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

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

1. Insurer code

This will be provided by APRA when advised of the method of delivery of the data.

2. 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 This information is only used for cross-referencing by APRA – it will not be published except in any individual data reports prepared for the insurer concerned.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 (“-“).

Table 2

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.

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.

Table 5

Where this information is not available, enter a hyphen (“-“).

18. Litigation Status

Extent to which case has proceeded through the legal system

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:

1. 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.
2. 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.