Docstoc

ACORD P_C and Life Form Changes

Document Sample
ACORD P_C and Life Form Changes Powered By Docstoc
					                             ACORD P&C and Life Form Changes
Each month you will receive this complimentary notification of changes to the ACORD Forms Library.
The following is a list of the Revised and New ACORD forms that were recently released. On the following
pages you will find the reason for the change and Form description. Copies of the forms mentioned in this
announcement and the full Forms Instruction Guide can be obtained by going to the ACORD Web site
(www.acord.org or www.acordadvantage.org ). Or, by contacting memberservices@acord.org for a sample.

P&C
Countrywide - Revised
1 (2004/06) Property Loss Notice
2 (2004/06) Automobile Loss Notice
3 (2004/06) General Liability Notice of Occurrence/Claim
4 (2004/06) Workers Compensation – First Report of Injury or Illness
70 (2004/05) Personal Policy Change Request (Except Auto)
93 (2004/05) Young Driver Questionnaire

State Specific
61 CT (2004/05) Connecticut Auto Supplement
61 OR (2004/06) Oregon Auto Supplement – Uninsured Motorist Coverage Selection Form
65 MN (2004/05) Minnesota Guaranty Association Notice
90 HI (2004/05) Hawaii Personal Auto Application
133 FL (2004/07) Florida Workers Compensation Joint Underwriting Association, Inc. Addendum to ACORD 130 FL
134 FL (2004/07) Florida Workers Compensation Joint Underwriting Association, Inc. Instructions for Completing
ACORD 130 FL & ACORD 133 FL
137 AR (2004/05) Arkansas Commercial Auto
138 HI (2004/05) Hawaii Garage and Dealers
177 SC (2004/06) Associated Auto Insurers Plan of South Carolina – Commercial Application
179 SC (2004/06) Associated Auto Insurers Plan of South Carolina – Garage Application
184 SC (2004/06) Associated Auto Insurers Plan of South Carolina – Garage Supplemental
186 SC (2004/06) Associated Auto Insurers Plan of South Carolina – Uninsured & Underinsured Auto Insurance
Coverages Form for Commercial Risks
856 CA (2004/05 California FAIR Plan Property Insurance – Business Owners Application
AK 2004 NCCI WCIP State Instructions – Alaska – (for use with ACORD 133)
MS 2004 NCCI WCIP State Instructions – Mississippi – (for use with ACORD 133)
VY 2004 NCCI WCIP State Instructions – Vermont – (for use with ACORD 133)

NEW Forms
50 CA (2004/07) California Insurance Identification Card
51 CA (2004/07) California Evidence of Liability Insurance

FIG Text Changes
50 GA Additional text added regarding vehicles qualifying as “Fleet”
302 Additional instructions added regarding the printing of the form in pdf format on 8 ½ x 13 paper


Life
NEW Forms
951 (2004/05) 1035 Exchange/Rollover/Transfer Form
Countrywide - Revised

This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
Form #: 1                (2004/06)                Property Loss Notice

Reason for Change:

    1.   In PRODUCER section change Producer to Agency.

    2.   In PRODUCER section add fields for Fax and e-mail.

    3.   On page 2 revise CA fraud statement and add WV.


Form Description
Use the ACORD Property Loss Notice (ACORD 1) for reporting commercial and personal lines property
losses including Homeowners, Dwelling Fire, Inland Marine, Commercial Property, Flood, Wind and others.

Countrywide - Revised

Form #: 2                (2004/06)                Automobile Loss Notice

Reason for Change:

    1.   In PRODUCER section move field for Fax and add field for e-mail.

    2.   On page 2 revise CA fraud statement and add WV.


Form Description
Use the ACORD Automobile Loss Notice (ACORD 2) for the reporting of both commercial and personal lines
automobile losses.


Countrywide - Revised

Form #: 3                (2004/06)                General Liability Notice of Occurrence/Claim)

Reason for Change:

    1.   In PRODUCER section change Producer to Agency.

    2.   In PRODUCER section add fields for Fax and e-mail.

    3.   Re-align ACORD copyright.

    4.   On page 2 revise CA fraud statement and add WV.


Form Description
Use ACORD 3 to report both commercial and personal liability losses.


Countrywide - Revised

This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
                                                  Workers Compensation – First Report of Injury or
Form #: 4                (2004/06)
                                                  Illness
Reason for Change:

    1.   Re-align ACORD copyright.

    2.   On page 2 revise CA fraud statement and add WV.

    3.   Re-alphabetize State Fraud Statements.



Form Description
ACORD, in conjunction with the IAIABC (International Association of Industrial Accident Boards &
Commissions) developed this standard First Report. The form tracks with the IAIABC and ANSI X12 EDI
standard for reporting Workers Compensation losses.

The form is designed as a first notice of a claim for injury or illness by an employee. In nearly all cases, the
form is completed by the employer and sent directly to the insurer or to the state workers compensation
board. It contains information about the employer, insurance carrier, employee, the occurrence leading to
the injury or illness, and the nature of injury or illness. Instructions to the employer regarding completion
of the form are contained on the third and fourth pages of the form.

Although the form is accepted by insurers in all states, each jurisdiction mandates the form to be used
within that state with respect to the report made to the workers compensation board. . This version of
ACORD 4 is accepted in many jurisdictions. It is anticipated that this number will continue to increase
significantly as states adopt the IAIABC and ANSI X12 EDI Standard.

As of November 1, 1998, the following states are reported to accept ACORD 4. Consult your company about
use in other states.

Connecticut
Florida
Idaho
Illinois
Maryland
Mississippi
New Mexico
Ohio
Rhode Island
South Carolina.

In addition, Wisconsin accepts ACORD 4WI, Wisconsin Employer's First Report of Injury or Illness.

Countrywide - Revised



This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
Form #: 70               (2004/05)
                                                  Personal Policy Change Request (Except Auto)
Reason for Change:

    1.   In HOMEOWNER, DWELLING FIRE AND MOBILE HOME RATING/UNDERWRITING section, delete Storm
         Shutters group and replace it with Windstorm Loss Mitigation Features.

    2. In HOMEOWNER, DWELLING FIRE AND MOBILE HOME RATING/UNDERWRITING section,
       delete check boxes for ACORD 40 and 41.

    3.   On page 1, add “Please Complete Reverse Side”, to footer.

    4.   On page 2, in PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY section, add a CSL field to
         Automobile, Watercraft and Recreational Vehicles groups.


Form Description
Use ACORD 70 to request mid-term changes to any personal lines policy, except auto. For auto changes,
see ACORD 71, Personal Auto Policy Change Request. This form should be used instead of individual
turnaround endorsement requests. A copy of the request may be sent to the insured to confirm that the
change is submitted to the company. The form provides for property, mobile home, inland marine,
watercraft and umbrella changes.



Countrywide - Revised

Form #: 93               (2004/05)                Young Driver Questionnaire

Reason for Change:

    1.   Add Fraud Warning above Applicant’s Statement


Form Description
ACORD 93 is generally completed by drivers under the age of twenty-five. The Young Driver
Questionnaire provides additional underwriting information that is usually common to youthful drivers. This
form should be completed and signed exclusively by the young driver with no input from the parents and/or
agent. The top section of the form must be completed by the young driver in his/her own handwriting.

IMPORTANT: THIS FORM CANNOT BE USED IN WISCONSIN.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific - Revised

Form #: 61 CT            (2004/05)                Connecticut Auto Supplement

Reason for Change:

    1.   In PRODUCER section, change Producer to Agency

    2.   Add additional sentence to the end of paragraph four.

    3.   Delete “effective January 1, 1994”, from paragraph six.

    4.   Delete entire section headed “Stacking”

    5.   On page 2, add additional text above Insured’s signature.



Form Description
This form complies with Connecticut laws and regulations, which require that insureds:

 * Must be informed of the coverage available under Connecticut's UM statutes, including both standard
UM/UIM and UM Conversion coverage.

 * Must be permitted to select among various options relating to UM/UIM and UM Conversion Coverage

The applicant must sign this form, regardless of the coverage selections made.

Use with ACORD 90 CT, and all commercial auto applications.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific - Revised
                                                  Oregon Auto Supplement – Uninsured Motorists
Form #: 61 OR            (2004/06)
                                                  Coverage Selection Form
Reason for Change:

    1.   In UNINSURED MOTORISTS LIMITS SELECTION AND COST section, add additional text to the
         limits/cost options.



Form Description
This form complies with Oregon law, which requires that every applicant for auto liability insurance must be
offered:

 * UM coverage at limits equal to the policy's BI limits

 * An explanation of UM coverage

 * The right to select lower UM limits, but not lower than the minimum required by law

  * Information about the cost of UM coverage at the policy BI limits, and the cost at the selected limits,
if different

The law also requires that the insured must sign the form.

Use ACORD 61 with ACORD 90 OR and all commercial auto applications.



State Specific – Revised

Form #: 65 MN            (2004/05)                Minnesota Guaranty Association Notice

Reason for Change:

    1.   Revise area code in association telephone number

Form Description
This form complies with Minnesota regulations, which require that all applicants for insurance in Minnesota
must be provided with information with respect to their rights in case of an insurer insolvency under the
Guaranty Association laws.

Use with all ACORD applications.



State Specific – Revised

This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
Form #: 90 HI             (2004/05)
                                                  Hawaii Personal Auto Application
Reason for Change:

    1.   In PRODUCER section, change Producer to Agency.

    2.   In COVERAGES/PREMIUMS section, add / OTC to Comprehensive.

    3.   In BINDER/SIGNATURE section, update Notice of Information Practices

    4.   In BINDER/SIGNATURE section, replace Fraud Warning with state specific Hawaii Fraud Warning

    5.   In BINDER/SIGNATURE section, add field for National Producer Number.



Form Description
Following are the differences from ACORD 90, the generic Personal Auto Application.

 * Unique Personal Injury Protection and Additional Personal Injury Protection items are provided.

 * The applicant can select "stacked" or "non-stacked" Uninsured and Underinsured Motorists BI coverage;
however, there is no UM or UIM PD coverage available.

 * A state-specific fraud warning is added to the back of the form.



State Specific – Revised
                                                  Florida Workers Compensation Joint Underwriting Association,
Form #: 133 FL            (2004/07)
                                                  Inc. Addendum to ACORD 130 FL
Reason for Change:
    This form is modified at the request of the Florida Workers Compensation Joint Underwriting
    Association. For details on all the changes made, please contact Member Services at (800) 444-3341
    ext. 506
Form Description
This form is required, together with Florida Workers Compensation Application, ACORD 130 FL, when
applying to the Florida Workers Compensation Joint Underwriting Association for workers compensation
insurance.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific – Revised
                                                  Florida Workers Compensation Joint Underwriting Association,
Form #: 134 FL           (2004/07)                Inc. Instructions for Completing ACORD 130 FL & ACORD 133
                                                  FL
Reason for Change:
    This form is modified at the request of the Florida Workers Compensation Joint Underwriting
    Association. For details on all the changes made, please contact Member Services at (800) 444-3341
    ext. 506
Form Description
This form contains the instructions and rules provided by the Florida Workers Comp JUA
relating to applications for workers compensation insurance.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific – Revised

Form #: 137 AR           (2004/05)                Arkansas Commercial Auto

Reason for Change:

    1.   Update date field.

    2.   In PRODUCER section, change Producer to Agency

    3.   Change Comprehensive to COMP / OTC in six locations on form.

    4.   In ENDORSEMENTS section, in Notice of Information Practices add space between “and privileged” and add
         the letter “S” to the word instruction.

    5.   In Fraud Statement, add the letter “P” to Application and the letter “M” to Commits.

    6. Add field for National Producer Number.

Form Description
Use ACORD 137 AR to collect the coverage, limits and premium information necessary to write Business
Auto, Truckers or Motor Carrier insurance in this state.

Use this form with ACORD 127, Business Auto Section, or ACORD 132, Truckers/Motor Carrier Section.

The following are the specific differences in this state:

 * Personal Injury Protection coverages are revised to reflect unique Arkansas coverages and options.
Refer to your state manual.

 * Provision made for Uninsured Motorists Property Damage deductible; Underinsured Motorist Property
Damage is not available.

 * A statement is added, referencing the Arkansas Supplement, ACORD 61 AR, which must be used if the
applicant chooses Uninsured or Underinsured Motorists Bodily Injury coverages less than the limits of the
policy's basic Bodily Injury Liability limits.

 * A statement is added to the back of the form allowing the applicant to reject any or all of the Personal
Injury Protection coverages.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific - Revised

Form #: 138 HI           (2004/05)                Hawaii Garage and Dealers

Reason for Change:

    1.   Update date field

    2.   In PRODUCER section, change Producer to Agency

    3.   Add / OTC to COMP in two locations.

    4.   In Notice of Information Practices, correct spelling of “Privileged” and add the letter “S” to the word
         instruction.

    5.   In the Fraud Statement, delete the letter “L” from “a loss”.

    6. Add field for National Producer Number.

Form Description
Use this form to collect the coverage, limits and premium information necessary to write Garage and
Dealers insurance in this state.

Use this form with ACORD 128, Garage and Dealers Section.

The specific differences in this state are the same as shown above for ACORD 137 HI.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific - Revised
                                                  Associated Auto Insurers Plan of South Carolina –
Form #: 177 SC           (2004/06)
                                                  Commercial Application
Reason for Change:

    1.   All six pages, revise AIP # in footer

    2.   On page 4, Section 11 a, many limits were totally deleted or revised. Please treat this like a “new” section.

    3. Section 11 B, renamed to Non-Owned Auto Liability Coverage.

Form Description

Use this form in connection with insurance written through the Associated Auto Insurers Plan of South
Carolina. Refer to the Plan rules to determine how the form should be used.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific - Revised


Form #: 179 SC           (2004/06)                Associated Auto Insurers Plan of South Carolina –
                                                  Garage Application
Reason for Change:

    1.   Section # 6 BUSINESS/VEHICLE STORAGE INFORMATION section, Column one (Auto Service) deleted.
         “Franchised and Non-Franchised Commercial Trailer Dealer” check box moved to column two. “Land Motor
         Vehicle” check box is deleted.

    2.   Add “And Trailer” to Auto Dealers Header.

    3.   Page one and two footers, revise AIP Form Number.



Form Description
Use this form in connection with insurance written through the Associated Auto Insurers Plan of South
Carolina. Refer to the Plan rules to determine how the form should be used.

State Specific - Revised
                                                  Associated Auto Insurers Plan of South Carolina –
Form #: 184 SC           (2004/06)
                                                  Garage Supplemental Form
Reason for Change:

    1.   Add questions 1, 2, and 3, renumber remaining questions.

    2.   Revise AIP Form number in footer.



Form Description

Use this form in connection with insurance written through the Associated Auto Insurers Plan of South
Carolina. Refer to the Plan rules to determine how the form should be used.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific - Revised
                                                  Associated Auto Insurers Plan of South Carolina –
Form #: 186 SC           (2004/06)                Uninsured & Underinsured Auto Insurance Coverages
                                                  Form for Commercial Risks
    Reason for Change:

    1.   All pages, revise AIP form number in footer

    2.   On page 2, Section II, Offer of Additional Uninsured Motorist Coverage, under Split Limits, Bodily Injury,
         delete limit options three and four.

    3. On page 2, Section II, Offer of Additional Uninsured Motorist Coverage, under Split Limits,
       Property Damage, delete limit options two and three.

    4. On page 2, Section II, Offer of Additional Uninsured Motorist Coverage, under Single Limits,
       revise option four from $250,000 to $125,000 and delete options five and six.

    5.   On page 3, Section III, Offer of Underinsured Motorist Coverage, under Split Limits, Bodily Injury, delete
         limit options four and five.


    6.   On page 3, Section III, Offer of Underinsured Motorist Coverage, under Split Limits, Property Damage,
         delete limit options three and four.


    7. On page 3, Section III, Offer of Underinsured Motorist Coverage, under Single Limits, revise
       option five from $250,000 to $125,000 and delete options six and seven.




Form Description
Use this form in connection with insurance written through the Associated Auto Insurers Plan of South
Carolina. Refer to the Plan rules to determine how the form should be used.

State Specific - Revised
                                                  California FAIR Plan Property Insurance – Business
Form #: 856 CA           (2004/05)
                                                  Owners Application
Reason for Change:

    1.   Page 4, # 11 Contact section, revise item (1) and add field for Daytime Telephone Number.

Form Description
Use this form to apply for business owners insurance through the California FAIR Plan.




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
State Specific - Revised
Form #: AK                                        NCCI WCIP State Instructions – Alaska – (for use with
2004                                              ACORD 133)
Reason for Change:


Form Description
These instructions are posted with the 133 pdf version of the Forms



State Specific - Revised
Form #: MS                                        NCCI WCIP State Instructions – Mississippi – (for use
2004                                              with ACORD 133)
Reason for Change:


Form Description
These instructions are posted with the 133 pdf version of the Forms



State Specific - Revised
Form #: VT                                        NCCI WCIP State Instructions – Vermont – (for use
2004                                              with ACORD 133)
Reason for Change:


Form Description
These instructions are posted with the 133 pdf version of the Forms




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
New Forms
                         (2004/07)                California Insurance Identification Card
Form #: 50 CA

Form Description
Use this form to provide proof of insurance when requested by law enforcement, and to provide insurance
information in case of an accident.




New Forms
                         (2004/07)                California Evidence of Liability Insurance
Form #: 51 CA

Form Description
Use this form to provide proof of insurance when requested by law enforcement, and to provide insurance
information in case of an accident.




Forms Instruction Text Change Only

Form #: 50 GA                                     Insurance Identification Card

Form Instruction Revision
Additional text added regarding vehicles qualifying as “Fleet”




Forms Instruction Text Change Only

Form #: 302                                       Insurance Identification Card

Form Instruction Revision
Additional instructions added regarding the printing of the form in pdf format on 8 ½ X 13 in paper




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
Life

Countrywide - New

Form #: 951              (2004/03)                1035 Exchange / Rollover / Transfer Form

Form Description
The ACORD 1035 Exchange / Rollover / Transfer Form (ACORD 951) can be used to accomplish a FULL or a
PARTIAL Exchange of policies pursuant to Internal Revenue Code (IRC) Section 1035. This form can also
be used for Transfers and Rollovers. For the purpose of this form, the receiving company will be referred
to as "The Company". Complete the requested information concerning the existing policy and contract,
check the appropriate boxes, and date and sign this form. Refer to the application, and if applicable,
prospectus and any state required forms for additional important disclosures and information. Check with
both the receiving and surrendering company for form requirements specific to the transaction that is
being initiated.



Life New ACORD Forms in development
◊ 701 – Life Application Part 1
◊ 702 – Life Application Part 2
◊ 703 – Medical Examiner’s Report
◊ 751 – Authorization to Obtain and Disclose Information
◊ 753 – Pre-Notice
◊ 754 – Additional Other Proposed Insured
◊ 755 – Additional Owners
◊ 756 – Additional Beneficiaries
◊ 757 – HIV Antibody/Antigen Consent and Testing Life Form
◊ 759 – Important Notice Regarding Replacement
◊ 761 – Policy Effective Date Supplement – Date of Policy Application
◊ 762 – Policy Effective Date Supplement – Date of Policy Delivery
◊ 763 – Policy Effective Date Supplement – Date Policy Issued
◊ 766 – Product Comparison Form
◊ 767 – Temporary Insurance Agreement
◊ 768 – Life Insurance Application Part 2 Medical History Supplement Medical Condition
    Details/Additional Care Providers




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.
P&C ACORD Forms – Withdrawn
      40 - Residential Valuation Survey
      41 - Residential Property Replacement Cost Worksheet

P&C ACORD Forms Currently under Revision
      60 MN - MN FAIR Plan - Homeowners Application HO6 Condo Owners Coverage
      64 DC - Application to District of Columbia Property Insurance Facility for Basic Property
      Inspection and Insurance Program (Page 1)
      64 DE - Insurance Placement Facility of Delaware - Basic Property Insurance Application
      64 MN - MN FAIR Plan - Homeowners Application HO4 Renters Coverage
      64 WV - West Virginia Essential Property Insurance Association - Basic Property Insurance
      Application
      65 DC - Application to District of Columbia Property Insurance Facility for Basic Property
      Inspection and Insurance Program (Page 2)
      64 MD - Maryland Property Insurance Availability Program - Essential Property Insurance
      Inspection and Placement
      65 MD - Maryland Property Insurance Availability Program - Essential Homeowners Insurance
      Inspection and Placement (Page 1)
      65 MN - Minnesota Guaranty Association Notice
      66 MD - Maryland Property Insurance Availability Program - Essential Homeowners Insurance
      Inspection and Placement (Page 2)
      66 MN - MN FAIR Plan - Homeowners HO8 Application
      67 MN - MN FAIR Plan - Dwelling Fire Application
      68 MN - MN FAIR Plan - Commercial Fire Application
      68 ND - North Dakota Fire District Assignment - Supplement to Property Insurance Application
      139 MI - MI Automobile Placement Facility - Application for Commercial, Public Automobiles and
      Corporately Owned Vehicles
      171 IL - Illinois FAIR Plan Application for Commercial Property Insurance



P&C New ACORD Forms in development
      99 - Personal Auto Application Supplement - Accidents/Convictions Section
      101 - ACORD Form Supplement - Additional Remarks
      807 - Directors & Officers Liability Application




This information has been provided to you by ACORD to ensure that you are aware of the current versions of the forms. If you secure
access to these forms through an agency management or forms software package, please contact them to request the update.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:10
posted:11/12/2011
language:Romanian
pages:17