a02-129b

Document Sample
a02-129b Powered By Docstoc
					Physicians      (1)           (2)          (2a)                (3)                (4)          (4a)                 (5)                      (5a)                        (5b)                       (6)                       (6a)                       (6b)                     (7)
                                                                                                                                                                                                                                             # of medical malpractice       $ amount of
                                                                                                          # of medical malpractice # of medical malpractice                               # of medical malpractice                               incidents reported     incurred loss for all
                                                      Practice location(s)                                  court judgments and      court judgments and       # of medical malpractice           settlements       # of medical malpractice       by the insured       medical malpractice
                                                       name of city/town                                     arbitration awards,       arbitration awards,      claims closed without        in the past 5 years,            claims             in the past 5 years,      court judgments,
                                         If Group,          or zip code                     # of years       in the past 5 years,     in the past 5 years,          a loss payment           [not included in (5)]     currently open and      which did not result      arbitration awards,
  Policy                 Individual (I) # Providers    (fill-out 1 line per   # of years    in practice   in which a payment was in which no payment was          in the past 5 years     in which a payment was      pending against the             in a claim          and settlements
  Count      Specialty   or Group (G) in Group         practice location)     in practice      in NJ       awarded to the plaintiff awarded to the plaintiff     [not included in (5a)]    awarded to the plaintiff         insured          [not included in (5)-(6a)] in the past 5 years

    1
    2
    3
    4
    5
    6
    7
    8
    9
   10
   etc.
           (7a)                    (7b)              (8)        (8a)      (8b)       (8c)      (8d)       (9)       (10)      (11)        (12)       (13)      (14)      (15)       (16)      (17)
    $ amount of loss
adjustment expense for      $ amount of loss                                                                                                Reasons for Increase
all medical malpractice adjustment expense for
    court judgments,    all medical malpractice               Expiring   Renewal                         Rate
   arbitration awards,       claims, closed       Effective    policy     policy  $ amount       %     Increase/            Change in   New         Claims   Full/Part-                     Any Other
    and settlements             without a          date of    premium    premium of premium of premium Change in    New     Schedule Practitioner   Made       Time     Increased Change in Discounts
     included in (7)          loss payment         policy        $          $     increase   increase    Class     Claims    Credit   Discount       Step     Switch      Limits  Specialty   Lifted
Surgeons      (1)           (2)          (2a)                (3)                (4)          (4a)


                                                    Practice location(s)
                                                     name of city/town
                                       If Group,          or zip code                     # of years
 Policy                Individual (I) # Providers    (fill-out 1 line per   # of years    in practice
 Count     Specialty   or Group (G) in Group         practice location)     in practice      in NJ

   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  etc.
          (5)                      (5a)                        (5b)                        (6)

# of medical malpractice # of medical malpractice                               # of medical malpractice
  court judgments and      court judgments and       # of medical malpractice           settlements
   arbitration awards,      arbitration awards,       claims closed without        in the past 5 years,
   in the past 5 years,     in the past 5 years,          a loss payment           [not included in (5)]
in which a payment was in which no payment was          in the past 5 years     in which a payment was
 awarded to the plaintiff awarded to the plaintiff     [not included in (5a)]    awarded to the plaintiff
         (6a)                        (6b)                    (7)                    (7a)
                         # of medical malpractice       $ amount of          $ amount of loss
                             incidents reported     incurred loss for all adjustment expense for
# of medical malpractice       by the insured       medical malpractice all medical malpractice
         claims             in the past 5 years,     court judgments,        court judgments,
   currently open and       which did not result    arbitration awards,     arbitration awards,
  pending against the             in a claim          and settlements         and settlements
        insured          [not included in (5)-(6a)] in the past 5 years        included in (7)
         (7b)                (8)        (8a)       (8b)      (8c)       (8d)      (8e)       (9)

    $ amount of loss
adjustment expense for
all medical malpractice               Expiring   Renewal                                    Rate
     claims, closed       Effective    policy     policy  $ amount       %                Increase/
        without a          date of    premium    premium of premium of premium Reason for Change in
      loss payment          policy       $          $     increase   increase   increase    Class
 (10)      (11)        (12)       (13)      (14)      (15)       (16)      (17)

                         Reasons for Increase


         Change in   New         Claims   Full/Part-                     Any Other
 New     Schedule Practitioner   Made       Time     Increased Change in Discounts
Claims    Credit   Discount       Step     Switch      Limits  Specialty   Lifted
Podiatrists      (1)           (2)          (2a)                (3)                (4)          (4a)


                                                       Practice location(s)
                                                        name of city/town
                                          If Group,          or zip code                     # of years
  Policy                  Individual (I) # Providers    (fill-out 1 line per   # of years    in practice
  Count       Specialty   or Group (G) in Group         practice location)     in practice      in NJ

    1
    2
    3
    4
    5
    6
    7
    8
    9
   10
   etc.
          (5)                      (5a)                        (5b)                        (6)

# of medical malpractice # of medical malpractice                               # of medical malpractice
  court judgments and      court judgments and       # of medical malpractice           settlements
   arbitration awards,      arbitration awards,       claims closed without        in the past 5 years,
   in the past 5 years,     in the past 5 years,          a loss payment           [not included in (5)]
in which a payment was in which no payment was          in the past 5 years     in which a payment was
 awarded to the plaintiff awarded to the plaintiff     [not included in (5a)]    awarded to the plaintiff
         (6a)                        (6b)                    (7)                    (7a)
                         # of medical malpractice       $ amount of          $ amount of loss
                             incidents reported     incurred loss for all adjustment expense for
# of medical malpractice       by the insured       medical malpractice all medical malpractice
         claims             in the past 5 years,     court judgments,        court judgments,
   currently open and       which did not result    arbitration awards,     arbitration awards,
  pending against the             in a claim          and settlements         and settlements
        insured          [not included in (5)-(6a)] in the past 5 years        included in (7)
         (7b)                (8)        (8a)       (8b)      (8c)       (8d)      (8e)       (9)

    $ amount of loss
adjustment expense for
all medical malpractice               Expiring   Renewal                                    Rate
     claims, closed       Effective    policy     policy  $ amount       %                Increase/
        without a          date of    premium    premium of premium of premium Reason for Change in
      loss payment          policy       $          $     increase   increase   increase    Class
 (10)      (11)        (12)       (13)      (14)      (15)       (16)      (17)

                         Reasons for Increase


         Change in   New         Claims   Full/Part-                     Any Other
 New     Schedule Practitioner   Made       Time     Increased Change in Discounts
Claims    Credit   Discount       Step     Switch      Limits  Specialty   Lifted
Nurses      (1)           (2)          (2a)                (3)                (4)          (4a)


                                                  Practice location(s)
                                                   name of city/town
                                     If Group,          or zip code                     # of years
Policy               Individual (I) # Providers    (fill-out 1 line per   # of years    in practice
Count    Specialty   or Group (G) in Group         practice location)     in practice      in NJ

  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 etc.
          (5)                      (5a)                        (5b)                        (6)

# of medical malpractice # of medical malpractice                               # of medical malpractice
  court judgments and      court judgments and       # of medical malpractice           settlements
   arbitration awards,      arbitration awards,       claims closed without        in the past 5 years,
   in the past 5 years,     in the past 5 years,          a loss payment           [not included in (5)]
in which a payment was in which no payment was          in the past 5 years     in which a payment was
 awarded to the plaintiff awarded to the plaintiff     [not included in (5a)]    awarded to the plaintiff
         (6a)                        (6b)                    (7)                    (7a)
                         # of medical malpractice       $ amount of          $ amount of loss
                             incidents reported     incurred loss for all adjustment expense for
# of medical malpractice       by the insured       medical malpractice all medical malpractice
         claims             in the past 5 years,     court judgments,        court judgments,
   currently open and       which did not result    arbitration awards,     arbitration awards,
  pending against the             in a claim          and settlements         and settlements
        insured          [not included in (5)-(6a)] in the past 5 years        included in (7)
         (7b)                (8)        (8a)       (8b)      (8c)       (8d)      (8e)       (9)

    $ amount of loss
adjustment expense for
all medical malpractice               Expiring   Renewal                                    Rate
     claims, closed       Effective    policy     policy  $ amount       %                Increase/
        without a          date of    premium    premium of premium of premium Reason for Change in
      loss payment          policy       $          $     increase   increase   increase    Class
 (10)      (11)        (12)       (13)      (14)      (15)       (16)      (17)

                         Reasons for Increase


         Change in   New         Claims   Full/Part-                     Any Other
 New     Schedule Practitioner   Made       Time     Increased Change in Discounts
Claims    Credit   Discount       Step     Switch      Limits  Specialty   Lifted

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:10/26/2011
language:English
pages:17
xiaohuicaicai xiaohuicaicai
About