Exhibit A - Nycirb
New York CompensationInsurance Rating Board733 Third AvenueNew York, NY 10017Tel: (212) 697-3535July 15, 2021R.C. 2543Re:New York State Workers’ Compensation Loss Cost Filing andLoss Costs by Classification; Effective on October 1, 2021Members of the Rating Board:I write to inform you that today, the New York State Department of Financial Services(“Department”) approved the filing submitted by the Rating Board for a decrease of 6.4% in theoverall loss cost level in New York State, effective October 1, 2021. This approval represents thesixth straight year that the Department approved the loss cost change recommended by theRating Board’s Actuarial Committee.As previously explained in R.C. Bulletin 2537, the approved loss cost indication wasderived by applying Rating Board’s standard ratemaking methodology.Loss costs for each employment classification have been derived in accordance with theapproved filing and are now available for use on policies with effective dates on or after October1, 2021. Manual pages displaying the loss cost for each employment classification are attachedhereto as Exhibit A. Class loss costs are also published in the digital version of the New YorkWorkers’ Compensation and Employers’ Liability Manual (“Manual”) and have been madeavailable on the Rating Board’s website in Excel and WCRATE format.As a reminder, the published values, including the loss costs by classification and theprovisions for terrorism, natural disasters, and catastrophic industrial accidents are not rates.Therefore, insurers must apply their approved loss cost multipliers to the loss costs in the Manualto develop final rates. The revised loss costs are effective for all insurers as of October 1, 2021,and accordingly insurers do not have to (i) file to adopt the new loss costs, or (ii) refile loss costmultipliers that are currently approved by the Department in order to utilize the October 1, 2021loss costs. However, if an insurer seeks to change either its loss cost multiplier(s) or any otherpreviously approved independently filed rating factor or value, it must do so by filing thesechanges with the Department for approval prior to use.In addition, New York State Insurance Law section 2347(c) requires that at least thirtydays prior to billing, insurers provide insureds whose premium is affected by a rate change anestimate of the change as well as the reasons contributing to the change. To assist insurers insatisfying this statutory requirement, please find attached hereto as Exhibit B an explanatory
Members of the Rating BoardJuly 15, 2021Page 2memorandum containing information relating to the October 1, 2021 loss cost revision and alisting of the percentage change in loss costs for each employment classification.Please note that the enclosed Exhibit B reflects changes in loss costs, not rates.Accordingly, since each insurer develops final rates by applying its approved loss cost multiplier(s)to the published loss costs, the percentage change from previous rates shown in Exhibit B maydiffer from the rate that an insurer may charge as of October 1, 2021.In addition to the loss cost changes, please note the following:(1) The United States Longshore & Harbor Workers’ Coverage percentage is revised to 75.1%.Insurers do not have to file to adopt the new percentage.(2) The terrorism loss cost provision is revised to 0.03 per 100 of payroll, and 2.3% ofpremium for non-payroll classes.(3) The natural disasters and catastrophic industrial accidents loss cost provision is revised to 0.005 per 100 of payroll, and 0.4% of premium for non-payroll classes.(4) The construction employment territory premium differentials for all territories remainunchanged at 0.0%. Policies for employers whose employees are subject to payrolllimitation must continue to include the applicable territory differential on the policy evenif that premium amount is 0.(5) Maximum and minimum remuneration amounts have been updated and are included inthe attached pages.(6) Deductible premium credits, expressed as loss elimination ratios on Miscellaneous ValuesPage 5, have not changed with this revision.(7) As indicated in R.C. Bulletin 2525, the New York State assessment was updated effectiveJanuary 1, 2021. Future changes made by the New York State Workers’ CompensationBoard to the New York State assessment rate for policies effective on or after January 1,2022, will be announced in a separate bulletin in November or December of 2021.(8) The Workers’ Compensation Security Fund surcharge remains unchanged at 0.0%.Very truly yours,EnclosuresJeremy AttiePresident and CEO
Exhibit A
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingPage 1Effective October 1, 2021PART THREE – LOSS COSTS (NOT 970771 N0908 PC0909 PC0912 PC0913 131223126 3.812.802.073.412913291629232942 702.262416 06630673076308130853.583.113.224.037.0235593561 Refer to Page 3 for explanation.Loss Cost is per capita.TTTCodeNumber31103111311331143118Code is scheduled to be discontinued, effective October 1, 2022.Code is scheduled to be discontinued, effective October 1, 2023.
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingCodeNumber411441304131 TT41334150*(c)NPage 2Effective October 1, 6.5616.31CodeNumber72317309 F7313 F7317 F7327 733773647366 7016801 F68116824 F4.1515.4828.554.2910.8173677368737073777380 266.5611.52472047514771 .0413.007.713.966.026826 F683468366843 53855455547560656107.3518.118.973.349.156872 F6874 F6875 F6882688412.7746.0292.338.0240.207405 N742174227431 N7445 .395.1611.9050375040505750595069 11.523.022.537453 N75027515752075360.262.152.105.716.75443144324439 10.047600760176107.864.230.207380 – Ex-Medical Loss Cost for this classification is 6.10Refer to Page 5 for Loss Costs.Refer to Page 3 for explanation.FTTTLoss Cost provides coverage under the United States Longshore& Harbor Workers’ Compensation Act.Code is scheduled to be discontinued, effective October 1, 2022.Code is scheduled to be discontinued, effective October 1, 2023.
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingPage 3Effective October 1, ssCost5.600.180.993.530.74CodeNumber902990309040 #90449048 824.2811.065.295.2388008802880388098810 28833 850086018709 87238726 F873187421.830.122.022.150.279019902590269027 624.496.775.0010.40(e)FFor Loss Costs for Class 7711 refer to Pages 8 through 10.For Loss Costs for Class 7716 refer to Page 10.@8833 – Ex-Medical Loss Cost for this classification is 0.88Loss Cost provides coverage under the United States Longshore& Harbor Workers’ Compensation Act.#9040 – Ex-Medical Loss Cost for this classification is 3.25§9048 – Camps: Any adjustment in tuition fee made in consideration ofservices rendered shall not be considered as remuneration.The table below displays codes which have a corresponding non-ratableelement. The ratable and non-ratable components should be consideredjointly when determining premium.PLLoss Cost is per location.&8810 – Ex-Medical Loss Cost for this classification is 0.09ClassCode477174057431NNon-RatableElement Code077174457453
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingEffective October 1, 2021RESERVED FOR FUTURE USEPage 4
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingPage 5Effective October 1, 2021MISCELLANEOUS VALUESAmbulance – Volunteer Service Company – Code 7370Applicable in accordance with Manual Rule IIAmbulance – Loss Cost (Not Rate) 3,500Section (G)(3)Each additional Ambulance – Loss Cost 1,750(Not Rate)For a group policy subject to the provisions of Section 32.2 of the Volunteer Ambulance Workers’Benefit Law, premium is determined based on a charge for the first ambulance plus the additionalambulance charge for each additional ambulance coverd by the group policy.See Manual Rule regarding the application of this charge to antique ambulances.Construction Employment Geographic Territories and Differentials #Territory 1 Counties of The Bronx, Kings, New York, Queens, and Richmond0.0%Territory 2 Counties of Dutchess, Nassau, Orange, Putnam, Rockland, Suffolk, and0.0%WestchesterTerritory 3 All Other Counties0.0%# Location of work actually performed determines the territory for premium determinationpurposes. Territory Differentials are to be applied to each portion of an affected classification’smanual premium corresponding to the payroll related to work performed in each territory. Referto Rule VI (J).Deductible Program – Deductible applies on a per occurrence basis.Percentage Loss Elimination Ratios by Hazard GroupDeductible 100 200 300 400 500 1,000 1,500 2,000 2,500 %G0.1%0.2%0.3%0.3%0.4%0.7%1.0%1.3%1.6%2.7%Expense ConstantAn expense constant shall be charged for each policy, regardless of premium size, except forthose policies that insure Per Capita classification operations only. Refer to Rule XIII (F) for specialinstructions concerning policies insuring only Per Capita classifications. Expense constants arecarrier specific.
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingPage 6Effective October 1, 2021MISCELLANEOUS VALUES (continued)Maximum Weekly PayrollExecutive OfficersNon-Construction Employments – applicable in accordance with ManualRule VIII Section (A)(6)(a)(ii)Construction Employments – refer to Manual Rule VIII Section (A)(6)(a)(vii)Non-Executive Officers – applicable in accordance with Manual Rule V (F) forclassifications with footnotes limiting the maximum remunerationConstruction Employments – refer to Manual Rule V (G)Sole Proprietors and PartnersNon-Construction Employments – applicable in accordance with ManualRule VIII Section (B)(4)(a)Construction Employments – refer to Manual Rule VIII Section (B)(4)(b)*effective July 1, 2021 2,450.00 1,594.57* 6,500.00 1,594.57* 2,450.00 1,594.57*Minimum Weekly PayrollExecutive Officers – applicable in accordance with Manual Rule VIII Section (A)(6)(a)(1) 825.00Executive Officers of not-for-profit unincorporated associations – applicable with Manual 400.00Rule VIII Section (A)(6)(b).Sole Proprietors and Partners – applicable in accordance with Manual Rule VIII Section 825.00(B)(4)(a) and (4)(b)
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingPage 7Effective October 1, 2021MISCELLANEOUS VALUES (continued)New York State Assessment ChargesGeneral Instructions and InformationRefer to Rule VIII (L) Sections (1) and (2)Applicable Standard Premium Assessment Rate11.8%Determination of AssessmentIn accordance with Rule VIII (L) Section (3), refer to the New York State Workers’Compensation Board at www.wcb.ny.gov for procedures to determine the New York StateAssessment.Terrorism and Catastrophe Loss Cost ChargesTerrorismApplicable only in conjunction with Rule VIII Section (N)(1) of the ManualTerrorism loss cost (not rate) charge per 100 of total policy payrollFor non-payroll based classes, charge is % of non-payroll class manual premium .0302.3%Natural Disasters and Catastrophic Industrial AccidentsApplicable only in conjunction with Rule VIII Section (N)(2) of the ManualCatastrophe loss cost (not rate) charge per 100 of total policy payrollFor non-payroll based classes, charge is % of non-payroll class manual premium .0050.4%Workers’ Compensation Security Fund SurchargeApplicable only in accordance with Rule VIII (M) of the ManualCharge is % of total policy premium0.0%United States Longshore and Harbor Workers’ Compensation Coverage PercentageApplicable only in connection with Rule XI (D)(3)(b) of the Manual75.1%(Multiply a Non-F classification rate by a factor of 1.751 to adjust for differences in state and federalbenefits and assessments)
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingPage 8Effective October 1, 2021MISCELLANEOUS VALUES (continued)LOSS COSTS (NOT RATES) FOR VOLUNTEER FIREFIGHTERS – Code 7711PopulationUp to 300301 to 500501 to 700701 to 1,0001,001 to 1,5001,501 to 2,0002,001 to 2,5002,501 to 3,0003,001 to 3,500AnnualLoss Costs 4,874 5,613 7,412 9,315 12,337 13,764 17,132 18,594 22,326Population3,501 to 4,0004,001 to 4,5004,501 to 5,0005,001 to 5,5005,501 to 6,0006,001 to 6,5006,501 to 7,0007,001 to 7,5007,501 to 8,000AnnualLoss Costs 25,715 29,422 31,657 33,883 36,889 39,893 43,547 46,531 49,511Population8,001 to 8,5008,501 to 9,0009,001 to 9,5009,501 to 10,00010,001 to 15,00015,001 to 20,00020,001 to 25,00025,001 to 35,00035,001 to 50,000AnnualLoss Costs 52,468 55,777 59,195 62,477 74,089 85,593 96,702 113,874 142,611For populations over 50,000, the annual loss cost shall be 142,611 plus 22,375 for each 10,000people or major part thereof.Minimum loss costFor All Population Groups: 4,874A. The premium charge for the “home area” shall be the sum of:1. The premium charge corresponding to the population of the “home area,”and2. A loss cost (not premium) charge of 115 per fire protection contract where the “homearea” has obligated itself to provide protection to another “home area” pursuant to a fireprotection contract,and3. The separate premium charges for each “outside area” corresponding to the population ofeach such “outside area” that is serviced by the “home area” under a fire protection contract.However, when a “outside area” has more than one contract for fire protection, the additionalpremium charge for each “home area” providing fire protection to such “outside area” shallbe a proportionate share of the total premium corresponding to the population of the “outsidearea,” provided that the books and records of the “home area” are maintained so as to showseparately its contract price as well as the total cost of all contracts being paid by the “outsidearea.” The proportionate share shall be determined on the basis of the ratio that the contractprice paid to the “home area” bears to the total contract price for all fire protection for such“outside area.”
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingPage 9Effective October 1, 2021MISCELLANEOUS VALUES (continued)LOSS COSTS (NOT RATES) FOR VOLUNTEER FIREFIGHTERS – Code 7711 (continued)B. The premium charge where a fire company or fire department operates in, or is maintainedjointly by, two or more villages, towns, or fire districts, shall be the sum of the separate premiumcharges for each village, town, or fire district, corresponding to the population of each suchvillage, town, or fire districts.C. Section 30 of the Volunteer Firefighters’ Benefit Law makes a county, city, town, village, or firedistrict responsible for such benefits to volunteer firefighters of the fire departments orcompanies in their area.Employers’ Liability coverage is not automatically afforded under these circumstances to the firedepartments or companies who firefighters are covered by the municipality’s policy. However,the municipality may elect to extend Employers’ Liability coverage for an additional 10% of thatpremium which is developed for the volunteer firefighters of these fire departments orcompanies. Use endorsement WC 31 06 07 A “New York Volunteer Firefighters’ Benefit LawExtension of Employers’ Liability Insurance Endorsement.” This additional premium shall beassigned to Code 9850 “Premium for the Extension of Employers’ Liability Coverage toAdditional Interests under a VBFL policy.D. The premium charge for a group policy subject to the provisions of Section 32.2 of the VolunteerFirefighters’ Benefit Law is determined on the basis of the aggregate population of all entitiesinsured under the group policy. Refer to Rule II Section (F)(2) of this Manual.The terms “home area” and “outside area” used in Section (A) above are defined as follows:“Home Area”a. Any city, village, or fire districts, having its own fire department, or protected pursuant to afire protection contract with an incorporated fire company, located within the city, village, ordistrict.b. Any town fire protection district or town fire alarm district protected pursuant to a fireprotection contract with an incorporated fire company located within the town fire protectiondistrict or town fire alarm district.
NEW YORK WORKERS’ COMPENSATIONAND EMPLOYERS’ LIABILITY MANUALOriginal PrintingPage 10Effective October 1, 2021MISCELLANEOUS VALUES (continued)LOSS COSTS (NOT RATES) FOR VOLUNTEER FIREFIGHTERS – Code 7711 (continued)c. The territory of a town located outside of a city, village, fire district, town fire protection ortown fire alarm district, included within the area of operating set forth in the certificate ofincorporation of an incorporated fire company located in such territory.“Outside Area”Any city, village or fire district, town fire protection district or town fire alarm district which eitherdoes not have its own fire department or an incorporated fire company located within its boundariesand is protected pursuant to a fire protection contract.Firefighters – Volunteer, Including drivers – Elective Coverage for Assistance fromindividual Volunteer FirefightersLoss Cost (Not Premium) Charge – 47 per policy7716
Exhibit B
NEW YORK WORKERS’ COMPENSATIONOCTOBER 1, 2021 LOSS COST REVISIONEXPLANATORY MEMORANDUMAn overall loss cost decrease of 6.4% has been approved by the New York StateDepartment of Financial Services to become effective on October 1, 2021.The following is a description of the various components of the approved change:Loss Experience – The latest two policy years of experience produced a decrease of 1.7%in the overall loss cost level.Legislative Changes – This revision includes an estimate of the cost impact of the latestincreases in the maximum weekly benefits that were set forth in the 2007 workers’ compensationreform legislation. This component contributed an increase of 2.0% to the overall change.Loss Adjustment Expenses – A review of the latest data available resulted in an increaseof 0.6% in the Loss Adjustment Expense provision.Future Trends – The latest analysis of New York claim severity and claim frequencyindicates a continuing decrease in claim frequency, an upward trend in indemnity claim costs anda mild upward trend in medical claim costs. Combined with a projected wage trend, the finalselected net trend factor is -6.3%.Catastrophe Provision – This revision changes the loss cost for terrorism to 0.03 per 100 of total policy payroll (2.3% of premium for non-payroll classifications), representing adecrease of 33.3% from the previous provision. This revision also changes the loss cost for naturaldisasters and catastrophic industrial accidents to 0.005 per 100 of total policy payroll (0.4% ofpremium for non-payroll classifications), representing a decrease of 37.5% from the previousprovision. These changes contribute a decrease of 1.1% to the overall change.Classification Loss Costs – Although the average manual loss cost level is decreasing by5.4%, individual classification loss cost changes are based on the most recently available lossexperience for each classification. Both increases and decreases from the current loss costs havebeen actuarially calculated for each class. This process ensures that each classification loss costreflects the appropriate level relative to the experience of the other classifications.
Workers' Compensation - New YorkLoss Cost Comparison - October 1, 2020 to October 1, 2021ClassCodeOct. 2021Oct. 2020% ChangeClassCodeOct. 2021Oct. 2020% .315.227.03-4.8%-14.0%-7.9%-14.4%-15.1%-1-
Workers' Compensation - New YorkLoss Cost Comparison - October 1, 2020 to October 1, 2021ClassCodeOct. 2021Oct. 2020% ChangeClassCodeOct. 2021Oct. 2020% -5.0%-10.8%-10.8%-2-
Workers' Compensation - New YorkLoss Cost Comparison - October 1, 2020 to October 1, 2021ClassCodeOct. 2021Oct. 2020% ChangeClassCodeOct. 2021Oct. 2020% 266.77-22.2%2.1%-4.8%-2.5%-2.8%-3-
Workers' Compensation - New YorkLoss Cost Comparison - October 1, 2020 to October 1, 2021ClassCodeOct. 2021Oct. 2020% ChangeClassCodeOct. 2021Oct. 2020% 0240.2057.9610.3711.526.8342.5561.149.
July 15, 2021 . R.C. 2543 . Re: New York State Workers' Compensation Loss Cost Filing and . Number Loss Cost Code Number Loss Cost Code Number Loss Cost Code Number Loss Cost Code Number Loss . 0031 1.88 2070 5.59 2670 3.84 3114 2.31 3634 1.80 0034 3.59 2081 8.01 2683 4.61 3118 2.12 3635 1.81 0035 2.47 2089 5.85 2688 1.39 3122 5.23 3638 2 .
business written for Workers Compensation, Voluntary Compensation and Employers Liability insurance. Acting under the direction of the Superintendent of Financial Services, and pursuant to Article 23 of the New York Insurance Law, each carrier's experience must be submitted to the New York Compensation Insurance Rating Board (NYCIRB) in accordance
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Exhibit 3.4 – Bee-back Coupon Exhibit 3.5 – Shopper’s Report Chapter 4 Exhibit 4.1 – Rental Screening Criteria Chapter 5 Exhibit 5.1 – Utility Transfer Card Chapter 6 Exhibit 6.1 – Parcel Log Chapter 7 Exhibit 7.1 – Notice of Intent to Vacate Exhibit 7.2 –
Exhibit B Disadvantaged Business Enterprise Participation Exhibit C Insurance Certificate Exhibit D Confirmation Letter Exhibit D1 Letter Confirming Actual Dates of Certain Events Exhibit E Approved Exhibit H Street Pricing Comparables Exhibit I Independent Auditor’s Report Exhi
Exhibit 4.6 Proposed Overall Budget Compared to Actual 87 Exhibit 4.7 Functional Revenues and Expense Budget 89 Exhibit 4.8 Member Services Budget Worksheet 90 Exhibit 4.9 Budgeted Increases (Decreases) Projected for 20XX 91 Exhibit 4.10 Personnel Budget 93 Exhibit 4.11 Program Cost Analysis 93 Exhibit 4.12 Capital Acquisition Budget 94
Jun 11, 2021 · SPUR Exhibit C: Affidavit of Paul Eschete, Landman o SPUR Exhibit C-1: Eschete resume o SPUR Exhibit C-2: C-102s o SPUR Exhibit C-3: General Location Map o SPUR Exhibit C-4: Land plat and Ownership o SPUR Exhibit C-5: Sample Well Prop
Plumbers, Pipefitters & MES Local Union No. 392 Pension Fund. (Attachments: # 1 Exhibit A - Notice, # 2 Exhibit B - Loss chart, # 3 Exhibit C - Certification, # 4 Exhibit D - Robbins Geller firm resume, # 5 Exhibit E - Grant & Eisenhofer firm resume, # 6 Exhibit F - Labaton Sucharow firm
