upon salvage. Model Free form field for the vehicle model. It will be pre-loaded if the VIN passes edit. Name The name of the person at the insurance company to contact if there are any questions. Nature of Injury (ICD9 Code) The International Classification of Diseases ver. 9 code describing the nature of the injury. This is usually provided by a Medical Provider. Occupation A free form field containing the occupation of the person named in the claim (up to 50 characters). Odometer The odometer reading of the vehicle in miles. Office Code (Customer Code) The 9-character alphanumeric identifier assigned by ISO to the office that is reporting the claim. If you have a 12 digit numeric code from the INDEX or PILR systems, you will need to contact ISO ClaimSearch Customer Service, 800-888-4476, to find out the corresponding 9-character code for web reporting. Although this is a key field that must always be referenced as originally reported, if the claim was originally reported with a 12 digit code, the system will recognize the corresponding 9 character code when entered via the website. Outdrive Serial No. The manufacturer supplied serial number for the outdrive motor. Outer Hull Material The primary material that the outer hull is made of (choose from pull-down menu). Pager The individual’s pager number. Pager PIN The personal information number of the individual’s pager. Paid Amount The dollar amount paid to date for this claim.

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Part of Body The two-digit code for the part of the body where the injury occurred. Party A person or organization that is directly involved in the claim. Passport The unique number assigned to a person’s passport. Physical Risk Information The physical location of the property insured. This address is used when the location of the physical risk is separate from the Insured’s address or the location of loss; generally used in Commercial accounts with multiple locations or buildings. Phone The customary 10-digit telephone number. Point of Impact The location of damage to the vehicle. Police/Fire Report Case No. The case number assigned by the police or fire agencies investigating the claim. Policy Expiration Date The date the insurance policy ends. Policy Inception Date The date the insurance policy goes into effect. Policy Number A reference number used by an insurance company to identify a specific claim or policy. This is a key field and must always be referenced as originally reported. In the case of self-insureds that do not use policy numbers, duplicate the claim number in this field. Policy Renewal Indicator Indicates whether or not the policy has been renewed. Policy Type Indicates the type of insurance policy for this claim (choose from pull-down menu). Primary Propulsion The primary propulsion of the boat (choose from pull-down menu). Prior to Loss The actual cash value of the vehicle in dollars prior to the loss. Received The amount received for the vehicle in dollars when sold as salvage. Recovering Agency The name of the agency that recovered the vehicle. Recovery City The name of the city where the vehicle was recovered.

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Recovery County The name of the county where the vehicle was recovered. Recovery State The two-character code of the state where the vehicle was recovered. Recovery Telephone The phone number of the agency that recovered the vehicle. Registration The state assigned registration number for the boat. This number uniquely identifies each boat. Reserve Amount The dollar amount reserved for this claim. Role The role of the Party named in the claim. Routing Info This field is used for claim representative’s initials, adjuster code, desk location or other routing information. Service Provider Generally any person or business providing services due to the loss, but is not an involved party in the loss, such as Insured or Claimant. Settlement Amount The amount in dollars paid to settle the claim. SSN The nine-digit social security number of an individual involved in a record. State The two character code for the state (choose from list). Style The two-character alphanumeric vehicle style code. It will be pre-loaded if the VIN passes edit. Submit Once you have verified that the information entered is correct, clicking <Submit> will send your claim to the ClaimSearch database, add the claim, and perform a search returning any matches to you. Submit Claim Only---Do Not Search This is to be used only if you want to add the claim to the database without it being searched. It is used for special conditions. Please check with ISO before using. Suit Filed by Claimant? Indicates whether the claimant filed a lawsuit. Theft Type Indicates if the theft was partial or total. Time of Loss The time the loss occurred.

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TIN The tax identification number of the person or business involved in a record. Total Lost Days On a marine workers comp claim, the total number of days of work missed as the result of the injury. Tort Threshold Type Indicates if the tort threshold is verbal or dollar. Tort Threshold State The two-character code for the state in which the tort threshold applies. Trans The serial number of the transmission. Transmission Missing Indicates if the transmission was missing from the vehicle at time of salvage. V&MM Vandalism and malicious mischief. Vehicle Disposition The disposition of the vehicle (choose from pull-down menu). Vehicle Operator Relationship to Owner The relationship of the driver to the owner of the vehicle (choose from pull-down menu) Vehicle Type Category of the vehicle by the manufacturer (choose from pull-down menu). Vessel/Call Number The name or identification number of the vessel. VIN The unique 17 character identifier assigned by the manufacturer or state department of motor vehicles to identify a particular vehicle. Vehicles made before 1981, snowmobiles, trailers, personal watercraft, mobile, construction and farm equipment may have more (up to 20) or less than 17 characters as determined by the manufacturer. VIN Plate Missing Indicates if the VIN plate was missing from the vehicle at the time of salvage. Zip The five or nine-digit postal zip code of the location in a record.

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CLAIMS REPORTING – CASUALTY (INJURY/LIABILITY)

LOSS & POLICY Reporting to ISO ClaimSearch can provide you with information to help evaluate the claim, identify meritorious claims, and suspect claims. The information provided by the system can lead to the denial of a claim, negotiation of a reduced award, or further investigations by insurers or law enforcement. In order to enhance the quality of the database for claim professionals and special investigators, please submit as much information as possible. If new information is received later, update reports can be filed. (See CLAIMS REPORTING – EXISTING CLAIMS). Casualty claims include, but are not limited to: Worker’s Compensation, Liability (General Liability, Auto Liability, and Homeowner’s Liability), PIP, and Bodily Injury claims. This also applies to Third-Party Property Damage involved in an auto claim (ex. the damage to a fence run into by a car.) To begin submitting a Casualty claim, enter the required key fields – Office Code, Claim Number, Date Of Loss, and Policy Number, click the <Next> button to proceed to the next page. If you have reported a previous claim or claims with identical data in the required fields, we will pull up the original claim(s) submitted. By providing you with the original claim, you may update it or request a new search (see CLAIMS REPORTING – EXISTING CLAIMS). If a previous claim is not pulled up based on the data entered in the required fields, you will be brought to the BASIC INFORMATION page for the new claim. In addition, please note the following: • Dashes or spaces in the policy number and claim number fields will be removed during processing. • Self-insureds who do not maintain policy numbers should enter claim numbers in both fields.

On the following screens, all Required fields are marked with an “R”. Fields marked with an “S” are Searchable fields, meaning they are not required, but will enhance your search results if provided. Fields marked with an are considered important for ClaimDirector claims scoring. Fields marked with an * are considered important for Medicare Secondary Payer Reporting Service (CMS Reporting). CMS REPORTING NOTE – The section that follows explains basic Casualty Claims Reporting. For further explanation on how to report a claim for CMS and the corresponding field definitions, please see the CLAIMS REPORTING – CMS REPORTING section of this manual.

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BASIC INFORMATION The BASIC INFORMATION page records general information about the claim you are submitting to ISO. These data elements, which include policy type, addresses, loss and policy information, etc., apply to the claim as a whole. Policy Type – Use the drop-down list to select a Policy Type. The Policy Type chosen here will affect the options on the pages that follow. Once you move past this page and select a coverage type, you will not be able to alter the policy type on this page. You will need to exit the claim without submitting it and start again. If the claim was already submitted, then you will need to contact ISO ClaimSearch Customer Support (800-888-4476) for assistance with the claim. Show List - The Show List hyperlink will bring up a list of U.S. states and Canadian provinces to select the abbreviated code for that field. Physical Risk Information – This address is used when the location of the physical risk is separate from the Insured’s address or the location of loss; generally used in Commercial accounts with multiple locations or buildings. CAT Indicator/Number – These fields should be populated if the claim is due to a catastrophe as identified by PCS (Property Claim Service), for example, a claim due to hurricane damage. Agency Notified of Loss and Police/Fire Report Case No – These fields are to indicate if Police or Fire agencies were notified of the loss and provided a case number. Routing Info – This field is purely for your internal use to help with the handling of the claim. If provided, routing information will appear on the MY REPORTS page. Vessel/Call Number and 8F Fund Claim – These fields are used for Marine Workers Comp claims for Federal Longshore and Harborworkers’ claims.

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BASIC INFORMATION (continued) Mailing Address Information – This information is completed when the mailing address of the insured is different than the Location of Loss or the Insured’s primary residence. (For example, an address with a PO BOX would be entered here.) For Medicare Reporting – These fields are explained in CLAIMS REPORTING – CMS REPORTING section of this manual. SIU Information – If the claim has been assigned to an SIU for further investigation, please provide the SIU’s contact information. Submit Claim Only – DO NOT SEARCH—To submit a “No Search” claim, users should click on the ‘Submit Claim Only – DO NOT SEARCH’ box on the Basic Information page. If this box is checked, no Match Report will be generated. This feature should only be used for special circumstances. Please contact ISO for further information concerning this option. When all information has been completed, please click on the <Next> button at either the top or the bottom of the page.

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INVOLVED PARTY – INSURED The INVOLVED PARTY INFORMATION page records information about the individuals or businesses involved in the claim you are submitting to ISO. The data elements gathered on this page are only for the individual or business involved in the claim in the role type indicated at the top of the page. A separate INVOLVED PARTY INFORMATION page will be added for each individual or business directly involved in the claim. Parties that are associated with the claim but not directly involved may be entered as a Service Provider (see SERVICE PROVIDER INFORMATION). Role- Casualty claims require you to enter the Insured first. You will have the opportunity to add the Claimant’s information on the next page. On a casualty claim, the Insured is always the individual or business who holds the policy; not the injured party. If your company is self-insured, report your company’s name and address as the Insured’s Involved Party Information. Note: The individual or business reported as the Insured on a casualty claim is not searched against the database for Match Reports unless a coverage for the insured is reported. This is to avoid unwieldy match reports due to businesses with many workers compensation and/or general liability claims Name/Address/Phone - Complete all known information for the insured. Show List – This will open a pop-up window listing appropriate State and Territory Codes. Occupation – This is the occupation of the individual named on this page. The field can have up to 50 characters. Driver’s License Information – This is the driver’s license number and state of the involved party. This information will be searched against the database. Matches on this number will be provided in the Match Reports.

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INVOLVED PARTY – INSURED (continued) DOB – This is the Date of Birth submitted as MMDDYYYY (Month, Day, Year) without separators (- . /). This will enhance searches on the name of this involved party if provided. SSN – This is the 9 digit Social Security Number (for individuals) without hyphens. This provides a nationwide search against all SSN’s provided. Matches on this number will be provided in the Match Reports, but the number will be masked on the output in the format of (xxx-xx-9999). TIN – This is the 9 digit Tax Identification Number (for organizations) without hyphens. HICN, Medicare eligible, and Do not send this party to CMS – see CLAIMS REPORTING – CMS REPORTING. Investigation Details (involving this party) – If the claim as a whole has been assigned to an SIU for further investigation, then please complete these fields to indicate THIS NAMED party’s role in the investigation. Please complete these separately on each INVOLVED PARTY INFORMATION page. Click on <Previous> to return to the BASIC INFORMATION page. Click on <Next> to go on to the COVERAGE INFORMATION page for this involved party.

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INVOLVED PARTY – CLAIMANT The INVOLVED PARTY INFORMATION page records information about the individuals or businesses involved in the claim you are submitting to ISO. The data elements gathered on this page are only for the individual or business involved in the claim in the role type indicated at the top of the page. A separate INVOLVED PARTY INFORMATION page will be added for each individual or business directly involved in the claim. Parties that are associated with the claim but not directly involved may be entered as a Service Provider (see SERVICE PROVIDER INFORMATION). Role - On a casualty claim, the Insured information is immediately followed by the Claimant’s information. A Claimant is the individual or business making a claim against the Insured for injury or liability. Claimant information is searched for Match Reports. Name/Address/Phone - Complete all known information for the insured. Fields marked with an “R” are required. Fields marked with an “S” will provide enhanced search information in the Match Report. Show List – This will open a pop-up window listing appropriate State and Territory Codes. Occupation – This is the occupation of the individual named on this page. The field can have up to 50 characters. VIN in which this person was an occupant - Please complete this field for all claims involving a vehicle. Driver’s License Information – This is the driver’s license number and state of the involved party. This information will be searched against the database. Matches on this number will be provided in the Match Reports.

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INVOLVED PARTY – CLAIMANT (continued) DOB – This is the Date of Birth submitted as MMDDYYYY (Month, Day, Year) without separators (- . /). This will enhance searches on the name of this involved party if provided. SSN – This is the 9 digit Social Security Number (for individuals) without hyphens. This provides a nationwide search against all SSN’s provided. Matches on this number will be provided in the Match Reports, but the number will be masked on the output in the format of (xxx-xx-9999). TIN – This is the 9 digit Tax Identification Number (for organizations) without hyphens. This provides a nationwide search against all TIN’s provided. Matches on this number will be provided in the Match Reports. HICN, Medicare eligible, and Do not send this party to CMS – see “Claims Reporting – CMS Reporting”. Investigation Details (involving this party) – If the claim as a whole has been assigned to an SIU for further investigation, then please complete these fields to indicate THIS NAMED party’s role in the investigation. Please complete these separately on each INVOLVED PARTY INFORMATION page. Click on <Previous> to return to the BASIC INFORMATION page. Click on <Next> to go on to the COVERAGE INFORMATION page for this involved party.

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COVERAGE INFORMATION This COVERAGE INFORMATION page allows you to select the coverages that apply to the Claimant. The list of available coverages shown on this page is determined by the combination of Policy Type selected on the BASIC INFORMATION page, and the Role selected on the INVOLVED PARTY page. Select the coverages that apply to this involved party by clicking on the box to the left of the coverage type. Selected coverages are designated by a check mark. You may select multiple coverages for this involved party. To deselect a coverage, click the box again and the check mark will disappear. Click <Previous> to return to the Claimant’s Involved Party information. Click <Next> to assign the selected coverages to the involved party. The applicable pages are displayed for data entry of the specific information related to those coverages. NOTE: On most casualty claims there is no coverage for the insured, only for the individual making the claim (Claimant). At least one box must be selected before you proceed.

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GENERAL CASUALTY INFORMATION This page represents the general casualty information as it applies to the injury/property damage of the involved party named in the top left corner of the page and the Coverage type listed above the Alleged Injuries/Property Damage field. Alleged Injuries/Property Damage – Please enter the exact injury or damage to property of this involved party (up to 50 characters). This is different than the Loss Description on the BASIC INFORMATION page which describes the entire claim. (For example, Loss Description may be “Car hit fence”. Alleged Injuries/Property Damage may be “Neck/Head Injuries” to describe the Insured’s injuries or “2 ft section of fence broken” for the damage to the Claimant’s fence.) NOTE: The only required field on this page is Alleged Injuries/Property Damage. All others are optional, but are used to enhance other products and services, such as ClaimDirector. Part Of Body - The Show List hyperlink will open a new window with a listing of 2 digit codes for the different parts of the body. Tort Threshold Type/State – These should be completed for Tort lawsuits. Loss Time Start/End Dates – These are for workers compensation claims noting the Claimant’s time away from work. Court Filed, County/State, Date, and Docket/Case Number – If a court case has been filed, please enter the type of court (i.e. Federal, State, Municipal, etc), the county location, the state location, the date of filing, and the Docket or Case Number as assigned by the court.

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GENERAL CASUALTY INFORMATION (continued) Many of the fields on the bottom portion of the GENERAL CASUALTY INFORMATION page are related to Worker’s Compensation claims and affect the ClaimDirector scoring of such claims; however the information may be completed for ANY TYPE of casualty claim as they may apply. Click <Previous> to return to the COVERAGE INFORMATION page. Click <Next> to continue to GENERAL CASUALTY INFORMATION (ADDITIONAL).

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GENERAL CASUALTY INFORMATION (ADDITIONAL) Many of the fields on the bottom portion of the GENERAL CASUALTY INFORMATION (ADDITIONAL) page are related to reporting claims to CMS per Medicare requirements; however the information may be completed for ANY TYPE of casualty claim as they may apply. NOTE - There are NO REQUIRED fields on this page for basic ClaimSearch Claims Reporting. Please see CLAIMS REPORTING – CMS REPORTING. Click <Previous> to return to the GENERAL CASUALTY INFORMATION page. Click <Next> to continue to the CASUALTY COVERAGE INFORMATION page.

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CASUALTY COVERAGE INFORMATION The information on this page applies to the involved party listed in the upper left-hand corner of the page. Adjuster Name can be selected from drop down lists based on the information listed in your PREFERENCES. Although only Loss Type and Claim Status are required on this page, completing the Amount fields as well as the date a claim closed can assist other insurance companies in making decisions on their claim without contacting your company for this information. The Adjuster fields and the Routing/Misc. field are for your company’s internal routing to assist you in tracking who is handling a specific claim or portion of a claim. The Adjuster Name will display on the MY REPORTS page listing of Match Reports. Click <Next> to add the GENERAL CASUALTY INFORMATION and the CASUALTY COVERAGE INFORMATION to the claim and review the CLAIM SUMMARY page. Click <Skip> to cancel adding the GENERAL CASUALTY INFORMATION and the CASUALTY COVERAGE INFORMATION to the claim and review the CLAIM SUMMARY page. DO NOT USE YOUR BROWSER’S BACK BUTTON TO RETURN TO THE PREVIOUS PAGE. YOU WILL LOSE ALL INFORMATION ENTERED THUS FAR ON THE CLAIM AND HAVE TO BEGIN AGAIN. From the CLAIM SUMMARY page you will be able to make adjustments to the BASIC INFORMATION, INVOLVED PARTY INFORMATION AND COVERAGE INFORMATION already entered on the claim.

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CLAIM SUMMARY This is the summary page to show what has been added to the claim information. From this page, you are able to add involved parties (such as other insureds or claimants on the claim) using the <Add Party> button. You may also add Coverages, AKA (Also Known As) information, or Service Provider information (such as mortgagees or contractors) using the hyperlinks next to the role of the associated involved party. If you wish to change the BASIC INFORMATION page, please click on the <Edit Basic Info> button to take you to the page to make changes. NOTE: You cannot change Policy Type from the CLAIM SUMMARY page. To change Policy Type, click on CLAIM SUBMISSION at the top of the page to exit the claim without submitting it and start the claim anew. If you wish to change information on an Involved Party, AKA information, Service Provider information, or Coverage Information, make sure you click on the appropriate hyperlink that is listed on the line of information you wish to alter. You may use the Delete hyperlinks to delete an entire page of information by clicking on the appropriate hyperlink that is listed on the line of information you wish to alter. NOTE: Each claim is required to have at least one insured and one coverage. Generate ClaimDirector Score – If your company is signed up for ClaimDirector scoring and submits claims via the website. You will need to check this box for EACH claim you wish to have scored. Recall Search – Insured Vehicles – See CLAIMS REPORTING – AUTOMOBILE and ADDITIONAL CLAIMS REPORTING SERVICES – NHTSA VEHICLE RECALL INFORMATION for further information. Add Additional Claimant (CMS Only) – see CLAIMS REPORTING – CMS REPORTING for further information. When you have completely added all information to the claim, click on <Submit> to add the claim to the database.

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VERIFICATION OF SUBMISSION When all claim information has been added or updated, please click on <Submit> on the CLAIM SUMMARY page. A pop-up window should appear confirming that you wish to add the record to the database. Click <Cancel> to return to the CLAIM SUMMARY and make any necessary changes or click on any other link to cancel out of the claim without submitting it. Click <OK> and the claim will then become a permanent part of the database.

You should then see the message below notifying you that your submission was received. Click on the <View Reports> button to view reports for your claim. To see the different types of reports, go to CLAIM REPORTS. Click on <Add New Claim> if you want to begin entering information on your next claim.

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CLAIMS REPORTING – PROPERTY

LOSS & POLICY Reporting to ISO ClaimSearch can provide you with information to help evaluate the claim, identify meritorious claims, and suspect claims. The information provided by the system can lead to the denial of a claim, negotiation of a reduced award, or further investigations by insurers or law enforcement. In order to enhance the quality of the database for claim professionals and special investigators, please submit as much information as possible. If new information is received later, update reports can be filed (see CLAIMS REPORTING – EXISTING CLAIMS). Property claims apply to first party property damage, including, but not limited to: Commercial Property; Farmowners; Homeowners; Boat; Mobile Equipment; and Mobile Home claims. Liability claims associated with a Property policy should be submitted following the CLAIMS REPORTING – CASUALTY (INJURY/LIABILITY) section. To begin submitting a claim, enter the appropriate information about the claim that is being reported to the system. After completing the required fields – office code, claim number, date of loss and policy number, click the <Next> button to proceed to the next page. If you have reported a previous claim or claims with identical data in the required fields, we will pull up the original claim(s) submitted. By providing you with the original claim, you may update it or request a new search (see CLAIMS REPORTING – EXISTING CLAIMS). If a previous claim is not pulled up based on the data entered in the required fields, you will be brought to the BASIC INFORMATION page for the new claim. In addition, please note the following: • Dashes or spaces in the policy number and claim number fields will be removed during processing. • Self-insureds who do not maintain policy numbers should enter claim numbers in both fields.

On the following screens, all Required fields are marked with an R. Fields marked with an S are Searchable fields, meaning they are not required, but will enhance your search results if provided. Fields marked with an are considered important for ClaimDirector claims scoring. Fields marked with an * are considered important for CMS Reporting.

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BASIC INFORMATION The BASIC INFORMATION Page records general information about the claim you are submitting to ISO. These data elements, which include policy type, addresses, loss and policy information, etc., apply to the claim as a whole. Policy Type – Use the drop-down list to select a Policy Type. The Policy Type chosen here will affect the options on the pages that follow. Once you move past this page and select a coverage type, you will not be able to alter the policy type on this page. You will need to exit the claim without submitting it and start again. If the claim was already submitted, then you will need to contact ISO ClaimSearch Customer Support (800-888-4476) for assistance with the claim. Show List - The Show List hyperlink will bring up a list of U.S. states and Canadian provinces to select the abbreviated code for that field. Physical Risk Information – This address is used when the location of the physical risk is separate from the Insured’s address or the location of loss; generally used in Commercial accounts with multiple locations or buildings. CAT Indicator/Number – These fields should be populated if the claim is due to a catastrophe as identified by PCS (Property Claim Service), for example, a claim due to hurricane damage. Agency Notified of Loss and Police/Fire Report Case No – These fields are to indicate if Police or Fire agencies were notified of the loss and provided a case number. Routing Info – This field is purely for your internal use to help with the handling of the claim. If provided, routing information will appear on the MY REPORTS page.

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BASIC INFORMATION (continued) Mailing Address Information – This information is completed when the mailing address of the insured is different than the Location of Loss or the Insured’s primary residence. (For example, an address with a PO BOX would be entered here.) SIU Information – If the claim has been assigned to an SIU for further investigation, please provide the SIU’s contact information. For Medicare Reporting – This section should not be used for General Property claims, only Casualty claims should be reported to Medicare. For further information on these fields, please see CLAIMS REPORTING – CMS REPORTING Submit Claim Only – DO NOT SEARCH—To submit a “No Search” claim, users should check this box on the BASIC INFORMATION page. If this box is checked, no Match Report will be generated. This feature should only be used for special circumstances. Please contact ISO ClaimSearch Customer Support at 800-888-4476 for further information concerning this option. When all information has been completed, please click on the <Next> button at either the top or the bottom of the page.

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INVOLVED PARTY – INSURED The INVOLVED PARTY INFORMATION page records information about the individuals or businesses involved in the claim you are submitting to ISO. The data elements gathered on this page are only for the individual or business involved in the claim in the role type indicated at the top of the page. A separate INVOLVED PARTY INFORMATION page will be added for each individual or business directly involved in the claim. Parties that are associated with the claim but not directly involved may be entered as a Service Provider (see SERVICE PROVIDER INFORMATION). Role- The first Involved Party screen will always be for the Insured. You have two choices for the Role: Insured or Both Claimant and Insured. In property claims, the second choice will be used most of the time since it is generally the individual or business that holds the policy that is making the claim. Name/Address/Phone - Complete all known information for the insured. Fields marked with an “R” are required. Fields marked with an “S” will provide enhanced search information in the Match Report. Show List – This will open a pop-up window listing appropriate State and Territory Codes. Occupation – This is the occupation of the individual named on this page. The field can have up to 50 characters. Driver’s License Information – This is the driver’s license number and state of the Insured. This information will be searched against the database. Matches on this number will be provided in the Match Reports.

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INVOLVED PARTY – INSURED (continued) DOB – This is the Date of Birth submitted as MMDDYYYY (Month, Day, Year) without separators (- . /). This will enhance searches on the name of this involved party if provided. SSN – This is the 9 digit Social Security Number (for individuals) without hyphens. This provides a nationwide search against all SSN’s provided. Matches on this number will be provided in the Match Reports, but the number will be masked on the output in the format of (xxx-xx-9999). TIN – This is the 9 digit Tax Identification Number (for organizations) without hyphens. HICN, Medicare eligible, and Do not send this party to CMS – These fields should not be used for General Property claims, only Casualty claims should be reported to Medicare. For further information on these fields, please see “CLAIMS REPORTING – CMS REPORTING.” Send to CSLN? – This field only applies to Third Party Administrators (TPAs) who must indicate on a per claim basis whether the party should be sent to the Child Support Lien Network (CSLN). Investigation Details (involving this party) – If the claim as a whole has been assigned to an SIU for further investigation, then please complete these fields to indicate THIS NAMED party’s role in the investigation. Please complete these separately on each INVOLVED PARTY INFORMATION page. Click on <Previous> to return to the BASIC INFORMATION page. Click on <Next> to go on to the COVERAGE INFORMATION page for this involved party.

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COVERAGE INFORMATION The COVERAGE INFORMATION page allows you to select the coverages that apply to an Involved Party. The list of available coverages shown on this page is determined by the combination of Policy Type (selected on the BASIC INFORMATION page), and the Role (selected on the INVOLVED PARTY page). The auto coverages below (Collision, Comprehensive, Glass, Rental Reimbursement, Towing & Labor) are applicable only when auto and property coverage exist under the same policy, such as a Personal Combination Policy. Select the coverages that apply to this involved party by clicking on the box to the left of the coverage type. Selected coverages are designated by a check mark. You may select multiple coverages for this involved party. To deselect a coverage, click the box again and the check mark will disappear. Click <Previous> to return to the INVOLVED PARTY INFORMATION. Click <Next> to assign the selected coverages to the involved party. The applicable pages are displayed for data entry of the specific information related to those coverages. NOTE: Choose General Property for all property other than a boat, mobile equipment, or off road equipment. For the purposes of our example, we are only showing General Property. Boat and Mobile/Off Road Equipment options will take you to a separate page for each option. All fields are defined in the glossary. At least one box must be selected before you proceed.

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PROPERTY LOSS INFORMATION Complete the Adjuster and Loss Type information in the top half of the page. Select the appropriate Type of Property, Property Lost, and Property Damaged by clicking on the check box. Click on the check box a second time to deselect the option. In the bottom section, enter whole dollar amounts in the appropriate boxes for Policy & Loss amounts. The dollar amounts indicate what coverage is to be applied to the claim. Estimated Loss is required by State Fire Marshals for Fire claims. Although ISO ClaimSearch will not reject a claim that is missing this field, any State Fire Marshal Office may reject the claim directly back to your company when ISO submits the claim on your company’s behalf. Please click on Show List next to Loss Type for further information on the States that require this reporting. Click on <Previous> to return to the COVERAGE INFORMATION page. Click on <Next> to review the CLAIM SUMMARY page.

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CLAIM SUMMARY This is the summary page to show what has been added to the claim information. From this page, you are able to add involved parties (such as second insureds or partners) using the <Add Party> button. You may also add Coverages, AKA (Also Known As) information, or Service Provider information (such as mortgagees or contractors) using the hyperlinks next to the role of the associated involved party. If you wish to change the BASIC INFORMATION page, please click on the <Edit Basic Info> button to take you to the page to make changes. NOTE: You cannot change Policy Type from the CLAIM SUMMARY page. To change Policy Type, click on CLAIM SUBMISSION at the top of the page to exit the claim without submitting it and start the claim anew. If you wish to change information on an Involved Party, AKA information, Service Provider information, or Coverage Information, make sure you click on the appropriate hyperlink that is listed on the line of information you wish to alter. You may use the Delete hyperlinks to delete an entire page of information by clicking on the appropriate hyperlink that is listed on the line of information you wish to alter. NOTE: Each claim is required to have at least one insured and one coverage. Generate ClaimDirector Score – If your company is signed up for ClaimDirector scoring and submits claims via the website. You will need to check this box for EACH claim you wish to have scored. Recall Search – Insured Vehicles – See CLAIMS REPORTING – AUTOMOBILE and ADDITIONAL CLAIMS REPORTING SERVICES – NHTSA VEHICLE RECALL INFORMATION for further information. When you have completely added all information to the claim, click on <Submit> to add the claim to the database.

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VERIFICATION OF SUBMISSION When all claim information has been added or updated, please click on <Submit> on the CLAIM SUMMARY page. A pop-up window should appear confirming that you wish to add the record to the database. Click <OK> and the claim will then become a permanent part of the database. Click <Cancel> to return to the CLAIM SUMMARY and make any necessary changes or click on any other link to cancel out of the claim without submitting it.

You should then see the message below notifying you that your submission was received. Click on the <View Reports> button to view reports for your claim. To see the different types of reports, go to CLAIM REPORTS. Click on <Add New Claim> if you want to begin entering information on your next claim.

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CLAIMS REPORTING – AUTOMOBILE

LOSS & POLICY Reporting to ISO ClaimSearch can provide you with information to help evaluate the claim, identify meritorious claims, and suspect claims. The information provided by the system can lead to the denial of a claim, negotiation of a reduced award, or further investigations by insurers or law enforcement. In order to enhance the quality of the database for claim professionals and special investigators, please submit as much information as possible. If new information is received later, supplemental reports can be filed (see CLAIMS REPORTING – EXISTING CLAIMS). Automobile claims apply to vehicle thefts, salvages, and auto physical damage claims, including New York 1st party and 3rd party damage. To begin submitting a claim, enter the required fields – Office Code, Claim Number, Date Of Loss, and Policy Number, click the <Next> button to proceed to the next page. If you have reported a previous claim or claims with identical data in the required fields, we will pull up the original claim(s) submitted. By providing you with the original claim, you may update it or request a new search (see CLAIMS REPORTING – EXISTING CLAIMS). If a previous claim is not pulled up based on the data entered in the required fields, you will be brought to the BASIC INFORMATION page for the new claim. In addition, please note the following: • Dashes or spaces in the policy number and claim number fields will be removed during processing. • Self-insureds who do not maintain policy numbers should enter claim numbers in both fields.

On the following screens, all Required fields are marked with an R. Fields marked with an S are Searchable fields, meaning they are not required, but will enhance your search results if provided. Fields marked with an are considered important for ClaimDirector claims scoring. Fields marked with an * are considered important for CMS Reporting.

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BASIC INFORMATION The BASIC INFORMATION Page records general information about the claim you are submitting to ISO. These data elements, which include policy type, addresses, loss and policy information, etc., apply to the claim as a whole. Policy Type – Use the drop-down list to select a Policy Type. The Policy Type chosen here will affect the options on the pages that follow. Once you move past this page and select a coverage type, you will not be able to alter the policy type on this page. You will need to exit the claim without submitting it and start again. If the claim was already submitted, then you will need to contact ISO ClaimSearch Customer Support (800-888-4476) for assistance with the claim. Location of Loss – The physical location where the loss occurred. Show List - The Show List hyperlink will bring up a list of U.S. states and Canadian provinces to select the abbreviated code for that field. Physical Risk Information – The physical location of the property insured, generally in Comm. Property. Loss Description – A 50 byte field to provide a general description of the overall incident. Assigned Risk Indicator – Check if this vehicle was in a state assigned high-risk auto insurance plan. Agency Notified of Loss and Police/Fire Report Case No – These fields are to indicate if Police or Fire agencies were notified of the loss and provided a case number. Routing Info – This field is purely for your internal use to help with the handling of the claim. If provided, routing information will appear on the MY REPORTS page. NMVTIS Operators’s Reporting Entity ID – This field is to report a NMVTIS provided reporting ID. If no ID is provided in this field the ISO Company Code will be used for reporting to NMVTIS.

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BASIC INFORMATION (continued) Mailing Address Information – This information is completed when the mailing address of the insured is different than the Location of Loss or the Insured’s primary residence. (For example, an address with a PO BOX would be entered here.) Police Report, Single Vehicle Accident, Phantom Vehicle Accident, and Was accident witnessed – These fields are to provide more information regarding a vehicle accident involving a collision. SIU Information and Claim associated with Insurer Fraud Ring Investigation – If the claim or any part of the claim has been assigned to an SIU for further investigation, please provide the SIU’s contact information and/or indicate if associated with a fraud ring. For Medicare Reporting – This is only used for casualty claims reporting to Medicare. Submit Claim Only – DO NOT SEARCH—To submit a “No Search” claim, users should check this box on the BASIC INFORMATION page. If this box is checked, no Match Report will be generated. This feature should only be used for special circumstances. Please contact ISO ClaimSearch Customer Service (800-888-4476) for further information concerning this option. When all information has been completed, please click on the <Next> button at either the top or the bottom of the page.

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INVOLVED PARTY – INSURED The INVOLVED PARTY INFORMATION page records information about the individuals or businesses involved in the claim you are submitting to ISO. The data elements gathered on this page are only for the individual or business involved in the claim in the role type indicated at the top of the page. A separate INVOLVED PARTY INFORMATION page will be added for each individual or business directly involved in the claim. Parties that are associated with the claim but not directly involved may be entered as a Service Provider (see SERVICE PROVIDER INFORMATION). Role- The first involved party page for an automobile claim is always for the Insured. This is the person who owns the policy, regardless of whether they are making a claim. Please select whether they are making a claim and what position, if any, the insured had in the vehicle. Name/Address/Phone - Complete all known information for the insured. Fields marked with an “R” are required. Fields marked with an “S” will provide enhanced search information in the Match Report. Show List – This will open a pop-up window listing appropriate State and Territory Codes. Occupation – This is the occupation of the individual named on this page. The field can have up to 50 characters. Vehicle Operator Relationship to Owner - Please choose from the drop-down menu for all automobile claims. VIN in which this person was an occupant - Enter the appropriate VIN in this field for all automobile claims. If vehicle information has been entered on the claim already, you may select the VIN from a drop-down menu or enter a new VIN in this field.

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INVOLVED PARTY – INSURED (continued) DOB – This is the Date of Birth submitted as MMDDYYYY (Month, Day, Year) without separators (- . /). This will enhance searches on the name of this involved party if provided. SSN – This is the 9 digit Social Security Number (for individuals) without hyphens. This provides a nationwide search against all SSN’s provided. Matches on this number will be provided in the Match Reports, but the number will be masked on the output in the format of (xxx-xx-9999). TIN – This is the 9 digit Tax Identification Number (for organizations) without hyphens. Driver’s License Information – This is the driver’s license number and state of the Insured. This information will be searched against the database. Matches on this number will be provided in the Match Reports. HICN, Medicare eligible, Do not send this party to CMS – These fields are only used for reporting casualty claims to CMS. See Claims Reporting – CMS Reporting. Investigation Details (involving this party) – If the claim as a whole has been assigned to an SIU for further investigation, then please complete these fields to indicate THIS NAMED party’s role in the investigation. Please complete these separately on each INVOLVED PARTY INFORMATION page. Click on <<Previous>> to return to the BASIC INFORMATION page. Click on <<Next>> to go on to the COVERAGE INFORMATION page for this involved party.

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COVERAGE INFORMATION – Insured Coverage The COVERAGE INFORMATION page allows you to select the coverages that apply to an Involved Party. The list of available coverages shown on this page is determined by the combination of Policy Type (selected on the BASIC INFORMATION page), and whether the Insured is making a claim (if Insured is not making a claim, this page will not appear.) The following Casualty/Liability coverages are available for Insureds: • Medical Payments • PIP • Underinsured Motorist • Uninsured Motorist • Other Auto The following Vehicle coverages are available for Insureds: • Collision • Comprehensive (should be used when reporting Theft or Salvage information) • Glass • Rental Reimbursement • Towing & Labor The General Property (1st Party) coverage below is applicable only when auto and property coverage exist under the same policy (such as a Personal Combination Policy). Other coverage options may be available depending on the Policy Type selected. At least one box must be selected before you proceed.

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VEHICLE COVERAGES If you checked a Casualty coverage for the Insured on the previous page, you will be brought to the casualty coverage information pages before the GENERAL VEHICLE INFORMATION (see GENERAL CASUALTY INFORMATION for further information).

GENERAL VEHICLE INFORMATION This page is the information for the insured’s vehicle. It contains the information specific to the vehicle as well as the recovery or salvage information as applicable. On the top half of this page, complete all general information for the vehicle of the involved party listed in the top left-hand corner of the page. VIN - If you have entered a valid VIN on the INVOLVED PARTY page, you do not need to enter the Year, Make, Model, Style and Vehicle Type. The system will automatically do it for you. If you enter an invalid VIN, you will have to enter the Year, Make, Model, Style and Vehicle Type. Engine, Trans, and Chassis – These refer to the serial numbers for these parts of the vehicle. License Plate Information – License Plate Number will be searched against the database for the State provided. Matching claim information will be provided on the Match Reports. Theft Type – The partial theft indicator should be used whenever contents of a vehicle or major parts are stolen. Partial thefts will NOT generate recoveries; total thefts will attempt to be recovered. Please complete as much information as possible. If Recovery or Salvage information is being reported, please scroll down and refer to the next page of the manual. If Recovery or Salvage are not being reported, please click <Next> to proceed to the Vehicle Coverage Information page.

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GENERAL VEHICLE INFORMATION (continued) Theft Recovery - If a vehicle has been stolen and recovered, please complete the Recovery section at the bottom of the page. The following fields are required for reporting recovery information: Date of Recovery, Recovering Agency, Recovery Location State, Recovery Classification (if required for Federal Reporting), and Condition of Recovered Vehicle. NOTE – Although the field names state “Recovery Location”, the information should be in reference to the Agency making the recovery, not the recovered vehicle’s location. Salvage - If a vehicle has been salvaged, please complete the Salvage segment at the bottom of the page. The Date of Salvage is required on all owner retained or 3rd party buyer salvage reporting. The Buyer Information is required ONLY IF THE OWNER IS NOT RETAINING SALVAGE. (Owner/Insured retaining salvage is assumed.) Please see Additional Services – National Motor Vehicle Title Information Systems for specific information on how to report salvage for NMVTIS purposes. Click on <Previous> to return to the COVERAGE INFORMATION page Click on <Next> to continue to the VEHICLE COVERAGE INFORMATION page.

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VEHICLE COVERAGE INFORMATION The information on this page applies to the involved party, coverage type, and VIN listed at the top of the page. Adjuster Name can be selected from drop down lists based on the information listed in your Preferences. Although only Loss Type and Claim Status are required on this page, completing the Amount fields as well as the date a claim closed can assist other insurance companies in making decisions on their claim without contacting your company for this information. The Adjuster fields and the Routing/Misc. field are for your company’s internal routing to assist you in tracking who is handling a specific claim or portion of a claim. The Adjuster Name will display on the MY REPORTS page listing of Match Reports. Click <Next> to add the GENERAL VEHICLE INFORMATION and the VEHICLE COVERAGE INFORMATION to the claim and review the CLAIM SUMMARY page. Click <Skip> to cancel adding the GENERAL VEHICLE INFORMATION and the VEHICLE COVERAGE INFORMATION to the claim and review the CLAIM SUMMARY page. DO NOT USE YOUR BROWSER’S BACK BUTTON TO RETURN TO THE PREVIOUS PAGE. YOU WILL LOSE ALL INFORMATION ENTERED AND HAVE TO BEGIN AGAIN. From the CLAIM SUMMARY page you will be able to make adjustments to the BASIC INFORMATION, INVOLVED PARTY INFORMATION, and COVERAGE INFORMATION already entered on the claim. You will also be able to add other Involved Parties, Service Providers, AKA information, and other vehicles for this Involved Party.

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CLAIM SUMMARY PAGE This is the summary page to show what has been added to the claim information so far. From this page, you are able to add additional involved parties (such as insureds or claimants) using the <Add Party> button. If you wish to change the BASIC INFORMATION page, please click on the <Edit Basic Info> button to take you to the page to make changes. NOTE: You cannot change Policy Type from the CLAIM SUMMARY page. To change Policy Type, click on CLAIM SUBMISSION at the top of the page to exit the claim without submitting it and start the claim anew. If you wish to add or change information on an Involved Party (name is hyperlink), AKA information, Service Provider information, Additional Vehicle, or Coverage Information, make sure you click on the appropriate hyperlink that is listed on the line of information you wish to alter. You may use the Delete hyperlinks to delete an entire page of information by clicking on the appropriate hyperlink that is listed on the line of information you wish to alter. Generate ClaimDirector Score – If your company is signed up for ClaimDirector scoring and submits claims via the website. You will need to check this box for EACH claim you wish to have scored. Recall Search – Insured Vehicles – Checking this box requests ClaimSearch to search for Vehicle Recall information associated with the Insured’s vehicle(s). If a Recall is in effect at the time of the accident, it may have bearing on how the claim is handled. See NHTSA VEHICLE RECALL INFORMATION for further information. When you have added all information to the claim, click on <Submit> to add the claim to the database. Every claim must have an Involved Party making a claim. If your Insured is NOT making a claim, then a separate Claimant MUST be added (using the <Add Party> button) in order to submit to the ISO ClaimSearch database.

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ADDING INVOLVED PARTIES When you click on the <ADD PARTY> button on the CLAIM SUMMARY Page, you are brought to a new INVOLVED PARTY page. Other than the Role type, this page is completed the same as the first Involved Party. (Note - The example below only shows the top part of the page.) Role – The role type selected will affect what choices are available as Coverage Types on the following page. Both Claimant & Insured is used to indicate a person or organization that holds the policy, and is making a claim against that policy for injury or damages. This role will cause 1st party coverage types to be shown on the COVERAGE INFORMATION page (see COVERAGE INFORMATION – INSURED COVERAGE for the coverage types allowed). Claimant is used to indicate any claimant that is making a claim against the policy for injury or damages. This role will cause 3rd party coverage types to be shown on the COVERAGE INFORMATION page (see COVERAGE INFORMATION – CLAIMANT COVERAGE). Insured is used to indicate a person or organization that holds the policy, but is not injured or claiming damage themselves. Insured Roles are not given the option of coverage as they are not making a claim against the policy. Driver and Passenger are used to indicate the position of the individual within the vehicle. (Ex. Claimant Driver is used to indicate the driver of the vehicle is making a claim; Insured Driver is used to indicate that the Insured was driving the vehicle but is NOT making a claim.)

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COVERAGE INFORMATION – Claimant Coverage The COVERAGE INFORMATION page allows you to select the coverages that apply to an Involved Party. The list of available coverages shown on this page is determined by the combination of Policy Type (selected on the BASIC INFORMATION page), and the Role selected on the Involved Party page. If the Role is Claimant (Claimant, Claimant Passenger, or Claimant Driver), then the coverages below are available: The following coverages are available for Casualty/Liability coverage: • Bodily Injury • Medical Payments • PIP • Property Damage (Other Than Vehicle) • Other Auto The following coverages are available for Vehicle coverage: • Collision (Vehicle Damage) Other coverage options may be available depending on the Policy Type selected. At least one box must be selected before you proceed.

COVERAGE INFORMATION After the Coverage Information page, you will be brought to the corresponding Casualty, Vehicle, or Property coverage pages, in that order. Please refer to the following sections of the manual for separate instructions on completing each coverage type: • Claims Reporting – Casualty (Injury/Liability) – General Casualty Information • Claims Reporting – Automobile – General Vehicle Information • Claims Reporting – Property – Property Loss Information The remainder of this party is completed the same way as the first involved party. You will be brought back to the CLAIM SUMMARY when the involved party is completed. This provides you the option to continue adding or changing information on the claim, or to choose <SUBMIT> to submit the claim to the ISO ClaimSearch system.

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ADDING MULTIPLE VEHICLES Universal Format Reporting companies can now report multiple vehicle thefts in one claim, as well as multiple vehicle losses (with the same coverage & loss type) for one involved party. Previously if you attempted to report more than one vehicle theft loss in a claim, you received the error message “Auto Loss Type Theft can only be reported once in a claim”. Likewise, if you tried to report two vehicle losses for one involved party, you were not able to choose the same coverage and loss type combination. These restrictions have now been removed. You will however get a new error message if the VIN, Coverage, and Loss Type are duplicated within the claim, stating "Coverage and Loss for the VIN are not unique.” Reporting A Claim With Multiple Vehicle Thefts When reporting a claim with individual vehicle thefts under multiple involved parties, follow the CLAIMS REPORTING – AUTOMOBILE to report each involved party and the individual vehicle associated with each party. When reporting a claim with multiple vehicle thefts under a single involved party, follow the CLAIM SUMMARY – ADD VEHICLE pages below.

Reporting A Claim With Multiple Vehicle Losses For One Involved Party When reporting a claim where a single involved party has multiple vehicle losses, enter the first vehicle following the General Vehicle Information and Vehicle Coverage Information pages per the CLAIMS REPORTING – AUTOMOBILE section of this manual. Add the remaining vehicles following the CLAIM SUMMARY – ADD VEHICLE pages below. Note – If your company utilizes the ClaimDirector scoring service, if you choose to report multiple VINs with the same coverage and loss type for an involved party, only the first VIN will be scored at this time.

CLAIM SUMMARY – ADD VEHICLE To enter additional vehicles, click on Add Vehicle on the CLAIM SUMMARY page to the right of the involved party name which is making the claim.

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GENERAL VEHICLE INFORMATION Enter the second VIN and corresponding vehicle information. The fields on this page are the same as previously discussed. Please scroll down to the bottom of the page to complete any relevant Recovery or Salvage Information. Click <Cancel> to return to the CLAIM SUMMARY page without adding a new vehicle. Click <Next> to select the COVERAGE INFORMATION that applies to this vehicle.

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COVERAGE INFORMATION Please select all coverage types that apply to the VIN displayed at the top of the coverage list. Click on a box next to the coverage type to select that coverage. Click on the box again to deselect that coverage. Click <<Previous>> to return to the GENERAL VEHICLE INFORMATION page. Click << Next>> to add the VEHICLE COVERAGE Information.

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VEHICLE COVERAGE INFORMATION The information on this page applies to the involved party and VIN listed in the first field of the page. Adjuster Name can be selected from drop down lists based on the information listed in your Preferences. Although only Loss Type and Claim Status are required on this page, completing the Amount fields as well as the date a claim closed can assist other insurance companies in making decisions on their claim without contacting your company for this information. The Adjuster fields and the Routing/Misc. field are for your company’s internal routing to assist you in tracking who is handling a specific claim or portion of a claim. The Adjuster Name will display on the MY REPORTS page listing of Match Reports. Click <Next> to add the GENERAL VEHICLE INFORMATION and the VEHICLE COVERAGE INFORMATION to the claim and review the CLAIM SUMMARY page. Click <Skip> to cancel adding the GENERAL VEHICLE INFORMATION and the VEHICLE COVERAGE INFORMATION to the claim and review the CLAIM SUMMARY page. DO NOT USE YOUR BROWSER’S BACK BUTTON TO RETURN TO THE PREVIOUS PAGE. YOU WILL LOSE ALL INFORMATION ENTERED AND HAVE TO BEGIN AGAIN. From the CLAIM SUMMARY page you will be able to make adjustments to the BASIC INFORMATION, INVOLVED PARTY INFORMATION, and COVERAGE INFORMATION already entered on the claim. You will also be able to add other Involved Parties, Service Providers, AKA information, and other vehicles for this Involved Party.

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CLAIM SUMMARY – MULTIPLE VEHICLES Once the GENERAL VEHICLE INFORMATION, COVERAGE INFORMATION, and VEHICLE COVERAGE INFORMATION have been completed, you will be returned to the CLAIM SUMMARY page to review the claim as entered thus far. This process may be repeated as many times as necessary, up to 100 VINs per Involved Party per claim.

ADD COVERAGE FOR MULTIPLE VEHICLE CLAIM If multiple VINs are reported for a single involved party, when selecting Add Coverage to the Involved Party, users will now be required to select the VIN that additional Vehicle coverages should be applied to for that Involved Party.

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CLAIM SUMMARY PAGE After each INVOLVED PARTY and appropriate COVERAGES have been completed, you will be returned to the CLAIM SUMMARY page. When you have completed adding all information to the claim, click on <SUBMIT> to add the claim to our database. If you wish to add coverages, AKA information, Service Provider information, Another Vehicle OR Delete an entire page of information, make sure you click on the appropriate hyperlink that is listed on the line of information you wish to alter. Add Additional Claimant (CMS Only) – This is for Medicare Reporting purposes only. It is not used to add Claimants directly involved in the claim, but additional claimants for the beneficiary’s estate or other claimant in the case of wrongful death or survivor action. Please use the <Add Party> button to add claimants directly involved in the claim. Please see CLAIMS REPORTING – CMS REPORTING for further information on the proper use of this hyperlink.

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VERIFICATION OF SUBMISSION On the CLAIM SUMMARY page, click on <Submit>. A pop-up window should appear confirming that you wish to add the record to the database. Click <OK> and the claim will then become a permanent part of the database. Click <Cancel> to return to the CLAIM SUMMARY and make any necessary changes or click on any other link to cancel out of the claim without submitting it.

You should then see the message below notifying you that your submission was received. Click on the <View Reports> button to view reports for your claim. To see the different types of reports, go to CLAIM REPORTS. Click on <Add New Claim> if you want to begin entering information on your next claim.

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CLAIMS REPORTING – PERSONAL COMBINATION POLICIES Homeowners’ claims are submitted based on the coverage afforded; first party property and liability property damage and first and third party bodily injury. Although automobiles are excluded under Homeowners policies, there exist policies that insure both Homeowners and Auto under a combination contract. These policies are not widely popular, but in the event of a loss that involves property and auto under these policies, we have made accommodations to allow these losses to be reported in Universal Format. We have added automobile loss types under property coverage to facilitate reporting of vehicle losses under the combination contract. Examples of these losses include insured vehicles damaged in fire losses at the insured residence, or vandalism of the house and vehicles on the premises. Auto Policies that include collision and / or comprehensive coverage usually exclude non-auto property. However, to respond to these combination policies, we have added property loss types under auto coverage and auto loss types under property coverages. Again, these losses are not frequent, but we wish to provide sufficient flexibility in Universal Format to respond for these losses when they occur.

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CLAIMS REPORTING – CMS REPORTING Medicare Secondary Payer Reporting Service Disclaimer Notice The following section is intended to guide users through the reporting of fields for the Medicare Secondary Payer Reporting Service to the Centers for Medicare and Medicaid Services (CMS). This manual provides definitions as received from CMS at the time of manual creation. CMS has its own manual that provides the official definitions and time frames for all reporting fields. The manual from CMS supersedes this one in all cases of discrepancy in requirements or time frames. ISO ClaimSearch also has a manual that fully describes the Medicare Secondary Payer Reporting Service. If you have any questions on how this service works, please contact your ISO ClaimSearch Account Executive or Customer Service for a copy of the Medicare Secondary Payer Reporting Service manual.

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LOSS & POLICY INFORMATION To begin submitting a claim, enter the appropriate information about the claim that you would like to report to the system. After completing the required fields of Office Code, Claim Number, Date of Loss and Policy Number, click the <Next> button to proceed to the BASIC INFORMATION page.

BASIC INFORMATION The BASIC INFORMATION page records general information about the claim you are submitting to ISO ClaimSearch. Required fields on the following pages are marked with an “R”. Fields marked with an “S” are Searchable fields, meaning they are not required, but will enhance your search results if provided. Fields marked with an * are considered important for Medicare Secondary Payer Reporting Service (CMS Reporting). POLICY TYPE – The following Policy Types in bold type qualify for CMS reporting, as long as they are used in conjunction with appropriate coverage and loss types: Boat Policies - Liability (Bodily Injury) Commercial Auto - Bodily Injury, No Fault, Medical Payments, and Uninsured Motorist Bodily Injury Commercial Liability Aviation - Bodily Injury Commercial Liability Businessowners - Liability and Medical Payments Commercial Liability Farm/Ranch - Liability, Medical Payments and WC Commercial Liability General - Liability, Medical Payments, and WC Commercial Liability Med Mal - Medical Malpractice Commercial Liability Ocean Marine - Liability and L&H and Jones Act Commercial Liability Other - Bodily Injury Commercial Liability Professional - Bodily Injury Personal Liability Farm - Bodily Injury and Medical Payments Personal Liability Marine - Bodily Injury and P&I Personal Liability Mobile Home - Liability, Bodily Injury, and Medical Payments Personal Liability Homeowners - Bodily Injury and Medical Payments Umbrella - Bodily Injury Workers Compensation - (including Employers Liability) Medical and Indemnity Workers Compensation Marine - L&H, P&I and Jones Act

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BASIC INFORMATION (continued)

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BASIC INFORMATION (continued) A new section has been added to this screen: “For Medicare Reporting.” An asterisk (*) will indicate the fields that are important for Section 111 reporting.

RRE CODE – If you are an insurer or self-insured company (group, company or office) with only one required reporting entity (RRE) code registered at the group, company or office level, the field will automatically be pre-populated with the RRE code. If your group/company/office has more than one RRE code, you will see a drop-down showing the RRE codes and a description of the codes. You must choose the RRE code from the drop-down for each claim to be queried for Medicare eligibility or to be reported to CMS. TPAs will always have to select the RRE code from the drop-down, even if the TPA has only one RRE code associated with it. The example above shows a drop-down for more than one RRE code. You must click on the drop-down to see the additional RRE codes. RRE TIN – For insurers and self-insured companies, if your group/company/office has only one TIN registered for each RRE, the field will be pre-populated with the TIN. If your group/company/office has more than one TIN, you will see a drop-down showing the TIN and a description of the TIN. You must choose the TIN from the drop-down. TPAs will always have to select the TIN from the drop-down, even if a TPA has only one TIN associated with it. The example above does not show a drop-down because there is only one TIN associated with this RRE code. RRE SITE ID – For insurers and self-insured companies, if your group/company/office has only one SITE ID associated to a particular TIN, the field will be pre-populated with the SITE ID. If your group/company/ office has more than one SITE ID per TIN, you will see a drop-down showing the SITE ID and a description of the SITE ID. You may choose the SITE ID from the drop-down. TPAs will always have to select the SITE ID from the drop-down, even if a TPA has only one SITE ID associated with it. The example above does not show a drop-down because there is only one SITE ID associated to this TIN. NOTE: Customers must register with CMS to obtain their RRE Code(s) and provide TIN information to CMS. It is necessary for participants to register with CMS prior to working with ISO. Once the RRE code(s) are assigned by CMS, customers using ISO ClaimSearch as their reporting agent must complete a Product Supplement and an Access Authorization Form in order to provide ISO with your RRE Code(s), TIN(s) and SITE ID(s) to be added to the ISO ClaimSearch membership system. Customers should not submit CMS data until ISO confirms that your membership setup has been completed in the ISO ClaimSearch system. You will not be able to report the RRE Code, TIN and SITE IDs until set up is complete.

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BASIC INFORMATION (continued) SELF-INSURED INDICATOR – Insurers and self-insured companies are not required to populate this field. ISO will pre-fill this field when sending your claims to CMS based on your ISO ClaimSearch member type. Only TPAs are required to populate this field because TPAs may be reporting for insurers or self-insureds. A TPA should check the ‘yes’ box if it is a self-insured claim and ‘no’ if it is not a self-insured claim. When all information has been entered, please click on the <Next> button at either the top or the bottom of the page to enter the INVOLVED PARTY INFORMATION.

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INVOLVED PARTY – INSURED

The INVOLVED PARTY INFORMATION page records information about the individuals or businesses involved in the claim you are submitting to the system. The data elements on this page refer only to the individual or business involved in the claim and in the role type indicated at the top of the page. A separate INVOLVED PARTY INFORMATION page will be added for each individual or business directly involved in the claim. Required fields on this page are indicated with a superscript “R”. Required fields include the Role, Business Name, or Individual’s Last and First Name, Street Address, City and State. ROLE – Casualty claims require you to enter the INSURED first. You will have the opportunity to add the CLAIMANT’S information on the next page. On a casualty claim, the INSURED is always the individual or business who holds the policy, not the injured party. For self-insured’s, this is your company’s information. NOTE – The individual or business reported as the INSURED on a casualty claim is not searched against the database for Match Reports unless coverage is reported for the insured. The insured will also not be reported to CMS without coverage. For some policy types, you will choose YES and NO as to whether the insured has a claim. In the instances when you choose, YES the insured will be assigned coverage and would be searched in ISO ClaimSearch as a claimant and would be reported to CMS. In the example that follows, an insured with no coverage and a separate claimant are being entered.

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INVOLVED PARTY – INSURED (continued) On this screen, you will notice the important fields for CMS reporting: Date of Birth, SSN, HICN, Medicare eligible indicator and Do Not Send this Party to CMS indicator. In this example in which the Insured is not claiming an injury, the CMS fields should not be populated for the insured because only the claimant will be reported to CMS. Click on <Next> to enter claimant information.

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INVOLVED PARTY – CLAIMANT The INVOLVED PARTY INFORMATION page records information about the individuals or businesses involved in the claim you are submitting to ISO. The data elements on this page refer only to the individual or business involved in the claim and in the role type indicated at the top of the page. A separate INVOLVED PARTY INFORMATION page will be added for each individual or business directly involved in the claim. Required fields on this page are indicated with a superscript “R.” Required fields include the Role, Business Name or Individual’s Last and First Name, Street Address, City and State. ROLE – On a casualty claim, the Insured information is immediately followed by the Claimant’s information. A Claimant is the individual or business making the claim against the Insured for medical payments or liability. NOTE: Claimants are searched against the ClaimSearch database for match reports and are reportable to CMS. GENDER – Gender is a CMS-required field. If no gender is reported, ISO will pass “Unknown,” which is an acceptable gender for CMS reporting.

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INVOLVED PARTY – CLAIMANT (continued) DOB – Date of birth is a CMS-required field. SSN – Social Security Number is a CMS-required field (unless the HICN is reported). HICN – This field allows you to enter the Medicare Health Insurance Claim Number (HICN), for the injured party on a claim. HICN is required if the SSN is not reported. Medicare eligible Indicator – This field should have “Yes” checked if you are aware that this involved party is Medicare eligible and if you would like this claimant to be reported to CMS. Checking “Yes” will also stop the Monthly Query process for this involved party. Do not send this party to CMS Indicator – If you mark the claimant as Medicare eligible = “YES” but do not want the claim sent to CMS, you may click on the ‘Do not send this party to CMS’ box. You may do this because the claim amount is below the required dollar threshold, coverage has not been confirmed, or if you do not have all required fields and do not want to receive a CMS rejection. If this indicator is checked, this claimant will not be reported to CMS until the indicator is removed. NOTE: CMS has set various dollar thresholds below which claims do not need to be reported to CMS. Please see the CMS User Guide for the thresholds. ISO ClaimSearch will not withhold claims that are below the threshold for CMS. It is up to each company to determine if a claim is below the threshold and should not be reported to CMS. For those claims, you may leave out the Medicare eligible indicator, or, if you want to mark the party as being Medicare eligible to remove it from the Monthly Query process, you can check the “Do not send this party to CMS Indicator.” ISO plans to send all claimants marked as Medicare eligible to CMS at your designated reporting period, even if fields that CMS requires are still missing. Some companies have expressed concern that CMS will reject an entire file if it contains a certain percentage of errors. If your company decides that it does not want claims that will reject to be sent to CMS, you can use the “Do not send this party to CMS Indicator.” It is important that you remove that indicator when all of the required fields are completed so the claim can be sent to CMS. ISO is not recommending that you do not send claims to CMS if you know they will reject; we offer this as an option for those customers who do not want such claims to be sent to CMS. Click on <Next> to go on to the COVERAGE INFORMATION page for this involved party.

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COVERAGE INFORMATION The COVERAGE INFORMATION page allows you to select the coverages that apply to the Claimant. The list of available coverages shown on this page is determined by the Policy Type selected on the BASIC INFORMATION page and the Role selected on the INVOLVED PARTY page. Select the coverages that apply to this involved party by clicking on the box to the left of the coverage type. You may select multiple coverages for this involved party. Coverages applicable for Medicare Section 111 are virtually all coverages that involve a medical payment or no-fault claim or a liability bodily injury claim. Please see the Policy Type list under BASIC INFORMATION for further guidance on applicable coverage types. Click <Next> to assign the selected coverage(s) to the involved party.

GENERAL CASUALTY INFORMATION The screen below represents the general casualty information as it applies to the injury/property damage of the involved party named at the top left corner of the page and the Coverage type listed above the Alleged Injuries/Property Damage field. Required fields on this page are indicated with a superscript “R.” The only required field on this screen is the Alleged Injuries/Property Damage field. Alleged Injuries/Property Damage – Enter the exact injury or damage to property of this involved party (up to 50 characters). This is different than the Loss Description on the BASIC INFORMATION page which describes the entire claim. For example, Loss Description may be “Car hit fence.” Alleged Injuries/Property Damage may be “Neck/Head Injuries” to describe the individual’s injuries or “Fence damaged” to describe the property damaged. This field is required by CMS through 12/31/10, if there is no Alleged Cause of Illness/Injury Code or ICD-9 Code provided. Alleged injury information reported on this page will be carried over to the GENERAL CASUALTY INFORMATION (Additional) screen. Click <Next> to go to the GENERAL CASUALTY INFORMATION (Additional) screen.

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GENERAL CASUALTY INFORMATION (continued)

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GENERAL CASUALTY INFORMATION (ADDITIONAL) The information on this screen was added primarily for Medicare Section 111 reporting, however, non-CMS claims can also be entered with this information, if applicable. NOTE: The new fields of information are entered into ClaimSearch for submission to CMS. On the match report, the information added will be included on the claim of the submitting company; however, these fields will not be included in match reports to other companies. ICD-9 Codes – (Internal Classification of Diseases, Ninth Revision, Clinical Modification) Diagnosis Code describing the alleged injury/illness. CMS requires five (5) digit ICD-9 Codes. The ISO ClaimSearch field is defined as six (6) digits. When entering this field, you may include the decimal. If you do, the decimal will be stripped on the file sent to CMS. CMS requires at least one ICD-9 Diagnosis code for new records and updates submitted on or after 1/1/11. CMS will review the accuracy of ICD-9 codes to injuries provided, so care in selection is recommended. The ICD-9 code must be on one of the three most current lists of valid ICD-9 codes. No “E” codes or “V” codes are permitted. The codes must not be on the list of Excluded ICD-9 codes found in Appendix H of CMS’s User Guide ver. 3.0, dated 2/22/10. ISO ClaimSearch will only check to see if this element is present or absent. ISO is not checking the validity of the data and will pass on the data to CMS as entered by the user. The CDC Reference hyperlink will provide website links so that you may access the ICD guides. This is the reference that CMS provides in their user guide. Cause of Injury – Enter the ICD-9-CM External Cause of Injury Code, “E Code” describing the alleged cause of injury/illness. CMS requires five (5) digit Cause of Injury Codes. Do not enter the decimal. CMS requires the Cause of Injury code on all new records submitted on or after 1/1/11. The CDC Reference hyperlink will display further hyperlinks that will allow you to select an appropriate injury code. This is the reference that CMS provides in their user guide. Product Liability – If the involved party is injured as a result of a defective product, you may indicate this by selecting the ‘YES’ check box. Please note there are two ‘YES’ options: one indicating a product liability but not a mass tort; the other ‘YES’ option indicates that this claim is a mass tort claim and a product was involved in the injury. Select ‘NO’ if this is not a product liability claim. See NOTE below. Product Generic Name, Product Brand Name, and Product Manufacturer - These fields should be populated if the claim involves a product liability. These fields will help identify the product and its manufacturer. If there is no generic name, supply brand name in this field. See NOTE below. Product Alleged Harm – This is a free-form text field that provides the opportunity to enter a more detailed description of the harm allegedly caused by a product (maximum 200 characters). See NOTE below. NOTE – CMS has advised that the Product Liability, Generic Name, Brand Name, Manufacturer, and Product Alleged Harm fields are currently under review by CMS. Users may populate these fields with data, however the data in these fields will NOT be sent to CMS by ISO ClaimSearch until CMS provides further instruction on the requirements for these fields.

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GENERAL CASUALTY INFORMATION (ADDITIONAL) (continued) CMS Date of Incident – Date of Incident (DOI) as defined by CMS: For an automobile wreck or other accident, the date of incident is the date of the accident. For claims involving exposure (including, for example, Occupational Disease and any associated cumulative injury) the DOI is the date of first exposure. For claims involving ingestion (for example, a recalled drug), it is the date of first ingestion. For claims involving implants, it is the date of the implant (or date of the first implant if there are multiple implants). The CMS Date of Incident is often different than the date of loss or incident used by insurers under current practice, which generally involves last exposure. State of Venue – Enter the US Postal abbreviation corresponding to the state whose law controls resolution of the claim. Insert “US” where the claim is a Federal Tort Claims Act liability insurance matter or a Federal workers’ compensation claim. Insert “FC” when the claim is in a country other than the US. The Show List hyperlink will bring up a list of states. Select the abbreviated code for that field. The state of venue may be different than the Loss Location field in ISO ClaimSearch. No Fault Insurance Limit (NFIL) – This field requires that you enter the dollar amount of the limit on no-fault insurance. Please do not enter dollar signs, commas, or decimals. Dollars and cents are to be reported. Fill with nines if there is no dollar limit such as a workers compensation no-fault state with a time limit or monetary policy limit. Leave blank if Plan Insurance is Workers Compensation or Liability Insurance (including Self-Insurance). “No Fault" Insurance means insurance that pays for medical expenses for injuries sustained on the property or premises of the insured, or in the use, occupancy, or operation of an automobile, regardless of who may have been responsible for causing the accident. This insurance includes but is not limited to automobile, homeowners, and commercial plans. Exhaust Date for NFIL – This field allows you to enter the date on which the limit was reached or benefits exhausted for No-Fault Insurance. Leave blank if No-Fault limit has not been reached/exhausted or if the Plan Insurance Type is Workers Compensation or Liability Insurance (including Self-Insurance). ORM – This field should be checked to indicate if there is an ongoing responsibility for medicals. Check ‘yes’ if you do have ongoing responsibility and ‘no’ if you do not have ongoing responsibility. ORM Termination Date – This field should be populated with the date that the ongoing responsibility for medicals ended, where applicable. This field should only be entered if you have previously checked this claim as an ORM. An ORM termination date may not be the date the claim is settled. It is the period of time in which a policy will respond for claims for the same incident. For ORM claims, the claim will be sent to CMS as an ADD record when the claimant is first marked as Medicare eligible, and it will be sent as an UPDATE record when the ORM Termination Date is provided. Future ORM Termination Dates are allowed, but should not be more than 6 months greater than the file submission date. Delete this Party/Coverage from CMS – Delete should be used in rare instances when your claim has been sent to CMS in error and should be removed from the CMS system. Total Payment Obligation to Claimant (TPOC) Date – Date payment obligation was established through settlement, judgment, award or other payment; this is the date the obligation is signed if there is a written agreement, unless court approval is required. If court approval is required, it is the later of the date the obligation is signed or the date of court approval. If there is no written agreement, it is the date the payment (or first payment if there will be multiple payments) is issued. For TPOC claims, the claim will be sent to CMS as an ADD record when both the claimant is marked as Medicare eligible and the TPOC Date is provided.

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GENERAL CASUALTY INFORMATION (ADDITIONAL) (continued) Total Payment Obligation to Claimant (TPOC) Amount – In regards to the TPOC Amount, if there is a structured settlement, the amount is the total payout amount. If a settlement provides for the purchase of an annuity, it is the total payout from the annuity. For annuities base the total amount upon the time period used in calculating the purchase price of the annuity or the minimum payout amount (if there is a minimum payout), whichever calculation results in the larger amount. Please do not enter dollar signs, commas, or decimals. Dollars and cents are to be reported. TPOC Funding Delayed beyond TPOC Date/ Add TPOC – If funding for the Total Payment Obligation to the Claimant is delayed, provide the actual or estimated date of funding. Fill with zeroes if not applicable. To add multiple TPOCs, click the ADD TPOC button. You will be allowed to add up to five TPOCs. Click <Next> to go to the CASUALTY COVERAGE INFORMATION screen.

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GENERAL CASUALTY INFORMATION (ADDITIONAL) (continued)

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CASUALTY COVERAGE INFORMATION The CASUALTY COVERAGE INFORMATION applies to the involved party listed in the upper left-hand corner of the screen. Required fields on this screen are indicated with a superscript “R.” The required fields are the Loss Type and Claim Status (which defaults to a status of "Open"). Loss Type – Loss types applicable for Medicare Section 111 are virtually all loss types that involve a bodily injury. Date Claim Closed – Although not a CMS-required fields, Date Claim Closed is important if you do not want claims that were closed prior to the CMS-defined look-back periods to be reported. If an ORM claim has a closed date prior to 1/1/09 and if a TPOC claim has a closed date prior to 1/1/10, ISO ClaimSearch will not perform a query of that claimant to determine Medicare eligibility since claims closed prior to those dates do not need to be reported to CMS. In this case, Claim Status should also be changed to reflect the closed status. Click <Next> to add the GENERAL CASUALTY INFORMATION and the CASUALTY COVERAGE INFORMATION to the claim and to review the CLAIM SUMMARY page.

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CLAIM SUMMARY On this screen, you may choose to submit the claim, or to add more information to the claim. If you choose to submit the claim, skip to the VERIFICATION OF SUBMISSION step below. CMS requires representatives to be reported if the injured party has a representative or an Additional CMS Claimant (ex. Family, Estate, or Other Claimant). To add a representative for a claimant, click on the Add Service Provider link for the appropriate involved party. (See ADDING A REPRESENTATIVE for further information.) To add an additional CMS claimant for a claimant, click on the Add Additional CMS Claimant link for the appropriate involved party. (See ADDING AN ADDITIONAL CMS CLAIMANT for further information.)

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ADDING A REPRESENTATIVE Roles for representatives that will be sent to CMS include the legal roles: Claimant Lawyer, Insured Lawyer, Law Office, Law Office Manager, Lawyer-Other, Paralegal, Guardian, Other Representative, and Power of Attorney. Fields that will be sent to CMS include the individual name, business name, TIN, address and phone number of the representative. If you have both the individual name and the business name, ISO recommends that for proper reporting to CMS; complete the representative’s business information in the Service Provider Information, and add the individual attorney’s information using the AKA Information page for the Service Provider (or vice versa). Select the appropriate role code from the drop down list. Complete the Business Name, Address, City, State, Business Phone, and TIN for the Legal Representation Firm. Click <NEXT> and you will return to the CLAIM SUMMARY page.

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ADDING A REPRESENTATIVE (continued) Select AKA Information for the Service Provider listed above. Complete the Individual Last Name and First Name of the legal representative, as well as their Address, City, State, Zip, Phone, and SSN. Click <NEXT> and you will return to the CLAIM SUMMARY page.

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ADDING AN ADDITIONAL CMS CLAIMANT As of April 1, 2010, CMS will require additional claimants to be reported for the beneficiary’s estate or other claimant in the case of wrongful death or survivor action as these parties will receive settlement proceeds from the claimant’s claim. ISO has added the additional Service Provider roles of Estate, Family and Other Claimant specifically to the Additional CMS Claimant page. Select the appropriate role code from the drop down menu and complete the relevant fields of information. Click <NEXT> and return to the CLAIM SUMMARY page.

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CLAIM SUMMARY WITH CMS INFORMATION Below is a CLAIM SUMMARY page that includes a Legal Representative Service Provider, Individual Attorney AKA Information, and CMS Additional Claimant Information. When all fields of information have been completed, click <SUBMIT> to add the claim to the database.

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VERIFICATION OF SUBMISSION On the CLAIM SUMMARY page, click <Submit>. A pop-up window should appear confirming that you wish to add the record to the database. Click <OK> and the claim will then become a permanent part of the database. Click <Cancel> to return to the CLAIM SUMMARY and make any necessary changes or click on any other link to cancel out of the claim without submitting it.

You should then see the message below notifying you that your submission was received. Click on the <View Reports> button to view reports for your claim. Click on <Add Another Claim> if you want to begin entering information on your next claim.

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CLAIMS REPORTING – EXISTING CLAIMS

SUNSETTING OF MONOLINE FORMAT SYSTEMS ISO ClaimSearch has supported multiple formats for the processing of insurance claims for many years. Some of these systems have become known as our Monoline Format or Legacy Format systems. The systems include: the Index System (casualty); the Property Insurance Loss Register (PILR), and the vehicle information databases formerly administered by the National Insurance Crime Bureau (NICB). Effective January 1, 2010, users are no longer able to submit new initial claims via the ClaimSearch website in the Monoline Formats. All companies were switched to Universal Format reporting to report new initial claims via the website. This does not affect a user’s ability to make changes to or reindex existing Monoline Format claims. The January 1, 2010, date also does not affect Monoline Format system-to-system customers. Effective January 1, 2012, all companies must switch to Universal Format reporting for both the website AND for system-to-system reporting. This will complete our sunset of our legacy systems and allow ISO ClaimSearch staff to concentrate our support on our newer more robust Universal Format and XML Format for the reporting of claims, and Additional Services.

RETRIEVING AN EXISTING CLAIM In order to retrieve an existing claim on the system, please click on CLAIMS REPORTING - CLAIM SUBMISSION just as if you were entering a new claim. Enter the Office Code, Claim Number, Date of Loss, and Policy Number fields EXACTLY how they were originally submitted to the system. If the system does not find a claim with the exact combination of fields, you will be brought to the BASIC INFORMATION page to enter new claim information. If you are not able to retrieve a claim that you believe is on the system, please contact ISO ClaimSearch Customer Service at 800-888-4476 or njsupport@iso.com for further assistance.

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UPDATING CLAIM INFORMATION – MONOLINE OR UNIVERSAL If you need to add, update, or delete information on a claim that has already been added to the database, enter the original Office Code, Claim Number, Date of Loss and Policy Number on the LOSS & POLICY INFORMATION page. The “Record found in database” pop-up (shown below) will appear. Clicking <OK> will bring up the CLAIM SUMMARY or INVOLVED PARTY LIST page for the claim you wish to update. If a claim is not pulled up based on the original information, you will be brought to the BASIC INFORMATION page to add a new claim. A claim is pulled up based on the original information. If the claim was entered by the Universal Format method, you will be brought to Universal Format pages. If the claim was entered by any other method, you will be brought to the Monoline Claims Reporting pages. These pages include the data elements of the former INDEX System, the former Property Insurance Loss Register (PILR), and/or the former NICB Auto Database. To add, update, or delete information in any field, click on any section that is blue and underlined to bring up that page and edit the information. Resubmit the edited claim by clicking on <Submit> on the CLAIM SUMMARY page. A match report based on the updated information should be received within minutes. NOTE - Once a claim has been submitted to the database, the fields of Office Code, Claim Number, Date of Loss, Policy Number, and Policy Type cannot be changed on the website. Please contact ClaimSearch Customer Service by calling 800-888-4476 if you need to change any of these fields.

RESEARCHING A CLAIM – MONOLINE OR UNIVERSAL If you need to perform another search on a claim without altering any information, enter the original Office Code, Claim Number, Date of Loss and Policy Number on the LOSS & POLICY INFORMATION page. The “Record found in database” pop-up (shown below) will appear. Clicking <OK> will bring up the CLAIM SUMMARY or INVOLVED PARTY LIST page for the claim you wish to research. Click on <Submit> on the CLAIM SUMMARY page without making changes to perform a new search on the claim. NOTE: If a claim is not pulled up based on the original information, you will be brought to the BASIC INFORMATION page to add a new claim.

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UPDATING A MONOLINE CLAIM TO UNIVERSAL FORMAT Many companies, even if currently submitting claims to ISO ClaimSearch via Universal Format, have older claims in legacy format on the database. The previously reported Casualty and Property claims may be converted to Universal Format to utilize the Additional Services offered by ISO ClaimSearch. At this time, Automobile claims may not be converted in this manner as it affects the Vehicle Recovery process. To convert a legacy claim to Universal Format, follow these steps:

RETRIEVE AND PRINT THE LEGACY CLAIM. To retrieve the claim, enter the Customer Code, Claim Number, Policy Number and Date of Loss and click <NEXT>.

You will receive the following RECORD FOUND IN DATABASE message. The system will ask if you want to update the claim in the legacy format or convert it to Universal Format.

ISO recommends that you click on CANCEL so the claim will remain in legacy format – then, PRINT the legacy claim. Printing the claim is very important. You will need the information because you must enter the data from the legacy claim into the Universal Format screens. Once you click OK to convert the claim in the step below, the system will delete the legacy claim from the database. IF MULTIPLE LEGACY CLAIMS HAVE THE SAME KEY FIELD INFORMATION (OFFICE CODE, DATE OF LOSS, CLAIM NUMBER AND POLICY NUMBER), THEN YOU MUST PRINT ALL CLAIMS PRIOR TO CLICKING OK TO CONVERT THE CLAIM. CLICKING OK WILL DELETE ALL CLAIMS WITH THE SAME KEY FIELD INFORMATION.

RETRIEVE AND CONVERT THE CLAIM. After printing, retrieve the legacy claim again, and when given the option, click on OK to convert the claim. If you click on CANCEL, your claim will remain a legacy claim.

RE-ENTER THE CLAIM DATA IN THE UNIVERSAL FORMAT SCREENS. Use your printout of the legacy claim(s) to complete the Universal Format screens.

AUTOMATED SYSTEMS NOTE: If your company uses a legacy system-to-system interface, the Supplements or Re-Indexes you submit for claims that have been converted to Universal Format will reject. Once a claim has been converted, you must submit changes to converted claims, such as Replacements and Researches, through Universal Format either using a system-to-system interface designed for this, or manually through the website.

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UPDATING A MONOLINE CLAIM TO UNIVERSAL FORMAT (continued) NON-INURERS NOTE: For non-insurers who pay a transactional ISO ClaimSearch fee, please note that every time a claim is converted to Universal Format a new search is performed and thus a charge is generated, just as any time you replace a claim to add additional information, a search is performed and a charge is generated. The charge would be at the Universal Format rate which may not be the same fee as the legacy fee. (For pricing information, please contact your ISO ClaimSearch Account Executive). If a customer chooses to not have a search performed, they must check the “Submit Claim Only – DO NOT Search” check-box at the bottom of the BASIC INFORMATION page. If this box is checked, no ISO ClaimSearch match reports will be generated, and no CMS warning messages will be generated. See below:

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CLAIM REPORTS Once a claim has been submitted to the system through “Claim Submission”, a report will be generated within a few minutes and is posted to the users REPORTS page (also known as the MY REPORTS page). A user can view, print, and delete any reports posted on their MY REPORTS page (See MY REPORTS) or view and print reports submitted by other users within the same office on the OFFICE REPORTS page (See OFFICE REPORTS).

REPORT TYPES The following Report Types are displayed on the MY REPORTS and OFFICE REPORTS pages. Further information on each can be found in the following pages.

Submitted Report Only - If no match is found, a report showing just the claim sent in will be issued. (Also known as a “No Match” report or a “Negative Match Report”.)

Submitted Report + – If no match is found on claim information, but NCIC and/or Shipping information is included in the report.

Match Report - If matches are found in the database, reports will be issued summarizing the claim. Automatic Update – A report generated by the system if a claim submitted by another organization

matches a claim your company previously submitted within a given timeframe, you will receive an Automatic Update on the claim regardless of the claims status (i.e. open, closed, closed without payment, etc).

Recovery Notice – A report that is generated by the system if a vehicle theft claim was submitted as a Total Theft and matches with a theft recovery notice submitted to the database by the NCIC.

Impound Update – A report that is generated by the system if a vehicle theft claim has received a Recovery Notice and further information has been received from states participating in the NICB Impound Program that the vehicle has been impounded.

ClaimDirector – A match report that includes ClaimDirector scoring information (See ADDITIONAL SERVICES – CLAIMDIRECTOR). This can only be received by ClaimDirector subscribers who have indicated that they wish to have a ClaimDirector score generated.

FastCheck – A match report that is generated based on an APD FastCheck request. (See ADDITIONAL SERVICES – APD FASTCHECK.) This can only be received by APD FastCheck subscribers that have submitted claims via the APD FastCheck link.

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SEARCH METHODS ISO ClaimSearch Claims Reporting will search against all Searchable fields on the claim at the same time. This will generate a listing of all matching claims in the database at the time of the search. The Searchable fields include:

Claimant Full Name and Address Insured Full Name and Address (if Automobile or Property claim; if Casualty, then only if the Insured

is an individual and coverage has been assigned to the Insured.) AKA Names and Addresses Driver’s License Number and State License Plate Number and State Home Phone Number Cell Phone Number Pager Number + PIN Social Security Number (SSN), if individual) Date of Birth (enhances Name search) Zip Code (not required, but if sent enhances Address search)

The list of claims returned will then be narrowed down by the following criteria: 1. Only claims within the membership layer(s) that your company subscribes to. 2. Cross-line matches will be returned. (For example, if you are Universal Format and are members of

both Casualty and Property layers, a Casualty claim will return BOTH Casualty and Property matches.)

3. Only claims with an “ISO Received Date” within the last 5 years from the search date. 4. For vehicle claims, VIN history will be returned for the life of the database (since 1992). 5. Workers Compensation claims are searched for the life of the database (since 1992). 6. There is a limit of 25 matches found per searchable party. (Note that this is 25 matches in a 5-year

period. A claim hitting this limit would generally be flagged for further investigation.) This criterion has been found to generate the most relevant listing for the handling of a claim. The information generated in the Match Reports is to be used as a tool to assist a claims handler in determining the best course of action for a claim, such as fast tracking to payment or sending to a Special Investigation Unit (SIU) for further investigation.

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SUBMITTED REPORT ONLY “Submitted Report Only” (sometimes referred to as a “No Match Report” or a Negative Return) indicates that there were no matches found in the system at this time and the match report contains only the information submitted by the user on the initiating claim. A statement in the Summary For Each Searchable Party section of the report stating “No matches for this party” as well as a statement after all initiating claim information “No Matches” confirm that this claim did not have matches. You may choose to print a copy of the report for your files as proof that the claim did not have matches at the time of initial report.

At the end of the report you will see the following words:

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SUBMITTED REPORT + Submitted Report + (Plus) indicates that no matching claims were found, but the report may include NCIC theft verification and/or vehicle shipping information, in addition to the information on the initiating claim. The additional information may be of value in the adjustment of the claim. NCIC Theft Verification – If a vehicle has been reported stolen to the police and has not yet been recovered, then the NCIC Status may display as “Active” with further details listed below it regarding the date, agency, VIN, and Case Number of the reported theft. This is also known as Vehicle Theft Verification.

Vehicle Shipping Information – If a manufacturer has reported the shipping and assembly information from their manufacturing plant, the information reported is embedded in the Vehicle Information section of the Initiating Claim.

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MATCH REPORT Match Reports contain several sections to help identify the various components of the claim and provide key information that has been identified by the industry as helpful in handling a claim. ISO CLAIMSEARCH MATCH REPORT SUMMARY – The header and following paragraph identifies the Type of Report, the unique ClaimSearch File Number, the date the Claim was received by ISO, and the ISO ClaimSearch Customer Support phone number. INITIATING CLAIM INFORMATION – This section provides key field information as it has been submitted to the ClaimSearch system. If any of these fields contains inaccurate information, please contact Customer Support to make the necessary changes. SUMMARY FOR EACH SEARCHABLE PARTY - This summary provides the involved party’s name, role in the claim, and coverage/loss types as applicable. Below this is a grid that identifies the unique ISO File Numbers of the claims which this party matched against and check boxes for the most common reasons that the two claims matched. There is also a listing of up to 15 Key Indicators that will identify characteristics of each involved party in the claim that may assist in the identification of questionable claims and increase referrals to the SIU, the NICB, and compliance with State Fraud Bureau requirements. Clicking on the ISO File Numbers will take you directly to that section of the report to view the matching claim details. Each Matching Claim section of the report also contains a hyperlink “Go To Summary” to bring you back to the Summary grid.

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MATCH REPORT (cont) The next section of the report is titled “ISO CLAIMSEARCH MATCH REPORT DETAILS” for initial claims or “ISO CLAIMSEARCH REPLACEMENT CLAIM DETAILS for claims that have been updated or resubmitted. The report shows an echo back of the claim information as submitted by your company beginning with the words “Initiating Claim” and the unique ISO File Number for this claim. Note - Thick black lines separate entire claims. Thin black lines separate sections within a claim to make reviewing the claim details easier to follow.

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MATCH REPORT (cont) The initial claim information is then followed by a “snap shot” of all claims that match the initial claim as they are in the ISO ClaimSearch database at the time of this report. The beginning of each matching claim is marked with the words “MATCHING CLAIM” and the matching claim’s unique ISO File Number.

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AUTOMATIC UPDATE Match Report, Submitted Report Only, and Submitted Report + are all reports generated by user activity. Automatic Update reports are generated by the system when claim activity on the system matches against a claim that you previously submitted. This can be due to a new claim being entered or a previous claim being updated within the system. Automatic updates include your company’s initial claim and only the claim that generated the report. These reports can be recognized by the words AUTOMATIC UPDATE in the heading below the Summary For Each Searchable Party grid (as shown below) as well as in the MY REPORTS summary under Record Type. This will occur for the following specified time frames after initial reporting of a claim regardless of the claims status (open, closed, closed without payment, etc), unless your company has requested that the Automatic Updates are turned off for closed claims. Monoline Casualty – 6 months Universal Format Casualty – 1 year Monoline Property – no automatic updates Universal Format Property – 60 days Monoline Vehicle – no automatic updates Universal Format Vehicle – 30 days

NOTE – If you are repeatedly receiving the same claim report on a regular basis, please check to see if it states Automatic Update on the header or in the Report Type. If it does, then another company is repeatedly sending their claim to the system with a new search being performed. Each time this occurs you will receive another Automatic Update notice. ISO ClaimSearch’s system is working correctly in this case. If this causes your system or claims handling an issue, please contact the company on the matching claim and let them know this directly. They may not be aware that they are having a system issue or that they are causing issues for others when they do this.

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RECOVERY NOTICE When a stolen vehicle has been reported by an insurance company, a claim is filed. If the vehicle is recovered by a law enforcement agency and entered into the National Crime Information Center (NCIC) system, a Recovery Notice report will automatically be sent to the initiating users’ MY REPORTS page. All pertinent details on the recovered vehicle can be found in the Vehicle Coverage Information section of the Initiating Claim on the report. These reports can be recognized by the words RECOVERY NOTICE in the Heading below the Summary For Each Searchable Party grid (as shown below) for Universal Format customers, as well as on the MY REPORTS page under Record Type. It is recommended that the MY REPORTS page be checked daily for Recovery Notices. If multiple vehicles were reported with the loss type of Theft on a single claim, the words “New Recovery” will display next to the Vehicle Coverage Information for the vehicle that has been reported as recovered.

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AUTOMATIC IMPOUND UPDATE ISO ClaimSearch automatically generates an Automatic Impound Update Report when a vehicle theft claim has received a Recovery Notice (see above) and further information has been received that the vehicle has been impounded. This information is received from states participating in the NICB Impound Program. These reports may be received at any time after the submission of a total theft claim by the member and recovery by a police agency. The Recovery Notice will always return first, followed by a separate report with the impound information. The impound information can be recognized by the words “Automatic Impound Update” in the report header, and will only contain the initial claim and the new impound information.

OTHER VEHICLE MATCH INFORMATION In Claims Reporting, VIN numbers are searched against the entire history of the database (claims received since 1992) to provide an entire VIN history for the match report. This history is generated from insurance claims, manufacturer shipping information, NCIC theft reporting, exports through the country’s ports, appraisal companies, impound agencies, and salvage company information. The manufacturer shipping information and NCIC theft verification are sent back with the initiating claim information either on a Match Report or as a Submitted Report +. Matching insurance claims, export information, impound information, theft recovery information, salvage information, and appraisal activity can all come back as part of the Match Report in the matching claim section. In addition, Theft Recovery or Automatic Impound Update reports may be generated at any time as their own individual reports when there is activity either by the NCIC or by the impound agencies. Below are explanations of the Vehicle Export, Vehicle Valuation, and Vehicle Salvage that will display as the VIN history part of the matching claim information of a match report.

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Vehicle Export – American ports provide information to the database regarding vehicles shipped out of the country. If a vehicle has been reported as exported out of the country, information will come back as a match that shows the vehicle information, the export date, export port, and destination.

Vehicle Claim Report – Some insurance companies use an external appraisal company to determine the value of a vehicle after an incident. When the appraisal company submits activity reports, a Vehicle Claim Report will be received showing the Activity Type of “Appraisal,” “Estimation,” or “Valuation”; the date the activity took place; and the vehicle information.

Vehicle Salvage Information – If a vehicle is determined to be a total loss and sold for salvage, Vehicle Salvage Information will appear as part of the Vehicle Coverage section of a match report. The information will include the VIN, date of salvage, and name and address of the salvage buyer. It may also include the value of the vehicle at the time of salvage and indicators whether the VIN Plate, Engine, or Transmission were missing at the time of salvage.

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ADDITIONAL MESSAGES The following section defines other messages that you will find within Match Reports that may be of value in the adjustment of the claim or flag a claim for further investigation. ***More matches outside this report*** - this message indicates that there are more claims in the database that match the specified field. These claims were not returned on the match reports for one of two reasons:

1. The ISO Received Date is older than 5 years from the search date. If the claim was received more than 5 years ago, it may be possible to view the matching claim through the Claims Inquiry tool which does not have the 5 year restriction. (See Claims Inquiry.)

2. The matching claim is in a layer that your company is not a member of. (For example, the matching claim is a Property claim and your company is only a member of the Casualty and Auto layers.)

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SSN/TIN Validation – ISO searches Social Security Numbers (SSN, for individuals) and Tax Identification Numbers (TIN, for organizations) against the listing provided by the Social Security Administration (SSA). This listing provides a validation that indicates if a number has been issued or not, or if the person to whom it was issued has died. If the SSN/TIN has been issued, then a statement indicates the dates of issuance, and the state it was issued in.

If the SSN/TIN has not been issued, a statement will indicate this.

Information will also be provided if the SSA has been notified of an individual’s death. The information will include the name of the person who died (decedent’s name), date of death, and city/state of death as reported to the SSA.

MASKING – For privacy concerns, the first 5 numbers of the SSN/TIN are masked with X’s on match reports. On Monoline reports, all insured and claimant SSN/TIN are masked. On Universal Format reports, the default is to have the masking for all parties, but companies may choose to have the masking removed for their own company claims. In order to change the default, the company’s home office must contact ISO ClaimSearch Customer Support (800-888-4476) to request the masking be removed for their claims across the entire company.

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VIN Validation – In 1981, manufacturers began issuing vehicles a standardized 17 character Vehicle Identification Number (20 characters for off-road equipment). The VIN identifies specific information about the vehicle. These numbers are checked against a VIN Edit Table that is comprised of information submitted to the database by vehicle manufacturers. If the number checks as valid against this table, then you will see (Pass) after the VIN number.

If the number has a (Fail) message after the VIN number, it can mean that the VIN was reported incorrectly to the insurer (either intentionally or unintentionally), entered incorrectly by the insurer, is for a vehicle older than 1981 (for example, historic or antique cars), or may be a newer make or model that has not yet been updated on the table by the manufacturer. Also note that a failed VIN will still be searched as it may have been reported this way on other claims. The example below shows a claim that has failed the validation, but can be found on other claims within the database.

NOTE - The VIN Decoder with VINAssist tool may be of use to determine why a VIN is failing the validation check. (See VIN DECODER WITH VINASSIST).

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ADDITIONAL CLAIMS REPORTING SERVICES Additional Services are offered to all ISO ClaimSearch Universal Format customers. The Standard services listed below are part of the standard membership contract and are offered at no additional cost. These services may simply require additional fields to be completed to gain the benefits of this service. The Optional services require an additional signed agreement and may require additional fields to be completed to gain the benefits of the service. The sections that follow only address the general purpose of the service and how to access these services within standard Claims Reporting. For pricing of the individual services, please contact your ISO ClaimSearch sales representative. (If you do not know your ISO ClaimSearch sales representative, please contact our Customer Service team at 800-888-4476 or njsupport@iso.com.) Standard Additional Services Offered: EDR Investigate® Management Reports (See ACCOUNT MANAGEMENT – MANAGEMENT REPORTS for further info.) Mandatory – Statutory Reporting for the Industry NHTSA Vehicle Recall Information National Motor Vehicle Title Information System (NMVTIS) Optional Additional Services Offered: APD FastCheckSM Append-DSSM ClaimDirectorSM CSEA (CSLN or OCSE) Reporting Marine Index Bureau Claims Medicare Secondary Payer Reporting Service (CMS) OFAC Compliance Solutions (See OFAC section of this manual for further information)

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STANDARD ADDITIONAL SERVICES

EDR INVESTIGATETM EDRs (Event Data Recorders) can be found on select motor vehicle models manufactured over the last several years. Their main function is to record data required to operate factory-installed safety systems, including anti-lock braking, traction control and supplemental restraint systems (SRS) such as air bags. In this capacity, EDRs continuously monitor and record driving factors such as speed, braking, engine RPM, throttle, safety belt usage and air bag deployment. The retrieval of this data can therefore be of particular value to the understanding of an accident or “near miss” incident, as several seconds of data preceding the event are typically stored and can be harvested. Through a partnership with Injury Sciences LLC, ClaimSearch will also provide an efficient mechanism for insurers to obtain on-site EDR data extraction services and analysis of data. Upon receipt of a harvest request submitted through ISO ClaimSearch, Injury Sciences will use its network of service providers located throughout the U.S. to retrieve the EDR information from the vehicle. Injury Sciences will then analyze the data and provide a report describing the characteristics of an accident, which may include information about the:

vehicle speed at the time of the accident seat belt usage braking activity severity of impact sequence of events in multi-car collisions

The linkage of ISO ClaimSearch to Injury Sciences technologies and services allows claims personnel to be notified immediately when an EDR is available in a vehicle; and then easily obtain the EDR data when there is a need to verify the circumstances surrounding an accident. This vital information can greatly enhance claims professionals’ ability to objectively analyze the complex variables involved in accidents and any resulting injuries. Viewing EDR Information The EDR indicator and information summary is now a standard part of the ISO ClaimSearch system’s Claims Reports, as well as through Claims Inquiry queries initiated by claims or special investigations personnel. “One-off” searching of VINs to determine EDR availability on a vehicle is also possible through the VIN Decoding feature. Claims Reporting/Claims Inquiry - When viewing a Claims Reporting Match Report or Claims Inquiry Search Result online, a field “EDR Available?” will be displayed after the VIN and Vehicle (Year, Make, and Model) information. Clicking on the words “EDR Available?” will display a pop-up window explaining EDR information. If the answer is “No” then the word “No” will display as shown in the sample below.

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If the answer is “Yes”, then the word will be blue and underlined which you may click on to access more information.

Clicking on the “Yes” will bring you to a pop-up window listing the type of data that may be available and why it may be important to the handling of the claim. The pop-up window also contains a button to request a data harvest and analysis report. Clicking this button will take you to the Injury Sciences website to complete a data request. Submitting that data request will result in a charge for the service.

VIN Decoding with VINAssist – When viewing the results of a VIN Decoding, the “EDR Available?” field will be displayed below the decoded VIN. Clicking on a “Yes” answer will display the EDR Details pop-up window, but the button for “Request Data Harvest & Analysis” will NOT be present. This is to ensure that the claim is first entered into the ISO ClaimSearch database per your agreement. Service Information The EDR Available Indicator and the EDR Details for this Vehicle are part of the standard ISO ClaimSearch auto layer membership. EDR “Request Data Harvest & Analysis” Reports are an optional service, and are available at an additional per transaction cost. To participate in this service, customers must sign an EDR Investigate Product Supplement to the ClaimSearch agreement. They must also submit claims using the ISO ClaimSearch Universal Format. Please contact your ISO sales representative for further information on this service. If you do not know your sales representative, please contact ISO ClaimSearch at 1-800-888-4476.

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MANDATORY – STATUTORY REPORTING FOR THE INDUSTRY Data Provided to State Agencies ISO ClaimSearch represents the industry and individual subscribers in ongoing interaction with fraud bureaus and/or fire marshals. In addition, most fraud bureaus have direct access to the system for their investigations. Casualty Reporting Services California Regulation 2698, Claims Analysis Bureau Reporting The ISO ClaimSearch system functions as a Claims Analysis Bureau (CAB) for the California Department of Insurance under California Insurance Law 953: Regulation 2698. The system maintains the required reporting of auto liability, medical payments and uninsured motorist bodily injury claims on California auto policies. Statutory Reporting for New York State Department of Social Services In New York, reporting to ISO ClaimSearch meets the requirement to provide copies of all bodily injury claims (other than workers compensation, medical malpractice and no-fault) to the Department of Social Services to assist in the identification and reporting of all income for New York public assistance recipients. Statutory Reporting for Connecticut Department of Administrative Services Reporting to ISO ClaimSearch meets the requirement in Connecticut for all insurers to notify the Department of Administrative Services (DAS) when a liability claim that may result in a monetary award is filed by a resident of the state. ISO ClaimSearch provides the Connecticut personal injury and workers' compensation claims it receives to the DAS on behalf of participants. New Jersey - Auto Accidents The New Jersey Office of the Insurance Fraud Prosecutor requires all insurers that write in excess of $2,000,000 in personal auto coverage to report all auto accidents involving bodily injury claims and auto physical damage in excess of $2,000 to ISO ClaimSearch via the system's Universal Format. Pennsylvania- Motor Vehicle Insurance Claims Pennsylvania requires reporting of all auto insurance claims to a central database. Participation in, and reporting auto claims to, ISO ClaimSearch fulfills that requirement. Property Reporting Services Statutory/Mandatory Reporting ISO staff works with state fire marshals to report on behalf of subscribers where there are mandatory reporting requirements for fire and other losses. Reporting to ISO ClaimSearch satisfies the fire reporting requirements in 21 states. The states are: Alaska Arizona Delaware Florida Georgia Idaho Illinois Kansas Kentucky Maryland Massachusetts Michigan Montana Nebraska New Hampshire New Mexico New York North Dakota Tennessee Washington West Virginia

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Fire Loss Reporting In 17 states, copies of Property reports are sent on behalf of subscribers to the state fire marshal on a monthly or quarterly basis. Reports are provided in hard copy or electronically. The list below shows the states and indicates those that receive electronic (e) reports. Arkansas Delaware Georgia Idaho (e) Kansas Kentucky (e) Maryland Massachusetts (e) Michigan (e) Montana Nebraska (e) New Hampshire New Mexico North Dakota Tennessee (e) Washington (e) West Virginia NOTE – When programming Universal Format reporting please consider that although Estimated Loss Amount is not required for ISO ClaimSearch reporting, individual state fire marshals may require this field on all 1st party fire losses per state law. Property System Participation In New York State, all companies licensed to write fire business must participate in ISO ClaimSearch - Property. Auto Reporting Services Theft and Salvage Claims Reporting to the ISO ClaimSearch system satisfies requirements for reporting theft and salvage claims in six states: California Massachusetts New York Connecticut New Jersey Rhode Island New York - Auto Physical Damage The state of New York requires reporting of all first party and third party auto physical damage claims of $2,500 or more to a centralized database, such as ISO ClaimSearch, or direct to the State. Pennsylvania - Auto Liability Pennsylvania requires the membership in, and reporting of all motor vehicle insurance claims data to, a comprehensive database system. Participation in ISO ClaimSearch fulfills this requirement. New Jersey - Auto Accidents The New Jersey Office of the Insurance Fraud Prosecutor requires the reporting of all auto accidents to ISO ClaimSearch via the system's Universal Format. Questionable Claims Reporting Referring to State Fraud Bureaus ISO ClaimSearch and NICB System participants can refer questionable claims through ISO ClaimSearch to the NICB's Questionable Claims Database, and through the NICB, to 24 state fraud bureaus: Arizona Colorado Delaware Florida Georgia Idaho Iowa Hawaii Maryland Minnesota Montana Nebraska Nevada New Hampshire New Mexico North Carolina North Dakota Ohio Oklahoma South Carolina South Dakota Texas Utah West Virginia

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Referring to State Fire Marshals Similarly, participants can refer questionable or suspicious fire claims to fire marshals in eight states: Illinois Iowa Louisiana Montana New Mexico Texas West Virginia Wyoming Service Information Mandatory-Statutory Reporting is part of the standard ISO ClaimSearch membership agreement. Any required fields of information are dependent on individual statutes and the types of claims reported to the database.

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NHTSA VEHICLE RECALL INFORMATION ISO ClaimSearch has the ability to search against the NHTSA (National Highway Transportation Safety Administration) files to determine if there are any potential recalls on all 1st party vehicles reported within a claim. ClaimSearch will attempt to obtain the Make and Model of the vehicle by decoding the VIN submitted via Claims Reporting. The NHTSA file will be searched by Make, Model and Year. If the VIN cannot be decoded, the Make, Model, and Year (if submitted by the customer) will be used to perform the search against NHTSA. Vehicles reported for all insured role types will be searched. For customers who are interested in obtaining recall information, the “Recall Search – Insured Vehicles” checkbox on the Claim Summary page must be checked for each claim to be searched.

If a recall was requested, a Vehicle Recall Information section will be displayed on the Match Report following the Vehicle Coverage section of the Initiating claim. If no recalls are found, this section will be returned, showing the Year, Make and Model which was searched, as well as a message stating: “A search of the NHTSA database produced no recalls on this vehicle, due to the absence of a recall, or the inability to identify this vehicle in the NHTSA database.” If one or more recall is found, a table will display up to 10 recall listings per insured vehicle.

Clicking on the NHTSA ID number will display a pop-up window with additional information regarding the recall. Below is just one example of this.

Service Information NHTSA Vehicle Recall Information is part of the standard ISO ClaimSearch auto membership agreement, but requires checking the “Recall Search” check box to gain the benefit of this service.

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OPTIONAL ADDITIONAL SERVICES

APD FASTCHECKSM APD FastCheckSM is the original rules-based scoring system specifically for reporting Auto Physical Damage claims at first notice of loss. This optional service has now been superseded by ClaimDirector. If your company is currently signed up for the APD FastCheck service and wishes to report these through Universal Format, please contact ISO ClaimSearch Customer Support (800-888-4476) for information on navigating these pages. If your company is interested in this service but not yet signed up, we ask that you refer to the ClaimDirector service instead.

APPEND-DSSM Append-DSSM is an optional service specially designed for customers reporting claims in Universal Format. Including a claimant’s Social Security Number (SSN) in search criteria on a claim can significantly increase the effectiveness of system searches and the amount of information returned for claim evaluation. Through the Append-DS service, if a claim is reported without an SSN, Append-DS automatically triggers a public records search to find this key data. When available, the SSN is then used to enhance ClaimSearch database searches for matching claims. In addition to SSN’s, Append-DS will also retrieve other public record details available on the claimant, including the claimant’s current and up to 4 previous addresses, phone number, age and date of birth – and add that information to the Search Criteria and Claims Report as well. NOTE – the SSN and other public records information is NOT automatically added to the claim information stored on our database. The Public Records Information is returned on the Claims Reporting Match Report, so that the customer’s claim system can be updated with the additional information. Users have the option of adding the Append-DS information to claim reports in the ISO ClaimSearch database by updating the claim with the additional information. (See CLAIMS REPORTING – EXISTING CLAIMS) Append-DS is designed to help customers:

streamline the claims-processing workflow and increase productivity save time in searching for and retrieving public-records data access all available information from ISO ClaimSearch to help facilitate claims processing decisions

and reduce claim losses Service Information Append-DS is an optional service, and is available at an additional cost. To participate in this service, customers must sign an Append-DS Product Supplement to the ISO ClaimSearch agreement. They must also submit claims using the ISO ClaimSearch Universal Format.

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CLAIMDIRECTORSM Introduction ClaimDirectorSM is an expert supervised system that applies widely used industry fraud indicators to claims submitted to the ISO ClaimSearch database. ClaimDirector allows insurance companies to report a claim to the ISO ClaimSearch database. ClaimDirector then analyzes claim attributes and industry-wide claims histories against fraud indicators using data contained in the ISO ClaimSearch database and data provided by the NICB. (The data provided by the NICB includes individuals and organizations that have been investigated by the NICB; NICB Prosecutions and Administrative Actions; U.S. Department of Health and Human Services sanctioned medical-providers; American Medical Association data provided by the NICB; exports; impounds; and shipping records.) Claim attributes and match information will be weighted to create the score. A ClaimDirector Match Report will provide customers with the ClaimDirector Score, claim attributes, and industry fraud indicators as well as cross-line match information in a single report. Thus providing claims handlers with expedient information to assist in determining the best way to proceed with the adjustment of the claim. ClaimDirector Score ClaimDirector will generate a numeric score that will range from 0 – 999 based on match information found in the ClaimSearch database. ClaimDirector delivers the score and a result report ClaimDirector Match Report in its own section at the top of the report. The result report will provide the company with the basis of the score (e.g., number and type of matches). High scores may indicate a significant number of matches were found in the database and/or the presence of other characteristics that suggest a heightened consideration of the need for further investigation. ClaimDirector generates scores whenever a claim is submitted with the “Generate ClaimDirector Score” field checked up to 6 times over the life of the claim. ClaimDirector currently scores Personal Auto Liability, Personal Auto Combined, Commercial Auto Liability, Auto Physical Damage, General Liability, and Workers’ Compensation claims. Future enhancements include the ability to score Homeowner claims. ClaimDirector scores will be based on matching claims that have an ISO Received Date within 5 years of the ISO ClaimSearch submission with the exception of Workers’ Comp and VIN matches which will not be restricted by date. ClaimDirector will deliver up to 25 detailed score summaries where output is created. This will allow the system to provide the necessary detailed reports needed by carriers when additional investigation is required. Searches ClaimDirector utilizes the same searches as Universal Format for claimants and insureds with coverage. In addition, it also searches on insureds without coverage for prior automobile, casualty & property claims, based on the name and address, SSN, VIN, driver’s license number, license plate number, and phone number. ClaimDirector also provides the number of searchable elements the claim was searched on (maximum 6). In other words, if all searchable elements are provided, the system will find all claims matched in the database. If some searchable elements are missing, some matches could also be missed.

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Customization Options In order to better meet your needs, ClaimDirector is designed to be highly customizable. Your company can choose to customize numerous features within ClaimDirector, such as thresholds (values that behave like filters; they allow the system to return the rule, matching claim, notification, etc. only if the threshold has been exceeded) and weights (the value a rule contributes to the ClaimDirector Score, if the rule fires) to customize scoring for your particular book of business. The thresholds are customizable options that will be determined by each company’s internal guidelines. Customers may customize ClaimDirector by setting these applicable values via an account management function which is available through the web. Customization will be available at the company level. The customization tool will provide customers with the ability to reset the above values to ISO defaults globally and individually. Note – ClaimDirector will be delivered with a set of default values for the features below. Therefore, your company may choose not to customize ClaimDirector or any particular ClaimDirector feature.

Advisory Lists Claim Frequency Factors Claim Frequency Thresholds Combo Rule Weights Loss Type Frequency Factors Loss Type Frequency Thresholds Masking/Unmasking of Social Security Numbers Matching Claim Threshold Notification Threshold Reserve Amounts Displayed or Not Rule Thresholds Rule Weights

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ClaimDirector Claim Reporting To submit a claim for ClaimDirector scoring, enter the claim using the appropriate CLAIMS REPORTING pages. (See CLAIMS REPORTING.) When you have entered all information and are on the CLAIM SUMMARY page at the end of the claim, check the box for “Generate ClaimDirector Score” before you click on <Submit>. Note - if you choose to report multiple VINs with the same coverage and loss type for an involved party, only the first VIN will be scored by ClaimDirector at this time

ClaimDirector Result Report A ClaimDirector Result Report is indicated on the MY REPORTS and OFFICE REPORTS pages with a Report Type of “ClaimDirector” and a yellow flag icon next to the Claim Number. Clicking on the Claim Number will display the ClaimDirector Result Report containing the ClaimDirector score, characteristics, and details, followed by the Claims Reporting Match Report. The next page shows a sample of what the ClaimDirector Result Report may look like.

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Service Information ClaimDirector is an optional service, and is available at an additional cost. To participate in this service, customers must sign a ClaimDirector Product Supplement to the ClaimSearch agreement. They must also submit claims using the ISO ClaimSearch Universal Format. Please contact your ISO ClaimSearch sales representative for further information on this service. If you do not know your sales representative, please contact ISO ClaimSearch at 1-800-888-4476.

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CSEA/ CSLN/ OCSE REPORTING The ISO Child Support Enforcement Agency Program (CSEA) cooperates with the Child Support Lien Network (CSLN) and the Office of Child Support Enforcement (OCSE) in identifying delinquent child support obligors who have filed insurance claims. The CSLN database is comprised of over 2.8 million obligors in 22 states. Claimants with bodily injury claims submitted to ISO ClaimSearch by participating companies are checked against the database of delinquent obligors maintained by CSLN and OCSE. Matches are referred to CSLN or OCSE that will, if the claim qualifies, refer the claim to the appropriate state Department of Child Support that will then file a lien against the proceeds of the settlement. (No information on CSLN or OCSE matches is returned directly to the insurer from the ClaimSearch database.) Insurers, self insurers and third party administrators can participate in the CSEA/CSLN/OCSE program on an individual state or “all states” basis. There is no additional charge to participate. Service Information There is no additional charge for the CSEA/CSLN/OCSE service. To participate in this service, customers must sign a CSLN/OCSE Product Supplement to the ISO ClaimSearch agreement. No additional fields of information are necessary for this service.

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MARINE INDEX BUREAU CLAIMS The Marine Index Bureau has served the US marine industry since 1937 as the central clearinghouse of bodily injury claims by maritime-industry personnel. The Marine Index Bureau has also been the industry’s repository on hull and machinery-loss information for commercial fishing vessels. ISO ClaimSearch has incorporated into its system the data formerly administered and maintained by the Marine Index Bureau. Members of the Marine Index Bureau will have the ability to add marine claims and obtain cross-line searches including marine and casualty losses. Claims submitted to the Marine Index Bureau involve Longshore, Harborworkers & Jones Act as well as Protection & Indemnity (P&I) claims. Marine claims are most often associated with liability claims (P&I) or Workers’ Compensation. For reporting marine casualty claims in Universal Format, use policy types:

Commercial Ocean Marine - for liability claims Workers’ Compensation Marine - for Longshore & Harborworkers’ claims

Coverage types and loss types are the same as other liability or WC claims. Although ClaimSearch Casualty fields of information are generally sufficient, there are a few fields that are specific to marine claims:

Vessel /Call Number: Vessel information may be considered the location of loss for accidents that occur while the ship is at sea. For cases involving losses off the vessel, for dockworkers, or other personnel associated with marine industry, but not actually on the ship, an actual location of loss is required. Selection of either vessel or location of loss is required.

8F Claims: 8F is a section of the Federal Longshore & Harborworkers Act that provides

reimbursement for similar previous injuries against a current injury involving Marine industry personnel. The 8F claim field is a Yes/No field and is optional.

Passport Number: Passport Number of claimant regardless of issuing country.

Occupation/Rating: Rating has been added to the occupation field to identify marine employees.

NOTE: Workers’ Compensation Marine for Longshore & Harborworkers’ claims are searched against the life of the ClaimSearch database (all claims received since 1992). Searches are not limited to five years. Service Information Companies may opt to be members of the Marine Index Bureau through specific membership agreements. They must also submit claims using the ISO ClaimSearch Universal Format.

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MEDICARE SECONDARY PAYER REPORTING SERVICE (CMS) INTRODUCTION The ISO ClaimSearch® Medicare Secondary Payer Reporting Service will help insurers comply with mandatory claim reporting requirements of Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007. The legislation, which will take effect on July 1, 2009, could affect most bodily injury settlements that involve an insurance carrier or self insurer and a Medicare eligible claimant/plaintiff. Section 111 of the act adds new mandatory reporting requirements for all responsible reporting entities (RRE), group health plan arrangements, property casualty and workers compensation insurers, and self-insureds. The legislation requires reporting of bodily injury claims filed by Medicare eligible claimants to the U.S. Department of Health and Human Services Center for Medicare & Medicaid Services (CMS). BENEFITS OF THE SERVICE The ISO ClaimSearch Medicare Secondary Payer Reporting Service solution is integrated with the ISO ClaimSearch claim reporting process. By reporting through ISO ClaimSearch, companies will realize significant savings and workflow process efficiencies of adding to an existing process. The ISO ClaimSearch Medicare Secondary Payer Reporting Service offers:

• help in identifying Medicare eligible individuals through an optional monthly query function • timely quarterly reporting to CMS • a process for notifying customers of the claims CMS rejects and acknowledgements • a process for correcting CMS rejections • timely warnings when claims with Medicare eligible claimants are missing CMS-required fields

SERVICE OVERVIEW Companies that select ISO as their reporting agent for Medicare Section 111 reporting may enter new claims or update previously reported claims through the ISO ClaimSearch® website or a system to system transmission. Only the Universal Format includes the additional data elements required in claims reports by CMS, therefore the Legacy (Monoline) reporting screens have been discontinued for new claim submissions as of 1/1/2010. If your company currently enters claims via the website using Universal Format, the new screens will be very similar to the screens you are already familiar with. Some additional fields have been added to existing screens, and a new screen has been added for Casualty claims. An asterisk (*) will indicate the fields that are important for CMS reporting. If your company currently reports to ISO ClaimSearch using a Universal Format or XML Format automated feed, but you wish to supplement the information reported through that feed by updating the claims, you will be able to pull up your previously reported Universal Format claims to add additional necessary fields via the ISO ClaimSearch website. The information you add through the website will not be eliminated by a system Replacement report, but the information can be overwritten by a system Replacement. If you need to convert a previously reported legacy claim to Universal Format in order for the claim to be reported to CMS, you will have the ability to delete the previously reported legacy claim and replace it with a Universal Format web claim. ISO will also provide warning indicators to assist customers in identifying fields that are missing required information for Medicare eligible individuals.

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DETERMINING MEDICARE ELIGIBILITY THROUGH MONTHLY QUERY To help companies identify Medicare eligible claimants, ISO will provide an optional query of the CMS database for each participating RRE. Using CMS software, the ISO ClaimSearch system will query your company’s entire history of claims that qualify for CMS reporting against the database every month. Note: All claims must contain the claimant’s name, Social Security Number (SSN), date of birth, gender, and RRE Code. (If gender is not submitted, ISO will submit Unknown which is a valid value for CMS.) ISO will post the results of the query to the Account Management section of the ISO ClaimSearch website so users can log in to check the Medicare eligibility of claimants. The system will provide that information in a text file format as well as a Microsoft Excel spreadsheet. It is each company’s responsibility to update claims with the Medicare eligible indicator to show which claims ISO ClaimSearch should send to CMS for Quarterly Claim Reporting. QUARTERLY CLAIM REPORTING Companies will be able to report and update claims using ISO ClaimSearch web. Customers will need to complete additional fields of information required by CMS including an indicator to notify ISO of the Medicare eligible claimants. ISO ClaimSearch will automatically forward any Medicare eligible claimants to CMS on a quarterly basis. The quarterly reports will include the following: ongoing responsibility for medicals (ORM) including no-fault and workers compensation; and Total Payment Obligation to the Claimant (TPOC) for all third party liability cases resulting in “a single settlement, judgment, award or other payment” ISO ClaimSearch will determine when to include the claims in the quarterly report to CMS as follows: Ongoing no-fault insurance and non-contested workers compensation claims (ORM)

• When your company first submits a claim with a Medicare eligible indicator, ISO ClaimSearch will send the claim to CMS.

• When your company updates any fields that CMS designates as “important,” ISO ClaimSearch will send the claim to CMS again as an update.

• When your company provides the ORM (ongoing responsibility for medicals) date, ISO ClaimSearch will send a final claim to CMS.

Single payment liability claims (TPOC)

• When your company marks the claim as Medicare eligible and provides the TPOC (total payment obligation to the claimant) date, ISO ClaimSearch will report the claim to CMS.

ACKNOWLEDGEMENT AND REJECTION SERVICE CMS will provide ISO with a file showing the claims that CMS accepted and rejected. ISO will post the results of that file on the Account Management section of the ISO ClaimSearch website so users can log in to see the rejected claims. ISO will also post the information in a text file format as well as a Microsoft Excel spreadsheet for download. ISO will link the acknowledgements and rejections to existing claims in ISO ClaimSearch to help companies locate their claims in the database. Users can update and resubmit the rejected claims to ISO ClaimSearch. The system will resubmit the corrected claim to CMS during the next quarterly reporting period. CLAIMS REPORTING – CMS REPORTING In order to report a claim to CMS, the claim must first be accepted by the ISO ClaimSearch basic service. Once the claim has been accepted by the ISO ClaimSearch basic service AND marked as Medicare eligible, then the claim will be picked up for CMS Reporting at the next quarterly reporting period. ISO ClaimSearch will send the claim to CMS even if it has missing or invalid data in a CMS required field (see Warning Indicators in this section). We will not send it on if the “Do Not Send To CMS” indicator is marked. Please see CLAIMS REPORTING – CMS REPORTING for step by step instructions on how to complete a Medicare eligible claim.

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SCREENING SERVICE FOR MISSING DATA — WARNING INDICATORS When companies mark claimants as Medicare eligible and send a claim to ISO ClaimSearch, the system will screen the claims to identify missing CMS-required fields. If fields are missing, ISO ClaimSearch will provide a warning indicator on the ISO ClaimSearch match report. The system will provide the warning when the company first marks the claim as Medicare eligible and anytime the claim is updated after that. The warning indicators will give your company the chance to update the claim before the next scheduled CMS quarterly submission period. The screening service includes rules for reporting contingent fields. For example, information on the claim representative isn’t required. However, if your company reports a representative, the individual’s name, business name and SSN or tax identification number are required. Missing CMS Required Field is shown between the Summary of the Involved Party and the Key Indicators grid of matching claims. There are currently 42 different warning code messages (see next page), but a maximum of 25 warning codes can be generated per Involved Party. If you receive 25 warning code messages, please review the entire Involved Party for CMS required fields as more than 25 fields may contain missing or invalid information.

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CMS MISSING REQUIRED FIELD WARNINGS (continued) Below is a list of the warnings that will be provided: RRE Code Missing or Invalid TIN Missing or Invalid Site ID Missing or Invalid Injured Party HICN or Injured party SSN is required Injured Party DOB Missing or Invalid One or more Injured Party Representative Last Name Missing or Invalid One or more Injured Party Representative First Name Missing or Invalid One or more Injured Party Representative TIN Missing or Invalid One or more Injured Party Representative Mailing Address Missing or Invalid One or more Injured Party Representative City Missing or Invalid One or more Injured Party Representative State Missing or Invalid One or more Injured Party Representative Zip Code Missing or Invalid One or more Injured Party Representative Phone Missing or Invalid Self Insured Indicator Missing or Invalid – required for liability & workers comp claims Date of Incident Missing or Invalid State of Venue Missing or Invalid No-Fault Insurance Limit Missing or Invalid ORM Indicator Missing or Invalid TPOC Amount Missing or Invalid Alleged Cause of Injury, Incident, or Illness Missing or Invalid (required after 01/01/2011) ICD-9 Diagnosis Code Missing or Invalid (required after 01/01/2011) Description of Illness/Injury Missing or Invalid or Alleged Cause of Injury and ICD-9 code (required after 01/01/2011) Product Generic Name Missing or Invalid (required after 01/01/2011) Product Brand Name Missing or Invalid (required after 01/01/2011) Product Manufacturer Missing or Invalid (required after 01/01/2011) Product Alleged Harm Missing or Invalid (required after 01/01/2011) ICD-10 Diagnosis Code Missing or Invalid (required after 01/01/2011) One or more Additional Claimant Individual/Business Indicator Missing or Invalid One or more Additional Claimant Business Name Missing or Invalid One or more Additional Claimant Last Name Missing or Invalid One or more Additional Claimant First Name Missing or Invalid One or more Additional Claimant SSN Missing or Invalid One or more Additional Claimant TIN Missing or Invalid One or more Additional Claimant Mailing Address Missing or Invalid One or more Additional Claimant City Missing or Invalid One or more Additional Claimant State Missing or Invalid One or more Additional Claimant Zip Code Missing or Invalid One or more Additional Claimant Phone Missing or Invalid One or more Additional Claimant Representative SSN/TIN Missing or Invalid One or more Additional Claimant Representative Mailing Address Missing or Invalid One or more Additional Claimant Representative Zip Code Missing or Invalid One or more Additional Claimant Representative Phone Missing or Invalid

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SERVICE INFORMATION Medicare Secondary Payer Reporting Service is an optional service, and is available at an additional cost. Customers planning to use ISO as their reporting agent for Section 111 Reporting must first register with the CMS and must sign an ISO Product Supplement and fill out Reporting Authorization Forms prior to entering data to be reported to CMS. Once your company has been set up for CMS reporting in the ISO ClaimSearch membership management system, you will receive confirmation that you may begin entering Medicare Section 111 claims. If you enter information prior to receiving the confirmation, you will not be able to enter the RRE Code(s), TIN(s) or Site ID(s) which are among the data elements required by CMS. NOTE: The ISO ClaimSearch screens and reporting requirements have been designed according to the CMS User Guide Version 3.0, published February, 2010. Please refer to the CMS User Guide for the CMS reporting requirements and definitions. Information in this ISO ClaimSearch guide is subject to change at any time based upon any changes received from CMS.

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CLAIMS INQUIRY Claims Inquiry (also known as Claims IQ, or IQ) is a tool used to follow up on information appearing in Match Reports or for conducting further investigation when warranted. Claims Inquiry does not add information to the database. For that reason, the underlying claim must first be added to the ClaimSearch database using the CLAIMS REPORTING tool before using CLAIMS INQUIRY. To report a claim, click on the words Claims Reporting at the top of the page. Claims Inquiry allows authorized users to access the ISO ClaimSearch database quickly and efficiently to perform customized searches of claims existing on the database. Claims Inquiry searches all layers of the database to which the member company subscribes (casualty, property, and/or auto). Claims Inquiry also searches the entire history of the database back to the first claims received in 1992. Note: This is by the date ISO RECEIVED the claim, not the DATE OF LOSS. You can broaden or narrow your search as much as you need based on how many fields of information you search on. Search for information by insured/claimant name, address (with mail-drop validation), phone number, Vehicle Identification Number (VIN), Social Security (SSN), Tax Identification Number (TIN), professional medical license, driver’s license, and license plate all from a single page. Claims Inquiry lets you narrow your search by name/date of birth, role in claim (insured, claimant, or both), search type (business name or individual name), and line of business (property, casualty or auto). It can even limit searches to a particular type of loss during a specific time period. Search results are returned immediately to the user on any matches to the submitting insurer, along with any other system information that helps verify SSNs, VINs, or TINs.

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NICB Data Currently Available Through ISO ClaimSearch®

Qualified ISO ClaimSearch Claims Inquiry users are currently able to access the NICB’s Questionable Claims database, which contains claims that have been designated as suspicious by qualified claims examiners/ investigators because they contain one or more "indicators of fraud." Questionable Claim information is a helpful tool in identifying suspicious claims before payments are made and can assist in the prosecution of insurance fraud offenders. Now, qualified NICB members with access to QuestTECH will be able to access additional NICB data to further assist in the claims investigation process.

ABOUT QUESTTECHSM

QuestTECHsm is a data source available only to qualified NICB members. With QuestTECH, NICB members with SIU level access will now be able to supplement the data they have traditionally obtained through ISO ClaimSearch®. While ClaimSearch provides access to some NICB data, qualified NICB members will now be able to include additional QuestTECH databases in their query, including: NICB’s Prosecutions and Administrative Actions, NICB’s Consumer Hotline Submissions, NICB’s Vehicle Interest File, and expanded Questionable Claims information. As an added feature, users will be able to query the multiple QuestTECH databases concurrently. This saves time and produces investigative results second to none.

QuestTECH databases:

Prosecutions and Administrations Actions: Provides the name, address, date of birth, social security number, driver’s license number, tax identification number and medical license, when relevant, of all individuals charged with insurance related crimes resulting from NICB investigations conducted in cooperation with member insurance companies and law enforcement. Other information includes the charged individual’s role in the case, specific charges filed, court jurisdiction information, and disposition (when available).

Consumer Hotline Submissions: Provides details of suspicious insurance claim circumstances identified by concerned citizens and provided to the NICB via a toll-free telephone hotline established for reporting this type of activity.

NICB Vehicle Interest File: Provides vehicle information recorded by NICB Special Agents during the course of their vehicle inspections and investigations. When these agents come across a suspect vehicle not reported by insurance companies to the ISO ClaimSearch database, they will add the vehicle to this database as a vehicle record in which NICB has a vested interest regarding future activity.

Expanded Questionable Claims Data: For NICB members with SIU level access, QuestTECH also provides referral codes for each suspicious claim.

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SEARCH METHODS The underlying claim must first be reported to and accepted by the ClaimSearch database before using Claims Inquiry. The fields of data entered will determine the breadth of the search. The more fields of information entered, the narrower the search and vice versa. Please design your searches to produce maximum efficiency. For example, you would not want to enter a name of John Smith and only the state of New York because the search would produce many results. Instead narrow the search by entering the city, or street name and city. You may also search only on an address to pull up all residents at that location. NAME SEARCHES ISO ClaimSearch has improved the quality of name matching by recognizing individual’s names by gender. For example, “Michelle’ is no longer matched in searches on “Michael,” but all variants of “Michael,” such as “Mike” and “Mikey” are matched. In addition, the system searches on first plus last name and on the reverse – on last plus first name. For example, on a query on “Michael Lee,” the system would also search “Lee Michael.” A search on just a name will generate a nationwide search on that name. This is not recommended unless the name is very unique as it would generally provide too many results for easy investigation into the claims party. It is recommended that all name searches use full names (given name and surname) and are narrowed down by other criteria, such as address, date of birth, social security number, or phone number. A name and address search may be used to narrow the name search. The more elements of the address that are added, the narrower the search will be. For example, a name and state search will search the whole state for that name, whereas a name, city, and state search will limit the name search to that particular city in that state. Searches may be further narrowed to a particular role code and/or a specific zip codes. Role codes are defaulted to search “All Roles”. To limit the name search to a particular role on a claim such as “Claimant”, click on the drop down next to “Role” to see a list of valid roles. Select the role you would like to search on and click submit. (See the Address Search section below for further information on limiting by zip code.) ADDRESS SEARCHES An advanced address-hygiene package is now utilized on all ISO ClaimSearch data. This software “cleans” address information and assigns the correct postal address as claims are filed. The system provides more accurate matches based on street address and zip. These processes mean better scoring and matching for better search results. For example, when a query has the address “1221 6th Ave., New York, NY”, that address will match records containing a “1221 Ave. of the Americas” street address. This is because the address hygiene software maps all “6th Ave.” and “Ave. of the Americas” addresses to “Ave. of the Americas” – the correct postal address. NOTE: The system does not replace the original address information as it was reported; it keeps the reported information and shows it in the outgoing match reports. If a zip code is not listed with the city being searched, the system will search the zip code(s) assigned to the city by the address-hygiene package. To direct the searches to a specific zip code, please enter the full five or nine digit zip code. You may also enter less than five digits. To limit the address search to a specific range of zip codes, enter the lowest and highest zip code numbers in the ZIP Range field, such as 60600 to 60699. Entering the first 3 digits of a single zip code (515) will search for any zip codes within the 00-99 range of that number (51500 and 51599) You may also enter the first 3 digits of two zip codes (515 to 525) which will search for any zip codes between those digits (51500 and 52599).

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SEARCH METHODS (CONT) NUMERIC SEARCHES Numeric searches are searches using the fields Date of Birth, Phone Number, SSN, VIN, Driver’s License, License Plate, and Professional/Medical License. Any numeric search can be entered with a full name to find all claims where the name and numeric field exist together on the claim. Date of Birth cannot be searched by itself, but may be used to narrow a national name search, or to search in combination with an address where multiple names are used. The broadest Date of Birth search is to search by the year itself (YYYY), to narrow the search further use month and year (MM/YYYY), the narrowest search is by the full date of birth (MM/DD/YYYY). Social Security Number (SSN) and Tax Identification Number (TIN) should be entered without hyphens or spaces to denote breaks in the number (NNNNNNNNN). This is purely a numeric search for all claims containing the exact number, therefore resulting in a nationwide search. Phone Numbers should be entered with the area code wherever possible, but can now be searched with and without a 3-digit area code. For example, searching on 555 1212 will find both 516 555 1212 and 673 555 1212. Driver’s License and License Plate will search all states for matching numbers. Entering a state in the state field of the same line will narrow the search to only the state indicated. Note: The numeric fields are not required fields when entering claim information and therefore searching on these fields by themselves may not pick up all possible matches within the system. It is recommended to search these IN ADDITION TO Name and Address searches, which are required fields on claim entry. INDIVIDUAL CLAIM SEARCHES To bring up an individual claim within the system, you may search specifically on your company’s Claim Number or the ISO File Number (ISO’s unique identifier for claims in the ClaimSearch database). DISPLAY OF RESULTS Using the gray bar at the bottom of the Single Party Search or Two Party Search pages, search results may be further limited and sorted. To limit your search results to a particular date range, enter the range of dates in the Date Range field (all dates is the default). To limit your results to a particular Type of Loss, select the Type of Loss from the drop-down menu (all types is the default). To select the order in which you want the records displayed, select Ascending or Descending. (Ascending is the default.) Ascending and descending refer to the date order of the “Activity & Date” on the system. Ascending is earliest date first; descending is most recent date first. No matter which of these you choose, records will first be sorted by insurance company code, then by date in the order indicated. After you have entered the parameters you wish to search, click the <Submit> button If your search has only one name match or you searched on a numeric identifier and there was at least one match, but less than 20 matches, the CLAIMS INQUIRY MATCH REPORT page will appear. If your search has more than one name match, the NAME SUMMARY page will appear. Pure numeric identifier matches (ex. VIN, SSN, or Phone) will not be displayed on this page. Instead, you must select at least one name to view to open the Claims Inquiry Match Report where the numeric identifier matches will be displayed as well.

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SINGLE PARTY SEARCH The Single Party Search page is where most queries are initiated. Use this search page when you have one or more data elements (i.e. name, address, SSN, etc.) about one individual or one organization whom you want to investigate. If you make a mistake, click <Reset> and retype the information. After entering your search parameters, click <Submit> to search the ISO ClaimSearch database. Company Claim Number is a required field on this page. This should be the Claim Number of the claim previously entered via Claims Reporting (either through the ISO ClaimSearch website or a system-to-system batch method) that has prompted this further investigation. Claims Inquiry searches are not intended to be used for personal searches, or to discover what may already be in the system prior to submitting your own claim into the system. Random compliance audits are conducted to ensure that the Claim Number entered in this field is a valid claim within the system; and is relative to the search being conducted. Role is a pull down menu where you can select the role the party had in the claim, ex. insured, claimant. Search Type allows you to search on the name as an individual or a business to cover cases where the party’s name is also the name of their business. The ISO File Number is also known as the ClaimSearch ID assigned uniquely to each claim by ISO. Type of Loss is a pull-down menu where you can select the line of business, e.g., property, vehicle, etc. You can search for a claim according to a specific time period of when the claim was filed by entering the set of dates under Date Range. If you are exploring the potential relationship between two parties, such as a claimant and a doctor, or a lawyer and a doctor, use the Two Party Search page.

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TWO PARTY SEARCH The Two Party Search page allows you to explore the relationship between two parties, such as a claimant and a doctor, or a doctor and a lawyer. Type in the search parameters (i.e. name, address, SSN, etc.) for each party and click <Submit>. Company Claim Number is a required field on this page. This should be the Claim Number of the claim previously entered via Claims Reporting (either through the ISO ClaimSearch website or a system-to-system batch method) that has prompted this further investigation. Claims Inquiry searches are not intended to be used for personal searches, or to discover what may already be in the system prior to submitting your own claim into the system. Random compliance audits are conducted to ensure that the Claim Number entered in this field is a valid claim within the system; and is relative to the search being conducted. Role is a pull down menu where you can select the role the party had in the claim, ex. insured, claimant. Search Type allows you to search on the name as an individual or a business to cover cases where the party’s name is also the name of their business. The ISO File Number is also known as the ClaimSearch ID assigned uniquely to each claim by ISO. Type of Loss is a pull-down menu where you can select the line of business, e.g., property, vehicle, etc. You can search for a claim according to a specific time period of when the claim was filed by entering the set of dates under Date Range. If you have data on only one party, use the Single Party Search page.

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SEARCH RESULTS

NAME SUMMARY When a search is submitted resulting in more than one matching name, the SEARCH RESULTS – NAME SUMMARY page appears. On this page, the following options are available: Print-Format Report will provide a pop-up window displaying the Name Summary information in a table that can be printed for future reference. Select Individual Reports: Click on a name that is blue and underlined to view the individual “name” match report along with any numeric search results. Plus Sign (+): Click on the plus sign (+) next to the name to expand the summary information. This will display key fields on the claim(s) to help identify which reports to select for further viewing and/or printing. Select Multiple Reports: Select names using the check boxes to the left of the name, and then click <VIEW> to generate a match report for all selected names as well as any numeric search results.

Select All On This Page: This will mark all check boxes on the page to view all reports on this page using the <VIEW> button, or to add all reports on this page to the Download List. After clicking this link, the option changes to Unselect All On This Page. Magnifying Glass Icon: Clicking on the magnifying glass next to a name brings you to the Decision Net search pages to search for further information using the Decision Net searches, such as Public Records or Criminal Records. (See DECISION NET section of this manual.)

Download List: Authorized SIU analysts may select reports to be added to and downloaded as a spreadsheet list through the IQ Download tool. Please contact ISO ClaimSearch Customer Support (1-800-888-4476) for further information on this tool and authorized user criteria. NOTE: Up to 100 match reports are listed on a page, however you may only select and view up to 20 reports at a time.

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MATCH REPORTS The SEARCH RESULTS – MATCH REPORT page shows the complete claim details of up to 20 claims that have matched on the data element(s) searched. The reports may contain one or more matches and may also contain other information highlighting elements within claim reports such as addresses that are mail drops, invalid SSNs, elements that have matches outside this query, etc. Hyperlinks: Data elements that are blue and underlined are hyperlinks that may be clicked on to search again on that specific element (known as a drill down search) or, in the case of the EDR Available? field, another report option. Note: depending on your membership agreements with ISO, your company may incur additional charges for drill down searches. Red Car Icon: Clicking on this icon next to a VIN will take you to the VIN Decoder tool with the VIN from the claim pre-loaded into the submission box. Click on Submit to see the VIN decoded for further information on the vehicle. Magnifying Glass Icon: Clicking on the magnifying glass next to a name brings you to the Decision Net search pages to search for further information using the Decision Net searches, such as Public Records or Criminal Records. (See DECISION NET section of this manual.) Additional Functions: Authorized SIU personnel may see an “Additional Functions” link in the top right corner of the match reports. Clicking on this allows the SIU to directly link to NICB for fraud reporting of that claim. (See NICB CLAIM REFERRAL for further information). Download List: Authorized SIU analysts may select reports to be added to and downloaded as a spreadsheet list through the IQ Download tool. Please contact ISO ClaimSearch Customer Support (1-800-888-4476) for further information on this tool and authorized user criteria. (See the next page for a sample Match Report.)

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ADDITIONAL MESSAGES The following section defines other messages that you will find within Match Reports that may be of value in the adjustment of the claim or flag a claim for further investigation. ***More matches outside this report*** - this message indicates that there are more claims in the database that match the specified field. These claims were not returned on the match reports for one of two reasons:

1. The field above this message appears on claims that do not match the current search criteria . 2. The matching claim is in a layer that your company is not a member of. (For example, the

matching claim is a Property claim and your company is only a member of the Casualty and Auto layers.)

Clicking on the field, or searching directly on this information in a single party search, may yield further claims.

SSN/TIN Validation – ISO searches Social Security Numbers (SSN, for individuals) and Tax Identification Numbers (TIN, for organizations) against the listing provided by the Social Security Administration (SSA). This listing provides a validation that indicates if a number has been issued or not, or if the person to whom it was issued has died. If the SSN/TIN has been issued, then a statement indicates the dates of issuance, and the state it was issued in.

If the SSN/TIN has not been issued, a statement will indicate this.

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Information will also be provided if the SSA has been notified of an individual’s death. The information will include the name of the person who died (decedent’s name), date of death, and city/state of death as reported to the SSA.

Note – For privacy concerns, the first 5 numbers of the SSN/TIN are masked with X’s on Claims Reporting Match Reports. However to aid fraud investigators, the SSN/TIN are NOT masked in Claims Inquiry to allow for investigations of misuse or misreporting of SSN/TIN numbers. Mail Drop – Two times a year ISO ClaimSearch receives a listing of addresses identified as “Mail Drop” from a third party vendor. ISO ClaimSearch cross-references against this listing when querying the database for Claims Inquiry search requests. Any name, address, and/or phone information that match against this list will provide additional information as shown below.

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VIN Validation – In 1981, manufacturers began issuing vehicles a standardized 17 character Vehicle Identification Number (20 characters for off-road equipment). The VIN identifies specific information about the vehicle. These numbers are checked against a VIN Edit Table that is comprised of information submitted to the database by vehicle manufacturers. If the number checks as valid against this table, then you will see (Pass) after the VIN number.

If the number has a (Fail) message after the VIN number, it can mean that the VIN was reported incorrectly to the insurer (either intentionally or unintentionally), entered incorrectly by the insurer, is for a vehicle older than 1981 (for example, historic or antique cars), or may be a newer make or model that has not yet been updated on the table by the manufacturer. Also note that a failed VIN will still be searched as it may have been reported this way on other claims. The example below shows a claim that has failed the validation, but can be found on other claims within the database.

NOTE - The VIN Decoder with VINAssist tool may be of use to determine why a VIN is failing the validation check. Click on the Red Car Icon displayed after the VIN to access this tool. (See VIN DECODER WITH VINASSIST for further information on how to use this tool).

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NUMEROUS MATCHES When you submit a search and see the page below, your query has returned more than 20 reports based on the elements requested. Since generating this report could potentially take a long time, you are given three options. Generate report for immediate viewing – Click on <Get Report> to have the system proceed to create the report. This may take awhile depending on the number of reports available. It could potentially cause your browser to time out of the website or not allow further activity through your connection until completed. Generate report but defer results – Enter a name or description for the report for you to review later. Click on <Generate Report>. The report will generate in the backend allowing you to continue working in the foreground. The report will be available for viewing under DEFERRED REPORTS when it is completed. (Please see DEFERRED REPORTS for further information.) Narrow your search – Make selections from the drop-down menus in Role or Type of Loss fields, and/or type in Date From/To information to narrow the search to fewer results. Role choices are: Claimant, Insured, Legal Provider, Other, Medical Provider and All. Type of Loss choices are: Property, Vehicle Related, Casualty, Workers’ Comp, Medical Provider and All. Once your criteria has been entered, click on <Narrow Search> to reduce the search results and generate a report for immediate viewing.

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PREVIOUS MATCHES The PREVIOUS MATCHES page lists all the searches you have conducted during your current active browser session (meaning any Claims Inquiry searches since your most recent login to the website.) Clicking on the item underneath SEARCH CRITERIA will bring you to any match reports obtained by your search. Please note that these previous matches are only stored for the length of your browser session.

DEFERRED REPORTS When you click on the Deferred Reports link, you will be brought to the Deferred Reports page. This screen lists reports that have been deferred due to a large number of matches. Clicking on a report title can bring you to an individual match report, or by checking multiple reports, you may view a number of match reports simultaneously. Please note the number of Total Pages before opening a report as this may be larger than you are expecting and may take a long time to open and to print.

IQ DOWNLOADS Authorized SIU analysts may select reports to be added to and downloaded as an Excel spreadsheet list through the IQ Download tool. Please contact ISO ClaimSearch Customer Support (1-800-888-4476) for authorized user criteria and further information on this tool.

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AMA SEARCHES ISO ClaimSearch users who are members of the National Insurance Crime Bureau (NICB) who have SIU or Claims level access can conduct an American Medical Association (AMA) Physician Masterfile Search. The AMA Physician Search contains active and historical licensure data on Medical Doctors (MDs) and Doctors of Osteopathy (DOs), as well as any associated disciplinary flags these individuals may have on file. The AMA Physician Search includes current and historical data on all physicians, including AMA members and nonmembers, as well as graduates of foreign medical schools who reside in the United States and have met the educational and credentialing requirements necessary for recognition as physicians. Very importantly for claims professionals and SIU investigators, these physician records are never removed from the AMA Physician Masterfile, even after a physician's death. The AMA Physician Search includes information on more than 130,000 deceased physicians. This wealth of information helps insurers conduct extensive and comprehensive analyses to support their investigations. Report Details The AMA Physician Search licensure data are determined by the reporting cycles of state licensing boards. States may report licensing data to the AMA on a monthly, bi-monthly, quarterly or twice annual basis. Physician disciplinary data reporting also varies by the state licensing board. South Dakota is currently the only one of 68 licensing boards that does not release disciplinary data to the AMA. Additional disciplinary actions may include the Department of Defense, US Health and Human Services, US Army, DEA, US Air Force, US Navy and Veterans Administration. To support your investigations, a match report may contain the following information:

• Name of Physician • Office Address of Physician • Office Telephone Number • Current/Historical Licensure

o Date Issued, Date Expired, License Type, License Status • Disciplinary Indicator

o State, Federal Agency, Army, Navy or Air Force Please contact the NICB Technical Support Group at 847-544-7003 with any questions regarding the ability to conduct AMA physician searches.

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VIN Decoding with VINAssist® VIN Decoding is a utility that features VINAssist®. This utility allows you to decode and decipher a Vehicle Identification Number to assist insurance professionals in properly identifying vehicles. Beginning in 1981, the National Highway Traffic Safety Administration (NHTSA), Department of Transportation, required manufacturers selling over-the-road vehicles in the US to provide the vehicle with a 17 character VIN. This applies to all passenger cars, multi-purpose passenger vehicles, trucks, buses, trailers, motorcycles and incomplete vehicles with a gross vehicle weight of 10,000 lbs. A VIN consists of 17 characters of letters (except I, O or Q) and numbers. VINAssist® operates similar to a spell-checker for vehicle identification numbers. On this page, enter the VIN number. Click <Submit> to decode.

Erroneously recorded VINs are edited and decoded by VINAssist® to reveal vehicle information such as model, type, year, manufacturer, and engine size and restraint system type. The VIN Decoding with VINAssist® page below indicates an example of what each VIN item signifies:

LETTER Country of Origin LETTER Manufacturer/Make NUMBER Vehicle Type LETTER Restraint System LETTER Line NUMBER Series NUMBER Body Style LETTER Engine NUMBER Check Digit LETTER Year LETTER Plant NUMBERS Serial Number VINAssist® is registered trademark of the National Insurance Crime Bureau, all rights reserved.

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INCORRECT VIN – If a VIN is incorrect, possible errors are highlighted in red letters. These indicate possible places where an incorrect value has been listed. However, the entire number should be checked when correcting errors. In the sample below, the Body Style digit (5) was altered to create an incorrect VIN, but this is not a field that is listed in error.

CORRECTING AN INCORRECT VIN - If the VIN displays errors, you can click on the blue and underlined digits in the DIGIT column. This will display further information at the bottom of the screen as to possible corrections for this digit. It is recommended to start at the beginning of the number and search through each element for possible corrections. In the sample below, the Body Style shows that the number (5) is not a possibility for this vehicle, but clicking on the (4) under “Possible Body Style selections” will resolve the other errors within the number. Note – the Check Digit and the Sequence Number fields do not display a listing of possible values, but ask you to enter in the correct value and click Submit.

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VIN Decoding with VINAssist (cont) CORRECT VIN – If a VIN is correct, all digits in the DIGIT column will display as blue and underlined. All words under DESCRIPTION AND MEANING columns will be in black type.

If you wish to print the results for further reference, please use the <PRINT> button provided on the page. See the EDR Investigate section of this User Manual for further information on using the “EDR Available?” feature. SIU CASE MANAGER SIU Case Manager is a powerful tool that offers the automation you need to manage claims and fraud cases more efficiently. This comprehensive browser-based system automates and integrates the many tasks involved in managing claims and underwriting investigations. SIU Case Manager helps automate workflow at all levels of your organization:

Claims handlers can refer claims electronically to SIU staff from the SIU Referral screen. Since the system pre-populates the screen with data from the claim report, your staff will save time and keystrokes as well.

Investigators can document case progress, report on case activities, and summarize outcomes. The application tracks such detail as daily activity, to-do lists, time, mileage, and expenses.

Managers can refer casework to their investigators, oversee staff activities, and compile case statistics.

Senior management can use the system to support enterprise-level reporting. The tool also helps refer cases to state fraud bureaus and the National Insurance Crime Bureau (NICB) for investigation and prosecution.

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With SIU Case Manager, you’ll increase SIU productivity, fight fraud more effectively, meet regulatory-compliance requirements, and improve your bottom line. Manage the referral process SIU Case Manager will help you manage the referral process by letting you authorize users to refer cases to your company’s SIU. Users can refer cases with suspicious activity. Lead investigators and support staff can view their assigned cases and access high-level information. Authorized users can transfer cases to other investigators and assign additional support staff. Track and summarize activity SIU Case Manager features an activity log to document all case-related activities. Investigators can enter log notes on all activities they perform throughout an investigation. And to help investigators plan their daily schedules and eliminate missed activities, the application includes a diary function they can use to keep a list of activities they need to complete. SIU Case Manager can also help compile case reports for each assignment. You’ll create:

Process reports, including automated status reports and referral-acknowledgment reports Investigative reports — such as case-closing reports and supplements — with a streamlined

reporting function State fraud bureau file reports to notify state fraud bureaus that your SIU has initiated a case for

suspicious activity Streamline management reporting To enhance your efforts further, SIU Case Manager provides management reports that compile and summarize case data for compliance reporting to state fraud bureaus. Reports include statistics on the number of cases your SIU opened, closed, and has pending; the amount of time spent on each case; and the claim settlement dispositions. SIU Case Manager also offers these features to help you manage the investigations process:

The stats/performance function provides a view of the current workload for an investigator, presents performance notes for a user, and tracks antifraud training activity.

A forms/manuals portal allows administrators to publish up-to-date forms and manuals for their users to download.

Customizable functions allow users to tailor the system to their needs. And we’ve built quality-review auditing functionality into SIU Case Manager. Use with other claims-analysis tools SIU Case Manager is one of several fraud-fighting tools available through ISO ClaimSearch® — the industry’s first and only comprehensive all-claims system. ISO ClaimSearch offers a variety of resources for claims handling, evaluation, and management and for fraud detection. You can use each tool separately or together as part of a complete fraud-detection package. ISO integrates SIU Case Manager with ISO ClaimSearch and ClaimDirectorSM, our claims-scoring product, allowing you to track and view all parties connected to a case. For more information on SIU Case Manager or to speak with a sales representative, please call ISO ClaimSearch Customer Support at 1-800-888-4476 or send e-mail to info.claimsearch@iso.com.

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NICB Referral – Home Page You can report questionable claims to the National Insurance Crime Bureau (NICB) database via ISO ClaimSearch. Questionable claims are claims that have been designated as suspicious by qualified claims examiners and investigators because they contain “indicators of fraud.” To get to the NICB Referral Home page, click on <NICB Submission> on the upper left-hand side of the ISO ClaimSearch on ISOnet Home page or on the hyperlink at the top of any ISO ClaimSearch page. You will be brought to the page below. To submit the questionable claim, click on <Click Here to Submit a Questionable Insurance Claim to NICB>.

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NICB REFERRAL – QUESTIONABLE CLAIM SUBMISSION You may refer both new claims and claims that you have already submitted to ClaimSearch via Claims Reporting. The referral process is the same for Property, Casualty and Vehicle claims, regardless of whether the claim was submitted under Monoline Reporting or Universal Format. If you have not previously submitted the claim, you will not have to enter any claim in Claims Reporting prior to referring it to the NICB. The details are as follows: • If the claim was previously submitted under Universal Format, you can update the claim as a

Questionable Claim. • If the claim was previously submitted under Monoline Reporting, the system will convert the Record to

Universal Format and you can update the claim as a Questionable Claim. • If the claim was not previously submitted, you can enter the claim as a new Questionable Claim

without first having to enter the claim in the Claims Reporting section of ClaimSearch. NOTE - ISO ClaimSearch discontinued Monoline Format web reporting of INITIAL claims on December 31, 2009. All companies must report INITIAL claims on the web using Universal Format starting January 1, 2010. This date does not affect system-to-system transmissions. Please see Sunsetting Legacy Format for further information. The process for updating a claim as a Questionable Claim and adding a claim as a Questionable Claim is as follows:

SUBMITTING A REFERRAL Once you click on <Click Here to Submit a Questionable Insurance Claim to NICB>, you will be brought to the page below. On this page, you have the option of either entering the Date of Loss, Office (Customer) Code, Policy Number, and Claim Number information (DCPC), or the All-Claim ID Number. If this is the first time you are reporting this claim to ClaimSearch, you will not have an All-Claim ID, which is a number uniquely assigned by ISO to each claim. The All-Claim ID will appear on the match report after a claim has been reported into the ISO ClaimSearch database. After you have entered the appropriate information, click on <Next> to proceed. The system will perform a search to see if you have previously submitted the claim to ClaimSearch.

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REFERRING PREVIOUSLY REPORTED CLAIMS (MONLINE OR UNIVERSAL FORMAT) If this claim was previously submitted under either Universal Format or Monoline Reporting, you will receive the following message: If the claim that you are referring is a Casualty claim, once you click on <OK>, you will be given the option to choose the claimant that you would like to refer. Otherwise, you will be brought to the next page.

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UPDATING A CLAIM AS QUESTIONABLE CLAIM Once you select the name of the claimant that you would like to refer (if the claim is a Casualty claim), or once you provide the DCPC or All-Claim ID, you will be brought to a page where you will be able to update the claim as a Questionable Claim. The page will request information about the specific claim and why it may be questionable. Complete the fields for law enforcement information and complete or correct the contact information for this particular referral. In addition, select up to seven (7) reasons describing the questionable claim activity. You can make a selection by clicking on the white box next to the reason and deselect by clicking again.

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UPDATING A CLAIM AS A QUESTIONABLE CLAIM (Continued) Select up to seven (7) reasons from the choices listed below describing the questionable claim activity. You can make a selection by clicking on the white box next to the reason and deselect by clicking again.

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UPDATING A CLAIM AS A QUESTIONABLE CLAIM (Continued) At the bottom of the same page, make selections for which State Fraud Bureaus should be notified (up to 3) and which State Fire Marshals should be notified, as applicable.

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UPDATING A CLAIM AS A QUESTIONABLE CLAIM (Continued) Finally, describe the reason as to why the claim is being submitted for referral. When you have completed all the steps, click on <ADD CLAIM> to continue.

To complete the submission, additional fraud ring investigation criteria will need to be submitted for each party on the claim. Select a box by clicking on it. Deselect a box by clicking on it a second time. Selecting a box indicates agreement to the statement at the head of the column for the party on the row that you selected. Please click <Update Claim> to update the claim information in the database. Click <Submit> to complete the referral to NICB.

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UPDATING A CLAIM AS A QUESTIONABLE CLAIM (Continued) Upon successful completion of the NICB Referral submission, you should receive the message below which contains the NICB File Number for this referral.

CLAIMS REPORTING MATCH REPORT WITH NICB REFERRAL Once a claim has been referred to the NICB for fraud investigation, the statement “This claim was referred to the NICB” will display at the top of the claim within subsequent Claims Reporting Match Reports. NOTE – Claims Reporting match reports already received in the My Reports will not automatically update with this message. Only match reports received after the referral has been completed will contain this message.

CLAIMS INQUIRY SEARCH RESULTS WITH NICB REFERRAL Once a claim has been referred to the NICB for fraud investigation, the statement “This submission was made based on suspicion for further investigation and should be corroborated by your independent investigation and should NOT, by itself, be the basis for a claim decision” will display at the bottom of the claim within subsequent Claims Inquiry Search Results. NOTE – Previous Matches and Deferred Reports already generated will not automatically update with this message. Only search results received after the referral has been completed will contain this message.

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DECISION NET® ISO ClaimSearch offers Decision Net® -- the one-stop resource for claims and investigation units looking to access a wide-range of information products for claims analyses and investigations. Decision Net provides access to:

• A suite of public record products backed by multiple data sources, with the ability to search billions of records in fractions of seconds. • Criminal & Civil Records – Provided through ISO’s Intellicorp, Ltd. unit that maintains one of the most extensive and reliable data repositories of nationwide criminal records and other public information. The system offers a full menu of searches with access to more than a hundred million federal, state, and county criminal and civil records nationwide. • Police reports and related information – accessing police reports through Decision Net makes your claims handling and investigations more efficient. After submitting a claim, you get a screen automatically pre-filled with required information – ready to initiate a request for a police report. That saves you time and money in your investigations or claims processing. • Electronic medical records – Decision Net medical-records service uses an on-line ordering-and-retrieval process to provide a timely, cost-efficient way of obtaining medical records information. The proprietary process complies with the requirements and privacy rules of the Health Insurance Portability and Accountability Act (HIPAA). • Instant Vehicle Reports – instantaneous vehicle registration data is available by searching VIN, Name and Address or License Plate. You can access this information by entering any of these three components. Results may vary by state. Data is available in 40 states. • Motor Vehicle Reports (MVRs) – available through an arrangement with ISO’s Insurance Information Exchange (iiX) unit. You get timely, comprehensive, and reliable information on an individual’s driving history and license details. • Event Data Recorder (EDR) - Through an alliance with Injury Sciences LLC, ISO ClaimSearch has introduced a new comprehensive Event Data Recorder (EDR) service. It offers the ability to order an EDR Investigate Report, which includes the retrieval of data from the involved EDR and an analysis of data harvest results.

The wealth of information provided through Decision Net is derived from numerous sources ranging from consumer records, business records, electronic white pages, federal courts, DMV records, VIN information, criminal records and many more. For more information, see the ISO ClaimSearch Decision Net User Manual. Just click on User Manuals and Guides on the ISO ClaimSearch home page or using the link at the bottom of any page in the website.

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OFAC The Office of Foreign Assets Control (OFAC) of the U.S. Department of Treasury administers and enforces economic and trade sanctions against certain foreign governments, organizations, and individuals. OFAC has compiled a master list of more than 5,000 “specially designated nationals and blocked persons.” U.S. insurance companies and their employees are responsible for screening claims against this master list. OFAC Lookup may be used to: • comply with the OFAC requirements. • perform searches on individual names to quickly ensure there is no match on the OFAC list. • identify any individual or organization on the OFAC list early in the life of the claim – so you don’t

discover after payment that an illegal payment was made. To access this service, please click on the “OFAC” heading located on the Menu list of the Home page or the hyperlink at the top of every page. This link will take you to the page below where you can enter search criteria information. You are required to enter a full name, and may enter additional information to narrow the search. Additional criteria may include City, State, Country, Date of Birth (DOB), Social Security Number (SSN), and/or Passport number.

Results will be returned in an OFAC Match Report. If there is a match, scores are assigned to indicate the degree of validity. (For example, if the first and last name you enter matches the first and last name on the OFAC list exactly, the score would be 100. If the first name you entered was spelled differently than the listing, but the last name you entered was the same as on the list, you may get a score of 90.) Additional information is also provided in the report such as Associated Names, Date of Birth (DOB), Alternate Date(s) of Birth, Place of Birth (POB), Alternate Place(s) of Birth, etc., to assist in due diligence that this is the same individual or organization that you are querying on.

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OFAC COMPLIANCE SOLUTIONS ISO currently offers several other levels of OFAC service. The OFAC Lookup Feature is provided as part of the ClaimSearch agreement at no additional charge. To participate in any of the other services below, customers must sign an OFAC Product Supplement to the ClaimSearch agreement. Each service details whether the service is provided as part of the standard agreement or at an additional charge.

STANDARD OFAC SERVICE ISO’s standard OFAC solution is an optional feature of the ISO ClaimSearch system. There are no additional fields or records that need to be programmed for the OFAC standard service. By signing the Product Supplement, all parties to a claim (insured, claimant and service providers) submitted to the ISO ClaimSearch database in Universal Format are automatically screened against the OFAC Specially Designated Nationals List. Should a match occur, contact person(s) specified in advance are notified by e-mail and directed to the secure ISO ClaimSearch website to view match results. ISO employs a special search algorithm when screening for OFAC matches. It is designed to recognize inverted letters, phonetic and cultural equivalents, and even misspellings. (For example, the submitted name of “Osama Ben Ladin” would trigger a match to the name “Osama Bin Laden.”) There is no additional charge to customers reporting claims in ISO’s Universal Format.

PREMIUM OFAC SERVICE The Premium OFAC Service is identical to the Standard Service with one exception. A match to the OFAC Specially Designated Nationals List triggers a public records search on the matching name. Public record details are returned online with the OFAC Report; and are of particular value when reviewing information on some of the more common names found in OFAC. There is a charge for Premium Service and customers must sign an OFAC Product Supplement.

OFAC HISTORICAL SWEEP ISO also offers an historical sweep of claims that customers have previously submitted to the ISO ClaimSearch database over a specified period of time. Claims are searched in batch with matches displayed in a secure segment of the ISO ClaimSearch website. A designated contact person is notified of matches via e-mail, with a link provided to the secure ISO ClaimSearch website to view results. There is a charge for OFAC Historical Sweep and customers must sign an OFAC Product Supplement.

OFAC ENTERPRISEWIDE SOLUTION ISO provides an enterprise-wide OFAC solution that allows customers to submit via FTP an electronic file of individual and business names they want screened against the OFAC List. Files are processed overnight and returned electronically. Submissions are not limited to claims but may also include policyholders, vendors, marketing lists, job applicants and other entities. There is a charge for OFAC Enterprisewide Solution and customers must sign an OFAC Product Supplement. This option requires a system to system batch process for the submitting of a file. Please contact ISO ClaimSearch Customer Support (800-888-4476) for further information on the requirements for this service.

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ACCOUNT MANAGEMENT

MANAGEMENT REPORTS As part of our continued efforts to provide clients with critical information in real time, the system offers the ability to view and download online management reports. Authorized management personnel can access and view management reports via the Accounts Management link on the ISO ClaimSearch Home page. The following reports are currently available:

ISO ClaimSearch Management Reports The Integrated Statistics Report – provides high level summary and detailed information

concerning company monthly and year-to-date activity. The report provides information on claims reporting for all services or database segments in which your company participates (Casualty, Property, and Auto) and for reporting formats – Monoline and Universal Format.

The Online Utilization Report – a monthly report that provides summary and detailed information

concerning online company and user activity. The report indicates who accessed the system during the period, their last activity date, the number of logons to the system, and what type of activity the user performed (i.e., Claims Reporting, Claims Inquiry, or NICB Referrals). NOTE - The Integrated Statistics Report and the Online Utilization Report each have their own Reference Guide.

The Executive Analysis Report – a quarterly report that provides an accounting of claims reported

to ClaimSearch on a group and company level and compares (benchmarks) this experience against industry totals.

ISO ClaimSearch Billing Report - provides online access to the transaction-based billing detail in

invoices for non-insurance company participants. All activities such as claims reporting and claims inquiry are itemized for each transaction processed through the system.

Medicare Secondary Payer Reports – Members who subscribe to the Medicare Secondary Payer

Reporting Additional Service have access to the CMS (Monthly) Query File and the CMS (Quarterly) Acknowledgment and Error Files. All files are posted in both text and Excel formats for download.

ClaimDirector Account Management – Members who subscribe to the ClaimDirector Additional Service have access to the ClaimDirector Customizer, ClaimDirector Management Reports (monthly reports of scores received on claims that can be used to trend the scores), and ClaimDirector Billing Detail (for claims submitted for scoring via the website).

Decision Net Account Management – Members who subscribe to the Decision Net Additional

Service have access to the Decision Net Billing Detail (monthly invoices showing the transactions per user per office.)

Please see the Account Management section of the website for further details on each report. Service Information ISO ClaimSearch Management Reports are part of the standard ISO ClaimSearch membership agreement and only require access to the Account Management section of the ISO ClaimSearch website. Medicare Secondary Payer Reports, ClaimDirector Account Management and Decision Net Account Management require subscriptions to the appropriate services as well as access to the Account Management section of the ISO ClaimSearch website.

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WHO TO CALL If you have forgotten your ISO ClaimSearch password, please contact the ISO Technical Help Desk by calling 1-800-888-4476. (Password requests CANNOT be handled via email.) For Law Enforcement Users, please contact the NICB for support by calling (1-800-447-6282, or by e-mail at nicbcsg@nicb.org. For all other questions or problems regarding ISO ClaimSearch, please contact ISO ClaimSearch Customer Support by calling 1-800-888-4476; or by e-mail at njsupport@iso.com. Please see the IF YOU NEED HELP section of this manual for further resources.