Utah Workers Compensation Insurer Loss Costs Multiplier Filing Form Page 2
ADVERTISEMENT
1
2PAGE 2
CALCULATION OF COMPANY LOSS COST MULTIPLIER
YES
NO
1.
Does this filing apply to all classes contained in item 3
of the Page 1?
If no, attach a list of affected classes.
[
]
[
]
2.
Loss Cost Modification:
A.
The insurer hereby files to adopt the prospective loss costs in the captioned reference filing: (Check one)
Without modification. (Factor = 1.000) ENTER IN 2B.
With the following modification(s). (Cite the nature and percent modification to the advisory organization’s
loss experience. Attach supporting date and/or rationale.) ENTER IN 2B.
B.
Loss Cost Modification Expressed as a Factor:
2B=
________________________
3.
Development of Expected Loss and Loss Adjustment Expense (Target Cost) Ratio.
(Attach exhibit detailing insurer expense data, impact of premium plans, and other supporting information.)
PROJECTED EXPENSES: compared to standard premium at company rates.
A.
Total Production Expense
_______________________%
B.
General Expenses
_______________________%
C.
Taxes, Licenses & Fees
_______________________%
D.
Profit & Contingencies including offset for investment Income
_______________________%
E.
Other (explain)
_______________________%
F.
TOTAL
3F=
_______________________%
4.
Expected Loss & Loss Adjustment Expense (Target Cost) Ratio:
_______________________
ELR = 1.000 - 3F (expressed in decimal form)
5.
Overall impact of expense constant & minimum premiums:
_______________________
(A 2.3% impact would be expressed as 1.023)
6.
Overall impact of size - of - risk discounts plus expense gradation
_______________________
recognition in retrospective rating:
(A 8.6% avg. Discount would be expressed as 0.914)
7.
Company Formula Loss Cost Multiplier: 2B/[(6-3F)x5]=
_______________________
8.
Company Selected Loss Cost Multiplier:
_______________________
Attach exhibit explaining any differences between 7 & 8.
9.
Are you amending your minimum premium formula?
YES
NO
If yes, attach documentation including rate level impact as well as
[
]
[
]
changes in multipliers, expense constants, maximum minimums, etc.
10.
Are you changing your premium discount schedules?
[
]
[
]
If yes, attach schedules and support detailing premium or rate level change.
ut-wclcm - 10/03
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal