Financial Sector (Collection of Data) (reporting standard) determination No. 2 of 2021
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Claim Data: Public and Product Liability and Professional Indemnity Insurance
Instruction Guide
These instructions have been prepared for the purpose of defining the claim information required to be submitted by insurers in respect of public and product liability and professional indemnity insurance. This information will contribute to a National Claims and Policy Database (NCPD) in respect of these classes of insurance. The intention is to create a database that holds information in respect of claims and policies for public and product liability and professional indemnity on a national basis. State and Territory Government insurers will also contribute to the NCPD where possible.1
Details of requirements in relation to reporting periods, method of submission and authorisation are set out in the Reporting Standard. The data submitted by each insurer will be validated by APRA at each reporting period. The data validation to be performed is outlined in Appendix A.
Part Record Layouts and Field Specifications - Financial Sector (Collection of Data) (reporting standard) determination No. 2 of 2021 - Record Layouts and Field Specifications | Zoe
Date of Report
M
M
8n
11
Date Finalised
M1
M1
8n
12
Jurisdiction of Claim
M1
M1
3a
13
Deductible/Excess
M
M
12n
14
General Nature of Loss
M1
M1
1a
15
Cause of Loss
M
M
3a
16
Body Functions or Structures Affected
M2
O
1a
17
Severity of Loss
M2
O
1a&1n
18
Litigation Status
M
M
1a
19
Gross Payments in the Reporting Period
M
M
12n
20
Gross Payments to Date
M
M
12n
21
Gross Case Estimate at Start of Reporting Period
M
M
12n
22
Gross Case Estimate at End of Reporting Period
M
M
12n
23
Gross Third Party Recoveries Received
M
O
12n
24
Gross Third Party Recoveries Outstanding
M
O
12n
25.1
Past economic loss
M
M
12n
25.2
Future economic loss
M
M
12n
25.3
Past medical, hospital, caring and related services
M
M
12n
25.4
Future medical, hospital and related services
M
M
12n
25.5
Future caring services
M
M
12n
25.6
General damages
M
M
12n
25.7
Interest
M
M
12n
25.8
Plaintiff legal costs
M
M
12n
25.9
Defendant legal costs
M
M
12n
25.10
Investigation costs
M
M
12n
25.11
Other
M
M
12n
1Date must be DDMMYYYY, no delimiter.
Key:
M – mandatory field on all records from 1 July 2004.
M1 – mandatory only if field 3 (Status at end of Reporting Period) = “F”.
M2 – mandatory only if field 14 (General Nature of Loss) contains a bodily injury component.
O – optional field.
a – alpha.
n – numeric.
Fields so indicated, as a combination, must be unique.
** A new claim is determined by the following process:
Image unavailable in extracted textClaims Record Data Field Definitions
Insurer code
A unique code assigned by APRA to each contributor.
Record type
• C = Claims Record
3. Status at End of Reporting Period
• C = Current
• F = Finalised
• R = Reopened
• S = Structured Settlement
A structured settlement occurs when a claim has been settled and payments are made as annuities over time, rather than in a single payment.
If a claim has been reopened and is closed again in the same period, the status should remain as finalised however there is a need to provide the updated finalised data for such a claim, such as $ paid etc. If a claim has been advised as finalised in a previous submission, has since been reopened AND is still open at the end of the current reporting period, the claim should be recorded as ‘Reopened’.
4. Month of End of Reporting Period
The data for each submission will relate to a six month period. Enter as DDMMYYYY the last day of the period being reported, e.g. insert 30062004 for data relating to the six months ending 30 June 2004.
Professional indemnity (not medical malpractice) and errors & omissions
PII
Association Liability
ASN
Directors' and Officers' liability
D&O
Defamation Insurance
DFI
Employment Practices
EPL
Financial Institutions Policy
FIP
Information & Communication Technology Insurance
ICT
Medical Indemnity/Malpractice
MAL
Management Liability
MAN
Superannuation Trustees
STL
Other
PIO
Note: where business is written as part of a package policy, the “Product type” is to be based on the nature of the cover offered, as set out in the above table. The fact that cover is sold in conjunction with other types of insurance is not collected.
6. Policy Number
A unique policy identifier (which may relate to several separate risk records) by which the exposure and premium information on each individual record can be identified. Used for matching the policy data in force at date of claim to the claim record. This information is only used for cross-referencing by APRA – it will not be published except in any individual data reports prepared for the insurer concerned.
Where individual claims data is being provided but its associated policy data is being provided in aggregate form in the facility data file, the facility number should be used as the policy number for the claim.
7. Risk Number
A unique risk identifier (which may be the same as the policy number if the policy contains a single risk) by which the exposure and premium information on each individual record can be identified. Used for matching the policy data in force at date of claim to the claim record. This information is only used for cross-referencing by APRA – it will not be published except in any individual data reports prepared for the insurer concerned.
8. Claim Number
A unique identifier of a claim. This information is only used for cross-referencing by APRA – it will not be published except in any individual data reports prepared for the insurer concerned.
9. Date of Loss
Enter as DDMMYYYY the date on which the incident giving rise to the claim is believed to have occurred.
For claims made policies where an actual date of loss is not available, code this field as the date that the claim is notified to the insurer. For losses incurred based (or occurrence based) policies, the Date of Loss should be the date of the event that gave rise to the claim, or the best estimate of the date of that event(s).
10. Date of Report
Enter as DDMMYYYY the date on which the claim was reported (not processed) to the agent or insurer.
11. Date Finalised
Enter as DDMMYYYY the date on which the finalised. This field should only be completed when all payments to the claimant(s) and any third party suppliers are believed to have been made and all recoveries expected from third parties (ignoring reinsurers) have been received. Note that a claim may be recorded as finalised even if recoveries from reinsurers have not been received.
Reopened claims that are still open at the end of the reporting period must not have a “date finalised”.
12. Jurisdiction of Claim
This is the state (ACT, NSW, NT, QLD, SA, TAS, VIC or WA) where the claim has been decided by a court judgement. If the claim is decided in a federal court, input the state where the claim was heard. However, if the claim is settled out of court, then input the state where the claim was settled, this would usually be the State or Territory in which the claimant resides.
A claim that never reaches the stage of a writ is an out of court claim.
Where an insurer has multiple claimants under the one claim and payments are made to each claimant, but in different jurisdictions, the jurisdiction of the principle claimant should be used.
If the claim was settled overseas, code the jurisdiction as that of the policy holder's principle address.
This field is mandatory for finalised claims only.
13. Deductible/Excess
Total of all deductibles or excesses applied to this claim in whole dollars. This may differ from the amount shown in field 20 on the related exposure record.
For Liability XOL policies, the relevant attachment point should be reported.
14. General Nature of Loss (Table 3)
General Nature of Loss
Code
Bodily injury or death
B
Property damage only
P
Financial loss only (no physical damage or bodily injury)
F
Both property damage and bodily injury
L
Both bodily injury and financial loss
X
Both property damage and financial loss
Y
Property damage, bodily injury and financial loss
Z
If a claim is comprised of more than one general nature of loss field type (i.e. P (property damage) and B (bodily injury)), then a claim may only be coded as L, X, Y or Z if the relevant component is greater than 15% of the claim amount.
15. Cause of loss (Tables 4 & 5)
Code one of the causes shown in the following tables (for appropriate class of business). The most significant contributing factor should be identified. Where a suitable cause of loss was not recorded in respect of a claim that occurred before 30 June 2004, report a hyphen (“-“).
APRA Code
Claim Type – Public & Products Liability (Table 4)
Current ISA Code(s) (for information only)
ABM
Abuse/molestation
L12
ANM
Animal bite/attack/impact
L88,L16, L62
ASB
Asbestos/Dust Diseases
L14
CAT
Catastrophe, e.g. Cyclone, earthquake
CUS
Care/custody/control
L50
COL
Collapse of building/structure/subsidence/landslide/weakening and or removal of supports/rusting/oxidation/discoloration including concrete cancer
L18, L42, L86, L40
CYF
Cyber – 1st party loss
CYT
Cyber – 3rd party loss
DFM
Defamation/slander
L53
DSC
Discrimination/harassment
L54
ELC
Electrocution
L21
ENV
Environmental contamination or pollution/spray/drift/other contamination/exposure to or contact with substance/ Not mould or asbestos
L72, L80, L19, L24
APRA Code
Claim Type – Public & Products Liability (Table 4)
Current ISA Code(s) (for information only)
EQB
Equipment breakdown and accidental breakage
L22, L11
EXP
Explosion and/or vibration/exposure to sudden or long-term sound or noise/excavation/drilling damage
L23, L56, L43, L65
NEG
Failed or injurious treatment by practitioner or consultant, or negligent advice
L29, L69
FLL
Fall including from height and slip & fall
L25, L41
FPW
Faulty product/faulty workmanship
L51, L59
FIR
Fire including welding
L27, L87
IMP
Impact or damage by object/vehicle/person, including physical assault/trapped by machinery or equipment
L30, L44, L66, L37, L83
LSL
Lease liabilities
L64
LFT
Lifting, carrying or putting down objects/machinery use/repetitive or overuse injury
L63, L66, L77<br>
MLD
Mould
L89
OTH
Other non financial loss i.e. losses with no tangible value attached such as 'Pain and Suffering'
L48
OFN
Other financial loss i.e. losses that are tangible
L26
WTR
Water
L46
WKR
Worker to worker injury
L47
APRA<br>Code
Claim Type – Professional Risk (Table 5)
Non performance or improper, inappropriate, inadequate, incorrect, incomplete, inaccurate, untimely provision of :
AA
Advice
AB
Assault /abuse / mistreatment
AE
Anaesthetic
BC
Breach of confidentiality
BL
Blood Products
BT
Breach of trust / fiduciary duties
CI
Conflict of interest
CO
Consent (incl. no valid consent, failure to warn, acting against patient’s wishes)
Legal expense coverage (disciplinary enquiries, investigations, inquests and the like)
ME
Medication
MI
Misleading and/or deceptive advice/conduct (specifically section(s) of federal Trade Practices Act, state Fair Trading Acts and the like)
OR
Other
PM
Project management
PR
Procedural
SE
Services other than specified above
SH
Sexual harassment
SI
Supervision / inspection
APRA<br>Code
Claim Type – Professional Risk (Table 5)
TE
Testing
TR
Treatment
UD
Unfair dismissal
16. Body Functions or Structures Affected (Table 6)
Code the most significant body function or structure affecting the claimant as known at the end of the reporting period, for all claims involving bodily injury where claim item 14 (General Nature of Loss) contains a bodily injury component i.e. B, L, X or Z.
APRA Code
Body Functions or Structures Affected
C
Cardiovascular, Haematological, Immunological and Respiratory
D
Death
E
Digestive, Metabolic and Endocrine Systems
G
Genitourinary and Reproductive
M
Mental or Nervous System
N
Neuro-musculoskeletal and Movement-Related
P
Sensory, Pain, Eye, Ear and Related Structures
S
Skin and Related Structures
V
Voice and Speech
17. Severity of loss (Table 7)
Code the severity of the loss underlying the claim for all claims involving bodily injury where claim item 14 (General Nature of Loss) contains a bodily injury component i.e. B, L, X or Z.
APRA<br>code
Severity of loss
L1
Minor or mild injury to soft tissue; minor lacerations; bruising; minor psychological harm
L2
Minor or simple fractures; larger lacerations
M1
Moderate injury usually involving nerve or tissue damage; major psychological harm
M2
Serious injury involving loss of tissue, internal bleeding, ruptured tissue or organs; serious and permanent psychological damage
S1
Major injury involving brain injury likely to lead to permanent impairment
S2
Major injury involving spinal cord injury likely to lead to permanent impairment
S3
Quadriplegia
S4
Paraplegia
S5
Other major injury leading to a disability that is likely to permanently reduce the earning capacity or activity in the community of the claimant
18. Litigation Status (Table 8)
Extent to which case has proceeded through the legal system.
APRA<br>Code
Litigation Status
O
Claim is not litigated
N
Plaintiff does not have legal representation
U
Plaintiff has legal representation but the claim has not been resolved.
L
Plaintiff has obtained legal advice but settlement was reached by negotiation (whether court proceedings were commenced or subsequent to a judgement but before an appeal court determination)
V
Case was settled by court judgement (whether lower court or appeal court) and defendant
paid judgement amount (i.e. either case was not appealed or appeal was not upheld)
W
Plaintiff has legal representation and elects to withdraw the claim.
X
Plaintiff has legal representation, but the case is not awarded in plaintiff’s favour
19. Gross Payments in the Reporting Period
The amount of payments made since the last reporting period, net of GST in whole dollars, no decimal point. Includes payments made to claimant and to third-party service providers (medical, legal, investigation) that are attributed to the claim.
Note:
Data should be provided based on your share only.
Income Tax Credits are excluded.
The values reported should represent the cost to the insurer however the standard assumes that GST paid out on a claim will be recovered by the insurer. If no recovery is available, then the full value should be reported including GST.
20. Gross Payments to Date
The amount of payments made on this claim since the claim was first reported, net of GST in whole dollars, no decimal point. Includes payments made to claimant and to third-party service providers (medical, legal, investigation) that are attributed to the claim.
21. Gross Case Estimate at Start of Reporting Period
Total of all payments expected to be made in future to the claimant(s) and third party providers at the start of the reporting period, net of GST in whole dollars, no decimal point. Equals field 22 on the corresponding claim record that was submitted for the previous reporting period. Will be zero if this claim was first reported in the current reporting period.
Note:
Data should be provided based on your share only.
Income Tax Credits are excluded.
The values reported should represent the cost to the insurer however the standard assumes that GST paid out on a claim will be recovered by the insurer. If no recovery is available, then the full value should be reported including GST.
22. Gross Case Estimate at End of Reporting Period
Total of all payments expected to be made in future to the claimant(s) and third party providers at the end of the reporting period, net of GST in whole dollars, no decimal point. Will be zero if the claim is finalised.
Note:
Data should be provided based on your share only.
Income Tax Credits are excluded.
The values reported should represent the cost to the insurer however the standard assumes that GST paid out on a claim will be recovered by the insurer. If no recovery is available, then the full value should be reported including GST.
23. Gross Third Party Recoveries Received
Total of all amounts that have been received to date from third parties in respect of the claim, net of GST in whole dollars, no decimal point. Excludes any amounts that have been received under reinsurance contracts.
Salvage should be reported as a third party recovery.
Note: Data should be provided based on your share only.
24. Gross Third Party Recoveries Outstanding
Total of all amounts that are expected to be received after the end of the reporting period from third parties in respect of the claim, net of GST in whole dollars, no decimal point. Excludes any amounts expected to be received under reinsurance contracts. Will be zero if the claim is finalised.
Salvage should be reported as a third party recovery.
Note: Data should be provided based on your share only.
25. Gross Claim Payments by Head of Damage before Third Party Recoveries (This field is not used)
A breakdown of the total settlement amount into the following heads of damage is required for finalised claims only. The total of items 25.1 to 25.11 must equal item 20
– Gross Payments to Date, with any rounding difference included in item 25.11 (Other).
Note:
Data should be provided based on your share only.
Income Tax Credits are excluded.
The values reported should represent the cost to the insurer however the standard assumes that GST paid out on a claim will be recovered by the insurer. If no recovery is available, then the full value should be reported including GST.
A finalised claim is one where field 11 (date finalised) has been recorded and field 22 (gross case estimate at end of reporting period) is zero.
Where a claim is settled out of court, contributors should provide a reasonable estimate as to how the total claim is distributed between the Heads of Damages categories.
25.1. Past economic loss
25.2. Future economic loss
25.3. Past medical, hospital, caring and related services
25.4. Future medical, hospital and related services 25.5. Future caring services
25.6. General damages
25.7. Interest
25.8. Plaintiff legal costs
25.9. Defendant legal costs
25.10. Investigation costs
25.11. Other
Appendix A: Data Validation
As well as unit record validation, overall reasonability checks will be carried out on each insurer’s data.
With each half-yearly data submission
Various comparisons between the current reporting period and the previous period will be carried out in order to monitor data reasonability and consistency. These may include:
• Change in the aggregate Gross Earned Premium, split by two digit ANZSIC code or single character occupation code;
• Changes in the total numbers of policies and claims;
• Counts of claims by various measures; causes of loss, severity or litigation status; and
• Changes in the average and total claims paid.
As well, various reasonability checks will be carried out within each period submission, including;
• Overuse of the various ‘Other’ categories and codes; and
• Comparison of the various premium fields against each other.
Other reasonability checks may be carried out on an ad hoc basis.