Washington Administrative Code

(1) The following definitions apply to this rule:(a) "Prospective loss cost" means that portion of a rate that:(i) Provides only for losses and loss adjustment expenses;(ii) Does not provide for expenses or profit; and(iii) Is based on historical aggregate losses and loss adjustm…

(1) When an insurer or rating organization files rates with the commissioner, it must demonstrate that the proposed rates satisfy the requirements of chapter 48.19 RCW. RCW 48.19.020 requires that premium rates for insurance are not excessive, inadequate, or unfairly discriminato…

(1) Under RCW 48.19.080, the commissioner may waive insurance rate filing requirements in chapter 48.19 RCW. Except as described in subsection (2) of this section, the commissioner will waive rate filing requirements for individual risks or classes of insurance for which the insu…

Under RCW 48.19.030 and 48.19.070, insurers are not required to file rates with the commissioner for certain inland marine risks that are not written according to manual rates or rating plans. The following inland marine classes of risks, which are characterized by large numbers …

(1) An insurer may file a schedule rating plan for the following monoline or packaged types or subtypes of insurance:(a) Commercial automobile;(b) Commercial crime;(c) Commercial fidelity and surety;(d) Commercial general liability;(e) Commercial inland marine;(f) Commercial mult…

(1) An insurer must not change an insured's rates solely because the insured's zip code has been changed by the United States Postal Service. This section does not prohibit insurers from using zip codes to define rating territories.(2) The zip code boundaries approved by the comm…

(1) Filers must include a common effective date for all rates submitted in a filing. If a filer includes a request in the filing, an insurer may use a different effective date for renewal policies, subject to a maximum interval of sixty days.(2) The proposed effective date must b…

(1) Under RCW 48.19.080, the commissioner will suspend the rate filing requirements in chapter 48.19 RCW for large commercial property and casualty accounts.(2) For purposes of this section, "large commercial property and casualty account" means property and casualty insurance as…

(1) This section prescribes standards that apply to insurers' rate stability rules, which are also sometimes called "transition rules" or "premium-capping rules." For the purposes of this section, a "rate stability rule" means a rating rule created by an insurer to limit premium …

(1) This section applies to insurers using insurance scores for rating of personal insurance under the provisions of RCW 48.19.035.(2) If an insurer uses insurance scores to calculate renewal premiums, the insurer must:(a) Update each policyholder's insurance score no less often …

These rules describe the standards that apply to insurers that use underwriting criteria or rating plans for personal insurance based on credit history. The rules have been adopted under the authority and purposes of the following laws: RCW 48.02.060; chapters 48.18; 48.19; and 4…

The definitions in this section apply throughout this chapter:(1) "Demographic factors" means the factors listed below if they are used in an insurer's rates, rating tiers, rating factors, rating rules or risk classification plan:(a) Age of the insured;(b) Sex of the insured;(c) …

SERFF is a dynamic application that the NAIC will revise and enhance over time. To be consistent with NAIC filing standards and provide timely instructions to filers, the commissioner will incorporate documents posted on the SERFF website into this chapter. By reference, the comm…

(1) An insurer must tell a consumer about significant factors that adversely affect the consumer's credit history or insurance score. As many as four factors may be needed to explain the adverse action.(2) An insurer must explain what significant factors led to an adverse action …

(1) Insurers must provide information that helps the consumer determine why the consumer was charged a higher premium or determined to be ineligible for coverage by the insurer. The following information must be included with the reason for the adverse action:(a) A description of…

An insurer must explain any adverse action in reasonably clear and simple language. Insurers must not use phrases that do not explain why the consumer was charged a higher premium or determined to be ineligible for coverage by the insurer.(1) Explanations of adverse actions that …

(1) Every insurer that uses an insurance scoring model to underwrite personal insurance coverage must file the model with the commissioner before January 1, 2003.(2) Every insurer that uses an insurance scoring model to determine personal insurance rates or premiums must file the…

(1) Insurance scoring models must be filed separately. The model must not be filed with any rate or rule filing.(2) The insurance scoring model must be filed in SERFF in accordance with the Washington State SERFF Personal Insurance Scoring Model Filing General Instructions posted…

(1) The commissioner will allow vendors to file insurance scoring models. The vendor must file the scoring model in SERFF in accordance with the Washington State SERFF Personal Insurance Scoring Model Filing General Instructions posted on the commissioner's website (www.insurance…

(1) The law says insurance scoring models will remain confidential unless the commissioner is taking an enforcement action. An insurer or vendor may request that its insurance scoring model be available for public inspection.(2) To restrict public access to an insurance scoring m…

"Eligibility rules or guidelines" mean rules that determine whether a consumer is eligible for insurance from a single insurer or a group of affiliated companies. Eligibility rules or guidelines do not include rules that determine which company within an affiliated group of compa…

Eligibility guidelines will be kept as confidential records if they:(1) Conform to the definition in WAC 284-24A-032; and(2) Are clearly identified.To ensure confidentiality, insurers should submit eligibility guidelines in a separate and distinct part of the related rate filing …

Actuarial analysts will review the model to determine whether it complies with Title 48 RCW. The scope of the review will include whether the model includes:(1) Any prohibited factors; and(2) Attributes that may result in unfair discrimination.[Statutory Authority: RCW 48.02.060,…

The commissioner will:(1) Notify the insurer or vendor that the model does not comply with Washington law;(2) State the reasons why the model does not comply with Washington law;(3) Offer the insurer or vendor sixty days to revise the model to resolve the issue(s) outlined in sub…

If an insurer uses credit history or insurance scores to segment personal insurance business for rating purposes, the insurer must:(1) Submit a multi variate analysis with the first rate and rule filing the insurer makes to comply with this law.(2) Submit a multivariate analysis …

(1) A multivariate statistical analysis must evaluate the rating factors listed below (if applicable to the rating plan, and to the extent that data are credible):(a) For homeowners, dwelling property, earthquake, and personal inland marine insurance:(i) Insurance score;(ii) Terr…

(1) Insurers should not submit actuarial data based on demographic factors with their insurance scoring model.(2) Insurers must submit actuarial data based on demographic factorsto support any difference in rates or premiums based on:(a) "No hit," which means the absence of credi…

(1) Our insurance company uses insurance scoring bands (a range of scores) to determine what to charge a consumer based on their personal insurance score. Does an insurer have to file its insurance scoring bands? Yes. If an insurer uses insurance scoring bands for rating purposes…

(1) "Insurer" means an authorized insurer that has premium, loss or loss adjustment expense data in Washington state for one or more of these lines of insurance:(a) Property, as defined in RCW 48.11.040;(b) Marine and transportation, as defined in RCW 48.11.050, if not exempt fro…

(1) The purpose of this chapter is to:(a) Incorporate the provisions of the NAIC Statistical Handbook into this chapter;(b) Prescribe the manner of reporting statistical data and the types of statistical data insurers must submit to statistical agents under RCW 48.19.370; and(c) …

(1) By reference, the commissioner incorporates all provisions of the NAIC Statistical Handbook into this rule, except:(a) Medical Professional Liability Reports: Statistical Plan Reporting Requirements; and(b) Medical Professional Liability Reports: Model Medical Professional Li…

(1) Under RCW 48.19.370(4), the commissioner may designate certain rating organizations or other entities as statistical agents to gather, compile, and report insurance statistical data.(2) RCW 48.19.370 says each insurer must report loss and expense experience to the commissione…

The commissioner may designate an entity as a statistical agent if the entity makes a written request to the commissioner that:(1) Identifies the line(s) of business for which the entity will collect and report statistical experience;(2) States the entity's qualifications to act …

Entities that are designated as statistical agents under WAC 284-24B-050 must promptly file with the commissioner:(1) Their statistical plans, including standard report formats; and(2) All changes in their statistical plans or reporting formats.[Statutory Authority: RCW 48.02.060…

Statistical agents must collect statistical data in a form and detail as required by the NAIC Statistical Handbook and any additional detail required by rules adopted by the commissioner.[Statutory Authority: RCW 48.02.060, 48.19.370. WSR 06-13-035 (Matter No. R 2005-02), § 284-2…

If the commissioner designates more than one statistical agent to collect statistical data for a particular line of insurance, those statistical agents must arrange to file reports that combine all data collected by the statistical agents for that line(s) of insurance. The statis…

The commissioner shall have access to all statistical data that statistical agents collect to comply with this chapter. If requested by the commissioner, statistical agents must promptly provide a copy of any report produced from data that the statistical agent is required to col…

(1) Aggregate data reported to the commissioner by statistical agents are available for public inspection.(2) If data submitted to the commissioner by a statistical agent appear likely to identify individual insurers, claimants or insureds, or the statistical agent or an insurer …

Insurers must affiliate with a designated statistical agent by January 1, 2007, and report data in accordance with the requirements included in the NAIC Statistical Handbook and the designated statistical agent's filed statistical plan.[Statutory Authority: RCW 48.02.060, 48.19.3…

(1) "Medical malpractice insurer" means an authorized general casualty insurer that has premium, loss or loss adjustment expense data for medical malpractice insurance.(2) "Medical professional liability insurance" or "medical malpractice insurance" provides coverage for tort cla…

(1) The purpose of this chapter is to:(a) Incorporate the provisions of chapter 284-24B WAC into this chapter;(b) Prescribe the manner of reporting statistical data and the types of statistical data medical malpractice insurers must submit to statistical agents under RCW 48.19.37…

Each medical malpractice insurer must:(1) Comply with the provisions of RCW 48.19.370 and chapter 284-24B WAC; and(2) Report its insurance statistical data to a statistical agent designated by the commissioner in accordance with the statistical plans filed by the statistical agen…

These data items, as specified by the NAIC Statistical Handbook, must be reported by each medical malpractice insurer to a medical malpractice statistical agent:(1) Company number: Experience must be reported by the company number assigned by the medical malpractice statistical a…

In addition to the data items specified by the NAIC Statistical Handbook, these data items, specific to this medical malpractice statistical plan rule, must be reported by each medical malpractice insurer to a medical malpractice statistical agent:(1) Claim dates:(a) Incident mon…

(1) Medical malpractice insurers must:(a) Comply with chapter 284-24B WAC, affiliate with a designated medical malpractice statistical agent by January 1, 2007, and promptly begin reporting data required under WAC 284-24C-040; and(b) Begin reporting statistical data specified und…

This chapter contains procedural rules to implement chapter 48.140 RCW. This chapter describes the rules, practices and procedures that insuring entities, self-insurers, health care facilities and providers must use to report data to the commissioner as required by chapter 48.140…

The definitions in this section apply throughout this chapter.(1) "Allocated loss adjustment expense" or "ALAE" means defense and cost containment expenses paid or incurred for defense, litigation and medical cost containment expenses and services. Either internal staff, such as …

RCW 42.56.400(11) protects data filed under chapter 48.140 RCW from public disclosure. To ensure data confidentiality, the commissioner will:(1) Develop a secure web-based data reporting application;(2) Train OIC staff on applicable laws and agency practices related to protecting…

(1) Except as provided in subsection (2) of this section, reporting entities must use the reporting site maintained by the OIC to report closed claims. To help reporting entities collect data, the commissioner will post reporting forms on the OIC internet site so that reporting e…

The reporting site will assign a permanent user ID to each reporting entity the first time it enters a closed claim into the reporting site.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140. WSR 07-12-057 (Matter No. R 2006-02), § 284-24D-050, filed 6/4/07, effective …