1. Purpose

These rules are promulgated to provide insurers and self-insurers with standards for the recording and reporting of claim information as required by 24-A M.R.S.A. § 2371 and for the collection and reporting of financial information by insurers as required by 24-A M.R.S.A § 2372.

2. Other sources of data

As provided in § 2371(4), the insurers' and self-insurers' statistical advisory organizations may obtain data from the Workers' Compensation Commission and integrate it with information obtained from other sources in preparation for reporting to the Bureau.

3. Reporting format

The Superintendent may establish a reporting format and medium, such as magnetic tape, compatible with the systems used by the statistical advisory organizations and the Bureau's data storage and management information system to provide for an efficient transfer of reports to the Bureau.

4. Preestablished information categories and codes

For those sections requiring the reporting of descriptive information, the statistical advisory organizations shall file with the Superintendent preestablished categories and codes of the most common outcomes or responses.

5. Specific provisions

A. Employee's prior workers' compensation claim history shall include all workers' compensation claim known or accessible to the insurer or self-insurer, including claims on injuries occurring prior to January 1, 1987.

B. Attorney involvement shall mean the earliest date the attorney's representation is known by the insurer or self-insurer.

C. Information reported pursuant to § 2371(2)(B)(3) shall be limited to the

date of maximum medical improvement.

D. If there is more than one hearing date for a single claim, the dates of each hearing shall be recorded, but the claim information may be based on the hearing which results in a decision.

E. Identification of offsets pursuant to § 2371(5) shall also include the following:

(1) Whether the insurer was eligible for recoveries from the Second Injury Fund; (2) The dollar amount recovered from the Second Injury Fund; and (3) Whether recovery was restricted by an inadequate balance in the Second Injury Fund.

F. Medical payment information reported pursuant to § 2371(2)(D) shall be provided for all claims unless the Superintendent approves an alternative collection procedure. Alternatives which the Superintendent may select include, but are not limited to, closed claim reporting only, sampling, specified categories of medical procedures, or information consistent with that collected by the Workers' Compensation Commission in establishing fee schedules.

6. Forms

The statistical advisory organization shall develop and file with the Superintendent a set of forms or a description of the method to be used to collect the data required by § 2371. Such filing shall be made not later than July 1, 1988.

7. Frequency of reports

Reports of experience required by § 2371 shall be submitted to the Superintendent of Insurance on a monthly basis unless otherwise specified by the Superintendent. The monthly submissions shall include the specified information on the following cases:

A. New claims not previously reported; B. Claims that have been controverted, modified, discontinued, suspended, commuted, settled, or otherwise closed and for which such status change has not previously been reported; and

C. Open claims not otherwise reported on in the prior six months.

8. Periodic profitability reports

The reports required pursuant to section 2372(1) shall be submitted quarterly on a policy year basis, unless otherwise permitted by the Superintendent, for all policy years 1987 and subsequent.

9. Residual market report

The reports required pursuant to section 2372(4) shall be submitted on a policy year basis for all policy years 1987 and subsequent. Quarterly reports shall be filed on incomplete policy years as well as those completed.

History. -- Effective. 3-21-88.

History. -- Statutory Authority.--24-A M.R.S.A. §§ 212, 2323, 2371, and 2372.

EFFECTIVE DATE (ELECTRONIC CONVERSION): January 14, 1997