01. Experience Modification Effective Date

Report the experience modification effective date, YYMMDD, only when different from the policy effective date. If the experience modification changes in accordance with New York Experience Rating Plan Manual rules, report the effective date of the experience modification that applies to the reported class codes, exposures and premiums.

Note: For the first split (split 0), the experience modification effective date must be equal to, or prior to, the policy effective date. For subsequent splits (splits1….), the experience modification effective date must be after the policy effective date, but prior to the policy expiration date.

 

02. Rate Effective Date

Report the rate effective date, YYMMDD, only when different from the policy effective date. If the rate changes in accordance with manual rules, report the effective date that applies to the reported class codes, exposures and premiums.

Note: The rate effective date must be prior to, or equal to, the effective date of the first split period.

 

03. Update Type

Report the 1-letter code that identifies the activity of the exposure data.

Code Description
R Original first reports and revised data on correction reports
P Previously reported data (used only on correction reports)

Refer to Part V for further instructions.

04. Exposure Coverage Code

Report the exposure coverage for each class on the policy.

Code Description
00 For use with Statistical Codes
01 State Act or Federal Act excluding USL&HW and Federal Coal Mine Health and Safety Act
02 USL&HW coverage on “F” and Non-"F" Classes

05. Classification Code

Report the 4-digit code corresponding to the classification assigned to the insured according to the rules of the New York Workers Compensation and Employers Liability Manual or the statistical code defined by the NYCIRB.

Refer to Part I, Item 17 for additional instructions.

  1. Payroll Classification Codes
     
    1. Payroll exposures are required for all classifications except those specifically indicated as exceptions in this section.

      Payrolls must be appropriately separated as of the effective date of the change whenever there is a change in experience modification.

      The exposure reported on the 1st report must be the audited exposure corresponding to the charged premium amount. When a final audit has not been made at the time of filing a statistical report, submit the estimated exposures and mark the Estimated Audit Indicator box in the Policy Conditions field with the symbol "Y". Without further request, correct the estimated exposure with a revised statistical report as soon as the audited payrolls are available.

    2. For eligible construction classifications subject to the Payroll Limitation Law, report the limited payroll amounts, if any, as determined in accordance with the Law.

      Refer to Rule V.G. in the New York Workers Compensation and Employers Liability Manual for detailed information regarding the Payroll Limitation Law.

  2. Other Than Payroll Classification Codes

    An employee covered under a per capita classification for a period of one year must be reported as an exposure of 10. For coverage less than one year, the exposure reported must be that fraction part of a year, expressed to the nearest tenth (with an implied decimal point), for which the coverage is in effect. Refer to the following table:

    Individual Durations of Coverage Between Fraction of Year To Be Reported As
          0   days to 17 days       0 year     00
          18   days to 1 month 23   days .1 year     01
      1 month 24   days to less than 3   months .2 year     02
      3 months       to 4 months 5   days .3 year     03
      4 months 6   days to 5 months 11   days .4 year     04
      5 months 12   days to 6 months 17   days .5 year     05
      6 months 18   days to 7 months 23   days .6 year     06
      7 months 24   days to less than 9   months .7 year     07
      9 months       to 10 months 5   days .8 year     08
      10 months 6   days to 11 months 11   days .9 year     09
      11 months 12   days to one year 16   days 1.0 year     10

    Example: An employee covered for six months (.5 of a year) shall be reported as an exposure of 05. Exposure shall be governed by the duration of coverage and not by the number of days worked.

  3. Per Location

    The exposure under Code 9027 (Building Operation - Dwelling) must be reported in accordance with the rules specified above for Per Capita classifications, treating one location year as an exposure of 10.
     
  4. Volunteer Firefighters

    The population of the "home area" must be reported under Code 7711 in the exposure field and the corresponding premium shall be reported in the premium field. Where there are separate charges for servicing other areas under contract, the statistical report must show as separate items the following:

    1. The number of contracts for servicing other “home areas” must be shown in the exposure field and the total of the charges must be shown in the premium column. It is not necessary to list each such charge separately.

    2. For each "outside area”, report the population in the exposure column and the corresponding premium in the premium field. For these items, report 1.00 in the manual rate field.
      Where only a proportionate share of the total premium for the "outside area" is paid because the "outside area" is covered by more than one contract, report in the manual rate field the ratio of the contract price for the "home area" to the contract price for all areas servicing such "outside area".

      Example: If the contract price for the "home area" is 25% of the total contract price for all areas, show .25 in the manual rate field.

      Note: WCSTAT requires the reporting of three positions after the decimal point. Therefore, in the above example, the 25% to be reported in the manual rate field must be reported as 0000250, with an implied decimal point before the “2”.

    Note: Do not include the population reported in the exposure field in the Exposure - Payroll Total.

  5. Volunteer Ambulance Workers

    The number of ambulances or first response vehicles servicing the ambulance district must be reported under Code 7370 in the exposure field and the corresponding premium shall be reported in the premium field. The exposure must be reported in accordance with the rules specified above for Per Capita classifications, treating one ambulance year as an exposure of 1.0.

  6. No Exposure Developed (1st Report)

    Report no exposure developed/no payroll by using statistical Code 1111 for the entire policy period and zero-fill the exposure field.

Report the carrier’s authorized rate corresponding to each classification code.

In the case of split rates due to a flat increase or decrease on an outstanding policy, either:

i)    Report the additional premium resulting from a flat increase under Code 0998. Report the premium credit
      resulting from a flat decrease under Code 0994, or

ii)   The exposure, authorized rate and corresponding premium may be split. The inception date of each period
       covered must be shown in the “Rate Effective Date” field.

08. Split Period Code

Report the single digit code when indicating changes in authorized rates or experience modifications during a policy period. Valid values are “0” - “9” where “0” is reported for the first effective period, “1” is reported for the second effective period, and so on up to a ninth effective period (if applicable). This field is zero-filled for policies with no changes in rates or experience modification.

 

09. Premium Amount

  1. Extension of Exposure

    The premium obtained by extension of payroll or other exposure at the carrier’s authorized rate must be reported under the appropriate classification codes.

  2. Flat Charges

    The premium obtained by flat charges does not vary by exposure and must be reported under the appropriate statistical codes.

10. Premium Amount Subject To Experience Modification Factor (Above Line - A)

Report the premium by classification as determined by:

  1.  Extension of Exposure

    Report the premium obtained by the extension of payroll or other exposure bases at the applicable manual rate corresponding to the appropriate classification code.


  2. Other Than Extension of Exposure

    Report premium that does not vary by exposure separately under the appropriate statistical code as follows:
(1) Construction Employment Territory Differential Premium
 
  Report the premium resulting from the application of territory differentials for construction employers subject to Rule V.G. of the New York Workers Compensation and Employers Liability Manual.
 
  a. Code 9126 - Territory 1 Differential Premium - Counties of The Bronx, Kings, New York, Queens and Richmond
 
  b. Code 9127 - Territory 2 Differential Premium - Counties of Dutchess, Nassau, Orange, Putnam, Rockland, Suffolk and Westchester
 
  c. Code 9128 - Territory 3 Differential Premium - All Other Counties
 
  Note: Exposures are not applicable to these codes.
 
(2) Drug-Free Workplace Premium Credits
 
  Report the premium credit amount under Code 9841 for policies written in conjunction with a carrier filed Drug-Free Workplace Program, when the program has been filed subject to experience rating.
 
(3) Employers Liability Increased Limits
 
  Refer to Part VI for the appropriate statistical codes to report the premium charged for providing increased limits for Coverage B for employees not subject to the New York Workers' Compensation Law. In those cases where the calculated charge is less than any minimum charge for the selected limits, the additional premium required to balance to such minimum charge must be reported under Code 9848.
 
(4) Flat Decrease / Increase on Outstanding Policies
 
  Refer to Item 7a of this Part.
 
(5) Deductible Programs
 
 

a.   Report the premium credit for the New York small deductible program under Code 9664.
 

 

b.   Report the premium credit for carrier deductible programs under Code 9664 when filed to be
      applicable prior to the application of the experience modification
 

(6) No Exposure/Premium Developed
 
 

Zero-fill the premium field under Code 1111, when no exposure develops on the policy.
 

(7) Premium for the Extension of Employers Liability Coverage to Additional Interests Under a Volunteer Ambulance Workers' Benefit Law (VAWBL) or Volunteer Firefighters' Benefit Law (VFBL) policy
 
  Report the premium charged for this additional coverage under Code 9851 for VAWBL policies endorsed by WC 31 06 13, and under Code 9850 for VFBL policies endorsed by WC 31 06 07.
 
(8) Rate Deviations
 
  Not applicable in New York to policies effective October 1, 2008 and subsequent.
 
(9) Repatriation Expense Premium
 
  Report the premium charged for repatriation expense on policies endorsed by WC 31 06 17, Foreign Voluntary Coverage, under Code 9606.
 
(10) Waiver of Subrogation Premium
 
  Report the premium charged for a waiver of subrogation on policies endorsed by WC 00 03 13, Waiver of Our Right to Recover from Others, under Code 0930.

11. Total Subject Premium Amount

Report the total premium amount subject to experience modification. This is the sum of class code and statistical code premium that is subject to experience rating.

12. Experience Modification Factor

Report the experience modification factor used to develop the charged premium.

Example:   A .95 experience modification factor must be reported as 0950. There is an implied decimal between the first and second digit in this field.

If a change in experience modification occurs subsequent to the inception date of the policy, the exposures, manual rates and corresponding premiums must be split and reported separately with the corresponding mod factor and mod effective date.

Note:   Zero-fill this field for policies not subject to experience modification and for policies subject to Merit Rating. Refer to Item 13g of this Part for instructions on reporting Merit Rating credit and debit premium.

Report the classification codes and corresponding exposures, rates (if applicable) and premium amounts separately for those classifications not subject to experience modification.

  1. Atomic Energy Radiation Exposure

    Refer to Part I, Items 11 and 12.

  2. Construction Classification Premium Adjustment Program Premium Credit

    Report the premium credit amount as a result of this program under Code 9046.

  3. Drug-Free Workplace Premium Credit

    Report the premium credit amount under Code 9846 for policies written in conjunction with a carrier filed Drug-Free Workplace Program, when filed not subject to experience rating.

  4. Deductible Programs

    Report the premium credit amount for carrier filed and approved deductible programs under Code 9663 when filed not subject to experience rating.

  5. Managed Care / Preferred Provider Organization Premium Credit

    Report the premium credit amount under Code 9874 for policies written in conjunction with a carrier filed and approved Managed Care or Preferred Provider Organization program.

  6. Merit Rating Premium Amount

    Report the premium amount resulting from the application of New York merit rating factors as follows:

      Merit Rating Factor Code
     
    .92

    9885
      1.00 9884
      1.04 9896
      1.08 9886

    Note: Zero-fill the premium amount when Code 9884 applies.

  7. Minimum Premium Policies
     
    1. Other than Maritime or FELA

      The additional premium necessary to bring the total standard premium up to the minimum premium must be reported separately from the classification code(s)’ manual premium and the expense constant. The Balance to Minimum Premium must be reported under Code 0990. The amount reported under this statistical code should not include the expense constant.

      Note:   If the minimum premium applies to a multi-state policy, the additional premium required to bring the total risk standard premium up to the minimum premium must be reported to the state with the highest minimum premium.

    2. Maritime or FELA

      Report the additional premium required to equal the separate minimum premiums under Code 9849 when manual premium is developed under Maritime or FELA classifications and where such premium together with any Maritime or FELA increased limits charge is less than any Maritime or FELA minimum premiums.
       
  8. Non-Ratable Premium Elements

    Report the exposures, manual rates and premium amounts under the associated statistical codes listed in Part VI for classification codes containing non-ratable elements.

    Note:   Report the same exposure under the non-ratable codes as reported for the companion ratable classification codes.
     
  9. Rate Deviations

    Not applicable in New York to policies effective October 1, 2008 and subsequent.

  10. Schedule Rating Premium Amount

    For policies written to include Schedule Rating credits or debits, report the premium credit amount under Code 9887 and the premium debit amount under Code 9889

  11. Short Rate Penalty Premium

    Report the additional premium resulting from the application of the Short Rate Cancellation Rule X.D. in the New York Workers Compensation and Employers Liability Manual under Code 0931.

  12. Workplace Safety and Loss Consultation Premium Surcharge

    Report the premium surcharge amount as a result of the New York Compulsory Workplace Safety and Loss Consultation Program under Code 9747.

  13. Workplace Safety and Loss Prevention Incentive Program (WSLPIP) Premium Credit Amounts
     
    1. Drug and Alcohol Prevention Program

      Report the premium credit amount under Code 9753 for policies written in conjunction with New York’s Drug and Alcohol Prevention Program.

    2. Return-To-Work Program

      Report the premium credit amount under Code 9743 for policies written in conjunction with New York’s Return-To-Work Program.

    3. Safety Incentive Program

      Report the premium credit amount under Code 9748 for policies written in conjunction with New York’s Safety Incentive Program.
       
  14. Safe Patient Handling Act Program Premium Credit

    Report the premium credit amount under Statistical Code 9651 for policies eligible for the Safe Patient Handling Act Program.

14. Exposure - Payroll Total

Report the sum of all payroll exposures. Do not include exposures reported for the non-ratable codes.

Note: Total payroll exposure is only required on first reports and corrections to first reports.

15. Total Standard Premium Amount

Report the total premium amount charged for the policy, excluding any approved expense constants, premium discounts, terrorism and catastrophe charges, New York Security Fund surcharges and any New York assessments.

Note: The total standard premium amount is only required on first reports and corrections to first reports.

16. Premium Discount Amount

Report the premium amount resulting from the application of approved premium discount plans under Code 0063 (stock company or Type A) or Code 0064 (non-stock company or Type B). Do not include the premium discount amount in the total standard premium. 

17. Expense Constant Amount

The premium amount resulting from the application of an approved expense constant must be reported under Code 0900 and must be reported separately from the classification code(s)’ manual premium and any Balance to Minimum premium. Do not include the expense constant amount in the total standard premium.

Note:   The expense constant on a multi-state policy must be allocated to the state with the highest applicable expense constant. If two or more states included on the policy have the same highest expense constant, the expense constant must be reported for the state developing the largest amount of standard premium.

 

18. Catastrophe Provision For Terrorism

Report the premium amount charged for terrorism under Code 9740.
Do not include the terrorism amount in the total standard premium.

19. Catastrophe Provision For Natural Disasters And Catastrophic Industrial Accidents

Report the premium amount charged for natural disasters and catastrophic industrial accidents under Code 9741.
Do not include the catastrophe amount in the total standard premium.

20. New York Workers Compensation Security Fund Surcharge

Report the surcharge amount under Code 9749 when the policy is subject to the Security Fund Surcharge.
Do not include the Security Fund surcharge amount in the total standard premium.