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PA Bulletin, Doc. No. 05-473


Notice to Workers' Compensation Insurance Carriers

[35 Pa.B. 1735]

   Insurance companies that write Workers' Compensation are required to report workers' compensation premium, loss and claim count information using 2004 Special Schedule ''W.'' Authority for this call is in section 655 of The Insurance Company Law of 1921 (40 P. S. § 815).

   Information to be reported by April 15, 2005, includes the following:

   For calendar year 2004:

   *  Premiums--written, unearned and earned.

   *  Losses--indemnity vs. medical for paid, reserves (case vs. bulk and IBNR), incurred.

   *  Amounts added to premium to yield standard earned premium at designated statistical reporting level.

   *  Deductible adjustments to yield first dollar premiums and losses.

   For evaluations as of December 31, 2003, and December 31, 2004, policy year information for large deductible (that is, deductible greater than $100,000) policies vs. all other policies including small deductible policies on a first dollar basis:

   *  Premiums--earned.

   *  Losses--indemnity vs. medical for paid, reserves (case vs. bulk and IBNR), incurred.

   *  Claim counts--indemnity vs. medical for incurred, closed with and without payments.

   Information regarding the submission of 2004 Special Schedule ''W'' has been sent to carriers and has also been posted at the Insurance Department's website at

   Persons who have not received this information or have questions concerning information contained in this notice should contact Brenna Murphy, Actuarial Associate, 1311 Strawberry Square, Harrisburg, PA 17120, (717) 783-2114,

Insurance Commissioner

[Pa.B. Doc. No. 05-473. Filed for public inspection March 11, 2005, 9:00 a.m.]

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