Reporting Form LOLRF 800.2
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 Lloyd’s 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.
Details of requirements in relation to reporting periods, method of submission and authorisation are set out in the Reporting Standard. The data submitted by Lloyd’s will be validated by APRA at each reporting period. The data validation to be performed is outlined in Appendix A.
Record Layouts and Field Specifications
Claim Data
| Claims Data | Data Item | Public &<br>Products | Professional Risk | Field type1 |
|---|
| 1* | Insurer code | M | M | 6a |
| 2* | Record type | M | M | 1a |
| 3 | Status at end of Reporting Period | M | M | 1a |
| 4* | Month of End of Reporting Period | M | M | 8n |
| 5* | Class of Business | M | M | 2a |
| 6* | Policy Number | M | M | 30a/n |
| 7* | Risk Number | M | M | 30a/n |
| 8* | Claim Number | M | M | 30a/n |
| 9* | Date of Loss | M | O | 8n |
| 10 | Date of Report | M | M | 8n |
| 11 | Date Finalised | M | M | 8n |
| 12 | Jurisdiction of Claim | O | O | 3a |
| 13 | Deductible/Excess | O | O | 12n |
| 14 | General Nature of Loss | O | O | 1a |
| 15 | Cause of Loss | O | O | 3a |
| 16 | Body Functions or Structures Affected | O | O | 1a |
| 17 | Severity of Loss | O | O | 1a&1n |
| 18 | Litigation Status | O | O | 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 | O | O | 12n |
| 24 | Gross Third Party Recoveries Outstanding | O | O | 12n |
| 25.1 | Past economic loss | O | O | 12n |
| 25.2 | Future economic loss | O | O | 12n |
| 25.3 | Past medical, hospital, caring and related services | O | O | 12n |
| 25.4 | Future medical, hospital and related services | O | O | 12n |
| 25.5 | Future caring services | O | O | 12n |
| 25.6 | General damages | O | O | 12n |
| 25.7 | Interest | O | O | 12n |
| 25.8 | Plaintiff legal costs | O | O | 12n |
| 25.9 | Defendant legal costs | O | O | 12n |
| 25.10 | Investigation costs | O | O | 12n |
| 25.11 | Other | O | O | 12n |
1Date must be DDMMYYYY, no delimiter.
Key:
M – mandatory field on all records from 1 July 2004.
O – optional field.
a – alpha.
n – numeric.
- Fields so indicated, as a combination, must be unique for each reporting period.
Claims Record Data Field Definitions
- Insurer code
This will be provided by APRA when advised of the method of delivery of the data.
- Record type
• C for Claims Record
3. Status at End of Reporting Period
• C for Current
• F for Finalised
• For claims that have been reopened, code a “C”
• S for Structured Settlement
4. Month of End of Reporting Period
The data will relate to a six month period. Code the last day of this period in this field as DDMMYYYY, e.g. insert code 30062003 for data relating to the six months ending 30 June 2003.
5. Class of Business
• PL = Public & Product
• PI = Professional Risk
6. Policy Number
The unique market reference field allocated by the Lloyd’s broker. 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
The broker reference field used to sub-divide accounting entries into different countries.
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
Code date on which the incident giving rise to the claim is believed to have occurred in this field as DDMMYYYY. In cases where the actual date of loss is not known or relates to a period of time, then use the date when the claim was made or the first advice was given to Lloyd’s syndicates.
10. Date of Report
Code date when claim was first advised (not processed) to the Lloyd’s syndicate as DDMMYYYY.
11. Date Finalised
Code date when claim is finalised as DDMMYYYY. 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.
If the status of the claim is Finalised, this field is mandatory. Where the claim is not finalised this field is “blank”.
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, i.e. the state in which the claimant’s payment is paid.
Where this information is not available, enter a hyphen (“-“).
13. Deductible/Excess
Total of all deductibles or excesses applied to this claim in whole dollars converted to A$ using end of processing month rates of exchange. This may differ from the amount shown in field 20 on the related exposure record.
Where this information is not available, enter a hyphen (“-“).
14. General Nature of Loss
Code the general nature of loss as
• P = Property damage only
• B = Bodily injury or death
• L = Both property damage and bodily injury
• F = Financial loss only (no physical damage or bodily injury)
• X = Both bodily injury and financial loss
• Y = Both property damage and financial loss
• Z = Property damage, bodily injury and financial loss
Code as a hyphen (“-“) if unknown
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.
Where this information is not available, enter a hyphen (“-“).
15. Cause of loss
Code one of the causes shown in the following table to the claim. The most significant contributing factor should be identified.
Where this information is not available, enter a hyphen (“-“).
| APRA<br>Code | Claim Type – Public & Products Liability | Current ISA Code(s)<br> (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/<br>Not mould or asbestos | L72, L80, L19, L24 |
| 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 | L48 |
| OFN | Other financial loss | L26 |
| WTR | Water | L46 |
| WKR | Worker to worker injury | L47 |
Table 2
| APRA<br>Code | Claim Type – Professional Risk |
|---|
| Non-performance or improper, inappropriate, inadequate, incorrect, incomplete, inaccurate, untimely provision of : |
| AA | Advice |
| DA | Documentation/ administration |
| SI | Supervision / inspection |
| DS | Design / specification |
| PM | Project management |
| TE | Testing |
| DI | Diagnosis |
| TR | Treatment |
| PR | Procedural |
| ME | Medication |
| IC | Infection control / prevention |
| AE | Anaesthetic |
| BL | Blood Products |
| CO | Consent (incl. no valid consent, failure to warn, acting against patient’s |
| APRA<br>Code | Claim Type – Professional Risk |
| wishes) |
| SE | Services other than specified above |
| EQ | Faulty and/or inadequate / inappropriate / inaccurate / contaminated equipment and/or premises |
| IP | Breach of intellectual property rights |
| DE | Defamation |
| CI | Conflict of interest |
| BC | Breach of confidentiality |
| BT | Breach of trust / fiduciary duties |
| UD | Unfair dismissal |
| LD | Loss of documents |
| FR | Fraud & dishonesty. Fidelity |
| MI | Misleading and/or deceptive advice/conduct (specifically section(s) of federal Trade Practices Act, state Fair Trading Acts and the like) |
| AB | Assault /abuse / mistreatment |
| HA | Harassment / discrimination |
| SH | Sexual harassment |
| IN | Insolvency |
| LE | Legal expense coverage (disciplinary enquiries, investigations, inquests and the like) |
| IT | Improper trading / collusive practices /unconscionable conduct |
| OR | Other |
Table 3
16. Body Functions of Structures Affected
Code the most significant body function or structure affecting the claimant as known at the end of the reporting period.
| 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 | Neuromusculoskeletal and Movement-Related |
| P | Sensory, Pain, Eye, Ear and Related Structures |
| S | Skin and Related Structures |
| V | Voice and Speech |
Table 4
Where this information is not available, enter a hyphen (“-”).
17. Severity of loss
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.
| APRA code | Severity of loss [acute bodily injury claims only] |
|---|
| L1 | Minor or mild injury to soft tissue; minor lacerations; bruising |
| L2 | Minor or simple fractures; larger lacerations |
| M1 | Moderate injury usually involving nerve or tissue damage |
| APRA code | Severity of loss [acute bodily injury claims only] |
| M2 | Serious injury involving loss of tissue, internal bleeding, ruptured tissue or organs |
| 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 |
Table 5
Where this information is not available, enter a hyphen (“-“).
18. Litigation Status
Extent to which case has proceeded through the legal system
| APRA 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 |
Table 6
Where this information is not available, enter a hyphen (“-“).
19. Gross Payments in the Reporting Period
The amount of the Lloyd’s share of payments made since the last reporting period, net of GST in whole dollars, no decimal point and converted to A$ using end of processing month rates of exchange. Includes payments made to claimant and to third party service providers (medical, legal, investigation) that are attributed to the claim.
20. Gross Payments to Date
The amount of Lloyd’s share of payments made on this claim since the claim was first reported, net of GST in whole dollars, no decimal point and converted to A$ using end of processing month rates of exchange. 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 Lloyd’s share 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 and converted to A$ using end of processing month rates of exchange. Equals field 22 on the corresponding claim record that was submitted for the previous reporting period. Zero if this claim was first reported in the current reporting period.
22. Gross Case Estimate at End of Reporting Period
Total of Lloyd’s share 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 and converted to A$ using end of processing month rates of exchange.
23. Gross Third Party Recoveries Received
Total of Lloyd’s share 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 and converted to A$ using end of processing month rates of exchange. Excludes any amounts that have been received under reinsurance contracts. Where this information is not available, enter a hyphen (“-“).
24. Gross Third Party Recoveries Outstanding
Total of Lloyd’s share 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 and converted to A$ using end of processing month rates of exchange. Excludes any amounts expected to be received under reinsurance contracts.
Where this information is not available, enter a hyphen (“-“).
25. Gross Claim Payments by Head of Damage before Third Party Recoveries (This field is not used)
A breakdown of Lloyd’s share of the total settlement amount (converted to A$ using end of processing month rates of exchange) 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 23.11 (Other).
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 this information is not available, enter a hyphen (“-“).
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
The individual claim data submitted by Lloyd’s will be validated by APRA as follows:
- Gross case estimate at the start of the current reporting period (claim field 19) will be compared with gross case estimate at the end of the previous reporting period (claim field 20) for each claim with a date of report prior to the start of the current reporting period. Any discrepancy must be explained.
- Gross claim payments submitted in information provided by Lloyd’s under Lloyd’s Security Trust Fund Determination No 1, less the gross payments received for all facilities, is expected to reconcile to within 5% of the gross payments for each accident year calculated from the individual claim records submitted. Discrepancies in the most recent accident years will be compared with the amount of payments made for all facilities.
While it is appreciated that more extensive reconciliation could be attempted, this could require significant changes to the existing reporting requirements to APRA or the submission of other information (such as management accounts) from insurers that would not be in standard formats.
APRA will expect that where Lloyd’s needs to demonstrate the reason for a discrepancy between the individual records submitted to the database and its aggregate data reported to APRA in the above forms, Lloyd’s will share such additional reports with APRA as required.